Nerve Function Status Research Articles

Properties of Resorbable Conduits Based on Poly(L-lactide) Nanofibers and Chitosan Fibers for Peripheral Nerve Regeneration

Tubular conduits have been developed to regenerate peripheral nerves and repair defects with a diastase more than 3 cm. An optimal design of a conduit consists of a tube based on poly(L-lactide) nanofibers and chitosan composite fibers with chitin nanofibrils. In the study performed with in vivo model for motor dysfunction, nerve functional status has been assessed by means of the sciatic functional index. It has been shown that chitosan monofibers and chitosan composite fibers with chitin nanofibrils in the design of conduits can increase the regeneration rate of the sciatic nerve, the sciatic functional index is 76−83. The degree of nerve conduction recovery, determined by measuring the amplitude of the M response, is 46%. The developed conduit design imitates the oriented architecture of the nerve, facilitates electrical communication between the ends of the damaged nerve, and promotes increased rate of nerve regeneration and the direction of nerve growth.

The Effects of Orthosis and Exercise on The Median Nerve Morphology and Functional Status of Patients with Carpal Tunnel Syndrome: A Randomized Pilot Study

The Effects of Orthosis and Exercise on The Median Nerve Morphology and Functional Status of Patients with Carpal Tunnel Syndrome: A Randomized Pilot Study

Redesigned Electrodes for Improved Intraoperative Nerve Conduction Studies during the Treatment of Peripheral Nerve Injuries.

Traumatic peripheral nerve injuries (PNI), present with symptoms ranging from pain to loss of motor and sensory function. Difficulties in intraoperative visual assessment of nerve functional status necessitate intraoperative nerve conduction studies (INCSs) by neurosurgeons and neurologists to determine the presence of functioning axons in the zone of a PNI. This process, also referred to as nerve "inching", uses a set of stimulating and recording electrode hooks to lift the injured nerve from the surrounding surgical field and to determine whether an electrical stimulus can travel through the zone of injury. However, confounding electrical signal artifacts can arise from the current workflow and electrode design, particularly from the mandatory lifting of the nerve, complicating the definitive assessment of nerve function and neurosurgical treatment decision-making. The objective of this study is to describe the design process and verification testing of our group's newly designed stimulating and recording electrodes that do not require the lifting or displacement of the injured nerve during INCSs. Ergonomic in vivo analysis of the device within a porcine model demonstrated successful intraoperative manipulation of the device, while quantitative nerve action potential (NAP) signal analysis with an ex vivo simulated "inching" procedure on healthy non-human primate nerve tissue demonstrated excellent reproducible recorded NAP fidelity and the absence of NAP signal artifacts at all points of recording. Lastly, electrode pullout force testing determined maximum forces of 0.43 N, 1.57 N, and 3.61 N required to remove the device from 2 mm, 5 mm, and 1 cm nerve models, respectively, which are well within established thresholds for nerve safety. These results suggest that these new electrodes can safely and successfully perform accurate PNI assessment without the presence of artifacts, with the potential to improve the INCS standard of care while remaining compatible with currently used neurosurgical technology, infrastructure, and clinical workflows.

Assessment of recovery time for the functional status of infraorbital nerve in open versus closed reduction of zygomatico-maxillary complex fractures: a comparative study

<p>Background and Objective: Zygomatico-maxillary complex (ZMC) fractures and associated infraorbital nerve paresthesia are the most prevalent features of facial trauma associated with road traffic accidents, accidental falls, and violent assaults. The objective of this study was to assess the recovery time of the infraorbital nerve functional status in individuals with paresthesia after open and closed reduction of ZMC fractures.</p> <p>Method: A comparative cohort study was conducted in the Oral and Maxillofacial Surgery Department of Mayo Hospital in Lahore. The study comprised 100 patients with unilateral isolated en bloc ZMC fractures and post-traumatic paresthesia. Patients were equally divided into two groups: Group A comprised of patients who underwent closed reduction while patients of Group B had open reduction with micro plate osteosynthesis. Demographic information, infraorbital nerve healing, post-op complications, and patients’ satisfaction were documented. To compare the outcomes of the two groups, statistical analyses were done and p-value <0.05 was taken as statistically significant.</p> <p>Results: The age distribution revealed a mean age of 37.43 ± 11.06 years, with 72% of the participants being males. In 63% of patients, there was overall functional nerve recovery. After 6 weeks, 74% of those in Group A (closed reduction) had functional nerve recovery, as compared to 52% of those in Group B (open reduction) (p = 0.023). Age subgroup analysis revealed no significant differences in the recovery rates. When compared to Group-A, patients in Group-B showed faster sensory improvement and better satisfaction levels. Complication rates were equal for both approaches.</p> <p>Conclusion: In ZMC fractures with paresthesia, both open and closed reduction procedures yielded good results in recovering infraorbital nerve function; however, the open reduction technique demonstrated quicker sensory recovery and more patient satisfaction.</p>

Frequency Domain Parameters of Heart Rate Variability in Patients with Gastro-Oesophageal Reflux Disease

Background: Gastro-oesophageal reflux disease (GERD) has been associated with autonomicnervous dysfunction along with reduced Heart Rate Variability.Objective: To observe cardiac autonomic nerve function status by heart rate variability analysis inpatients with Gastro-oesophageal reflux disease (GERD).Methods: This cross-sectional study was carried out in the Department of Physiology, SirSalimullah Medical College (SSMC), Dhaka from 1st January, 2017 to 31st December, 2017.Forthis, total 30 male and female diagnosed GERD patients from the Out Patient Department(OPD) of Gastroenterology, BSMMU aged 20-35 years were included in the study group. LowFrequency norm (LF norm),High Frequency norm (HF norm) and LF/HF ratio of HRV parameterswere recorded. Thirty age and BMI matched healthy subject also included as control. For statisticalanalysis, unpaired t-test was done as applicable.Results: The mean LF norm was 72.10±13.97 n.u. and the mean LF/HF was 3.34±1.14. Whichwere significantly (p<0.001) higher in GERD patients in comparison to that of healthy subjects.Which indicate sympathetic overactivity in GERD patients. However, the mean HF norm was24.54±10.56 n.u. Which was significantly (p<0.001) lower in GERD patients as compared to that of apparently healthy subjects. Which indicate decreased parasympathetic activity in GERDpatients.Conclusion: Parasympathetic hypofunction and sympathetic over activity were found in GERDpatients.

Factors affecting facial nerve outcome in vestibular Schwannoma surgery

Background: Preservation of facial nerve injury is a key important factor in vestibular schwannoma surgery as facial paralysis has devastating functional and psychological consequences for patients. Objective: To correlate different factors resulting in facial nerve preservation in vestibular schwannoma surgery by retro mastoid retro sigmoid approach. Method: This is a retrospective analysis of facial nerve status of 212 cases of vestibular schwannoma microsurgery through Retrosigmoid Retromastoid (RSRM) approach. This study was carried out in National Neurosurgical Referral Center(NNRC), National Academy Of Medical Sciences (NAMS), Bir hospital between January 2016 to December 2022.Preoperative and post operative details of facial nerve function status compared according to House and Brackmann (H and B) grading system, and factors influencing outcome in facial nerve preservation were analyzed. Recurrent and residual tumors were excluded. Results: A total of 212 cases of vestibular schwannoma were operated during the study period. The average age of presentation was 47 years. Most common affected age group was 51-60 years. Female to male ratio was 3:2.5. The most common clinical symptoms for vestibular schwannoma were sensorineural hearing loss followed by headache and difficulty in limb coordination. Tumor size and consistency was most important indicator of facial nerve function outcome. Conclusion: The incidence of post operative facial palsy is found to be correlated to tumor size and consistency. Improvement of the facial nerve outcome is detected in patients undergone simultaneous intraoperative monitoring (IONM).

Cavernous Malformation From Cranial Nerves: A Systematic Review With a Novel Classification and Patient-Level Analysis.

Cavernous malformations (CMs) occurring in the cranial nerve (CN) are extremely rare, and there is currently no comprehensive review on CN CMs, leading to a lack of sufficient understanding of CN CMs. We aimed to systematically review all published CN CM cases; summarize the epidemiology, clinical manifestations, treatment, and prognosis of CN CMs; and identify factors influencing the prognosis of CN CMs. This systematic review identified all cases potentially diagnosed with CN CM through a systematic search of PubMed, SCOPUS, Web of Science, and Cochrane databases. This represents the most comprehensive systematic review to date. We classified CN CMs based on their anatomic origins. Patient characteristics, disease manifestations, treatment approaches, and prognosis were summarized descriptively. Further analysis was conducted to identify factors influencing the prognosis of CN CMs. The final analysis included 108 articles (127 individual patient cases). The optic nerve (49/128, 38.3%) is the most commonly affected nerve. Notably, CN CMs can be categorized into 3 types: Intraneural, Perineural, and Extraneural. Preoperative nerve function status and novel classification were associated with the prognosis of CN CMs (P = .001; P < .001). The postoperative neurological deterioration rate for the Intraneural type was 19/37 (51.4%); for the Extraneural type, it was 13/69 (18.8%); and for the Perineural type, it was 1/22 (4.5%) (P < .001). We reviewed all the published CN CMs to date, offering a comprehensive description of CN CMs for the first time and identifying prognostic factors. The classification of CN CMs proposed in this study could serve as guidance for the selection of intraoperative treatment regimens. The findings of this systematic review are expected to provide a foundation for clinical decision-making in this crucial rare disease and lay the groundwork for developing relevant clinical guidelines.

Transcanal Endoscopic Facial Nerve Decompression in Posttraumatic Facial Paralysis: A Tertiary Care Experience

Purpose: Facial nerve decompression (FND) for traumatic facial palsy with lesion at geniculate ganglion and tympanic segment can be done through transcanal approach, by a microscope or an endoscope without opening the mastoid. The study analyzes the outcomes of transcanal endoscopic approach (TEA) for FND with regard to improvement in facial nerve (FN) function and hearing status, in lesions limited to perigeniculate and tympanic segment of FN. Methodology: This was a retrospective analysis of the case series from a tertiary care center, of the patients with posttraumatic FN paralysis, surgically treated with TEA. From January 2014 to December 2018, nine patients of traumatic facial palsy were selected for surgery. The patients posted for surgery were selected only when they had immediate-onset FN paralysis after trauma and not responding to treatment of systemic corticosteroid for 14 days with, House Brackmann grading (HBG) IV–VI, lesions confined to perigeniculate ganglion and tympanic segment of FN. Outcome analysis following TEA for FND was performed in terms of postoperative FN function and hearing improvement. Results: The TEA showed a postoperative improvement of FN function (HBG I/II) in 77.7% of patients within 6-month follow-up period. There was no significant improvement in FN function between 6th and 12th month. Postoperative hearing improvement was seen in eight cases, and there was no improvement in one case due to preoperative sensorineural hearing loss. Conclusion: TEA for FND is a direct approach for lesions confined to perigeniculate ganglion area and tympanic segment without involvement of mastoid segment of FN. It requires minimal bone drilling, provides proper visualization, and accurate surgical site assessment. Surgeries performed even in late presentations may have favorable outcomes.

Postoperative trigeminal neuropathy outcomes following surgery for tumors involving the trigeminal nerve.

To observe the evolution and outcomes of postoperative trigeminal neuropathy following surgery of tumor involving the trigeminal nerve. A prospective observational study was conducted between October 2018 and February 2019 involving 25 patients with tumors confirmed to involve the trigeminal nerve during surgery by senior author. Pre- and postoperative trigeminal nerve function status and clinical data were recorded. This study included 18 cases of meningioma and seven of trigeminal schwannoma. Among the meningioma cases, 55.6% of the patients reported facial sensory dysfunction before surgery, 33.3% presented ocular discomfort, and 5.6% had masticatory muscle atrophy. Postoperatively, all patients experienced facial paresthesia, 94.4% complained of eye dryness, and one (5.56%) exhibited keratitis. Additionally, one patient (5.56%) showed new-onset masticatory weakness. During follow-up, 50.0% of patients reported improvement in facial paresthesia, and one (5.56%) experienced deterioration. Eye dryness resolved in 35.3% of patients, and keratitis remission was observed in one patient. However, one patient (5.56%) developed neurotrophic keratitis. Overall, 55.6% of patients displayed mild masticatory weakness without muscle atrophy. In the cases of schwannoma, 28.6% of patients had facial paresthesia before surgery, 42.9% showed ocular discomfort, and one (14.3%) complained of masticatory dysfunction. Postoperatively, 85.7% of patients reported facial paresthesia and eye dryness, with one patient (16.7%) experiencing keratitis. During follow-up, 66.7% of patients demonstrated improvement in facial paresthesia, 28.6% showed eye dryness remission, and one patient (16.7%) recovered from keratitis. However, one patient (16.7%) developed new-onset neurotrophic keratitis. One patient (16.7%) experienced relief of masticatory dysfunction, but 42.9% reported mild deterioration. Another patient (14.3%) had facial anesthesia that had not improved. Postoperative trigeminal neuropathy is a common complication with a high incidence rate and poor recovery outcomes after surgery for tumors involving the trigeminal nerve. When trigeminal nerve damage is unavoidable, it is essential to provide a multidisciplinary and careful follow-up, along with active management strategy, to mitigate the more severe effects of postoperative trigeminal neuropathy.

Evaluation of Cardiovascular Sympathetic Nerve Function Status by Cold Pressor test in Healthy Adult Male Sedentary Individuals

Background: Sedentary lifestyle is an issue of great concern because of its deleterious health implication. It is associated with limited physical activity. Regular physical activity with good physical fitness are widely accepted as factors that reduce all cause of mortality and improve number of health outcome. Objective: To assess the cardiovascular sympathetic nerve function status by the cold pressor test in healthy adult male sedentary workers. Methods: This cross-sectional analytical study was conducted from January 2019 to December 2019 in the Department of Physiology, Rangpur Medical College, Rangpur. After obtaining permission, a total 60 subjects who were met the inclusion criteria was enrolled in the study after briefing them objectives of the study. Among them 30 were healthy adult male heavy workers (Group-A) and 30 were healthy adult male sedentary workers (Group-B). The basal systolic and diastolic blood pressure was recorded in resting condition. The evaluation of sympathetic nerve functions in selected individuals was done by cold pressor test. The individuals were selected from different areas of Rangpur district. For statistical analysis unpaired t-test was performed by computer-based software SPSS-23.0 version for windows. Results: The resting systolic and diastolic blood pressure are non-significant in selected individuals. Diastolic blood pressure response by cold pressor test was significantly lower in sedentary workers. (p&lt; 0.05). Conclusion: The study thus concluded that decreased diastolic blood pressure response by cold pressor test in sedentary individuals indicate impairment of the sympathetic nerve function. J Rang Med Col. March 2023; Vol. 8, No. 2:59-64

Aerobic and resistance exercises affect the BDNF/TrkB signaling pathway, and hippocampal neuron density of high-fat diet-induced obese elderly rats.

Obesity, caused by a high-fat diet (HFD) in elderly, is a risk factor for insulin resistance and a precursor to diabetes and can lead to impaired cognitive function. Physical exercise has positive effects on decrease obesity and improvement brain function. We investigated which type of aerobic (AE) or resistance (RE) exercise can be more effective in reducing HFD-induced cognitive dysfunction in obese elderly rats. 48 male Wistar rats (19-monthold) were divided into six groups: Healthy control (CON), CON+AE, CON+RE, HFD, HFD+AE, and HFD+RE. Obesity was induced by 5 months of HFD feeding in older rats. After obesity confirmation, RT (with a range of 50% to 100%1RM/3 days/week) and AE (running at 8-m/min for 15-min to 26-m/min for 60-min /5 days/week) was performed for 12-weeks. Morris water maze Test was used to evaluate cognitive performance. All data were analyzed using two-way statistical test of variance. The results showed that obesity had a negative effect on glycemic index, increased inflammation, decreased antioxidant levels, decreased BDNF/TrkB and decreased nerve density in hippocampal tissue. The Morris water maze results clearly showed cognitive impairment in the obesity group. But 12 weeks after AE and RE, all the measured variables were on the improvement path, and in general, no difference was observed between the two exercise methods. Two mods of exercise (AE and RE) may be having same effects on nerve cell density, inflammatory, antioxidant and functional status of hippocampus of obese rats. Each of the AE and RE can create beneficial effects on the cognitive function of the elderly.

Proximal humerus fractures: anatomy, diagnosis and management.

Proximal humeral fractures are common with a bimodal distribution and sex discrepancy, affecting younger men and older women. The presentation of a proximal humeral fracture can vary greatly because of this bimodal distribution and the associated differences in mechanism of injury. Initial management should involve assessment of life- and limb-threatening injuries as outlined by the British Orthopaedic Association Standards for Trauma, with particular attention paid to axillary nerve function and vascular status. Initial imaging should involve orthogonal X-rays in three planes to determine fracture characteristics and exclude glenohumeral dislocation. Computed tomography imaging improves interobserver agreement and is the gold standard in determining fracture management. Management depends on fracture pattern, patient functionality and bone stock. Most patients with proximal humeral fractures achieve good functional outcomes via conservative methods (sling support and early, graded mobilisation), although there is a lack of evidence in certain populations, including younger patients. Surgery is required for open fractures and more complex fracture patterns where there is a risk of avascular necrosis of the humeral head, unacceptable impairment of functionality or neurovascular compromise. Surgical techniques can be head-sparing or involve replacement of the humeral head. There are several head-sparing techniques, each with different cost-benefit and complication profiles with no one technique superior to any other. However, improvements in plate technology may render open reduction internal fixation a more suitable technique, particularly in younger patients. Head replacement techniques (hemiarthroplasty and reverse shoulder arthroplasty) are indicated when the risk of avascular necrosis is too high or in older patients with osteoporotic bone. In these patients, reverse shoulder arthroplasty is preferred as it achieves better functional results than hemiarthroplasty. Complication rates vary depending on the fracture configuration and the course of management undertaken.

Comparison of Two Manual Therapy Programs, including Tendon Gliding Exercises as a Common Adjunct, While Managing the Participants with Chronic Carpal Tunnel Syndrome.

Background Carpal tunnel syndrome (CTS) is the symptomatic compression neuropathy of the median nerve at the wrist level that may become a reason for upper limb disability, in the women and men population. Objective This study aimed to compare the efficacy of the neurodynamic technique (NT) and carpal bone mobilization technique (CBMT) incorporated with tendon gliding exercises (TGE) as an effect-enhancing adjunct while managing the participants with chronic CTS. Methods The study followed a two-arm parallel-group randomized comparative design. Thirty participants (aged 30–59 years) with chronic CTS were recruited randomly to both the NT and CBMT groups. In addition to the TGE (a common adjunct), NT and CBMT were performed in the NT and CBMT groups, respectively, for three weeks. The primary outcome measures including pain intensity, functional status, grip strength, and motor nerve conduction study were assessed using a visual analogue scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), hand-held dynamometer, and electromyograph, respectively, at baseline, 3 weeks postintervention, and follow-up at one week post end of the intervention. Paired and unpaired t-test were used to calculate the differences in intervention effects within and between the groups with keeping the level of significance α at 0.05. Results The data analysis revealed a significant (95% CI, p < 0.05) difference for all outcomes within each group compared across different time intervals. Similarly, a significant difference was found for all outcomes except pain and grip strength compared between groups at 3 weeks postintervention and follow-up at one week post end of the intervention. Conclusions The NT revealed more effectiveness than the CBMT when incorporated with TGE to improve nerve conduction velocity and functional status of the hand. However, both NT and CBMT were equally effective in improving pain and grip strength while managing the participants with chronic CTS. In addition, the TGE contributed as a beneficial, effect-enhancing adjunct to the NT and CBMT differently. Significance. The study will guide the physiotherapist in applying either of the combination techniques suitable for achieving treatment objectives while managing the participants with chronic CTS.

Five-year outcomes of trauma-specific function in patients after acute blunt popliteal artery injury: a matched cohort analysis

BackgroundFew studies focus on the trauma-specific functional outcomes after surgical revascularization and risk factors contributing to poor outcomes in patients with acute blunt popliteal artery injury (PAI). The objective of this study was to investigate the long-term trauma-specific functional outcomes in patients with acute blunt PAI and identify the associated risk factors.MethodsThere were 36 patients with acute blunt PAI who require surgical revascularization at a national trauma center of West China Hospital of Sichuan University between March 2010 and April 2019. After propensity matching, each patient was matched to one patient who did not have a concomitant vascular injury in control cohort. Functional outcomes were assessed with trauma-specific functional scores, physical examination of range of motion, nerve functional status and knee stability. A logistics regression model was established to determine the independent risk factors.ResultsThe 5-year (range 2–10 years) follow-up showed that 22 patients (22/36, 61.1%) had functional deficit due to limited activity or chronic neurological symptoms. Patients in vascular cohort had significantly decreased FIM score and AHFS score compared with matched patients without vascular involvement (P = 0.003 and P < 0.001), whereas there was no statistically significant difference in KSS (P = 0.136). Spearman correlation analysis of functional scores in vascular cohort showed that the FIM score was positively correlated with AHFS score (r = 0.926, P < 0.001), but not correlated with the KSS (r = − 0.007, P = 0.967). Additionally, there was significant difference in the range of motion of ankle between two groups (P < 0.001 and P = 0.034). Logistic regression analysis further demonstrated nerve injuries and compartment syndrome were risk factors for poor ankle function after surgery (OR 22.580, P = 0.036 and OR 12.674, P = 0.041).ConclusionMost patients who sustained blunt PAI had significant functional deficit associated with limited activity and chronic neurological symptoms of ankle and foot, and poor functional outcomes were related to nerve injury and compartment syndrome. Therefore, early and effective decompression for compartment syndrome remains the only potentially modifiable risk factor for improving functional outcomes following PAI.

Giant Facial Nerve Schwannoma with Extra-Temporal Involvement: A Series Of Two Cases.

Facial nerve schwannoma is a rare benign tumor of temporal bone arising from the schwann cells with incidence of 0.8%. They can arise from any segment of facial nerve with geniculate ganglion being the most common and labyrinthine segment the second commonest site. Intra-temporal location is common while only 9% of the cases have extra-temporal or parotid gland involvement. Bony remodeling or scalloping of the facial canal and the surrounding bone is the classic radiological feature of schwannoma. However schwannomas of temporal bone location can show bony erosions. The management option depends on site, extent, facial nerve function and hearing status. Surgery is reserved for large tumors with poor facial functions, hearing loss and giddiness. Giant facial nerve schwannoma with extra-temporal involvement is a rare entity with only handful number of cases reported in the literature. We present a series of two cases of giant facial nerve schwannoma with parotid gland involvement.

Relationship between Obesity and Sympathetic Nerve Function Status

In order to assess the effect of obesity on sympathetic nervous system a cross-sectional observational study was carried out in the Department of Physiology, Sylhet MAG Osmani Medical College between January 2017 and December 2017. Fifty obese and age-sex matched 50 non-obese subjects were included. Two non-invasive cardiovascular sympathetic function tests like blood pressure response to postural change (orthostatic test) and blood pressure response to sustained handgrip were done to assess sympathetic nerve function status.The fall in systolic blood pressure (SBP) in orthostatic test of obese group (9.02 ± 2.29 mmHg) was significantly higher compared to non-obese group (4.84 ± 0.96) (p&lt;0.001). Increase in diastolic blood pressure (DBP) in handgrip test of obese group (12.36 ± 2.78 mmHg) was significantly lesser than that of non-obese group (20.12 ± 2.64 mmHg) (p&lt;0.001). The results of this study suggested that obese adults have reduced sympathetic activity.

Microscopic Parotidectomy: A Prospective Study.

To assess the parameters' setting of the microscope during parotidectomy and the impact of microscopic parotidectomy on facial nerve functional status. A prospective study was conducted on 28 patients in a tertiary care center, who underwent microscopic parotidectomy. Microscope's settings' like magnification, focal length, diameter of the visualized field, and clock position were recorded. Facial nerve functional status was also recorded. All surgeries were performed by right-handed surgeons using Leica F 20 M525 microscope. Clock position of microscope for right parotidectomy ranged between 7 and 10 o clock and for left, it ranged between 7 and 12 o clock. Magnification ranged between 1.3 × and 3.2 ×; magnifications of 1.3 × and 1.8 × were preferred from incision to separation of parotid from sternocleidomastoid muscle, 1.8 × and 2 × for dissection of the facial nerve trunk, and 2 × and 3.2 × for individual branches of the facial nerve. Focal length ranged between 251 and 410mm and the diameter of the visualized field ranged between 7 and 14.7cm. Out of 24 cases of benign lesions, 2 (8.3%) developed facial paresis which resolved in 3months. Two out of four cases of malignancy developed permanent palsy as nerve branches were sacrificed to achieve tumor clearance. Using a microscope for parotidectomy is advantageous for facial nerve dissection, reducing chances of facial paralysis. The microscope was also found to be useful for teaching. The use of appropriate microscopic parameters avoids the glitch of transition from open to microscopic approach.

Parasympathetic Nerve Function Status in Major Depressive Disorder Patients and Its Correlation with Duration of Disease

Introduction:Cardiovascular (CV) morbidity is a major problem in patients suffering from depression. Greater CV mortality is found in cardiac patients with depression than without depression. Depressive disorder can cause altered autonomic nerve function. This study design to assess autonomic nerve function activity by heart rate variability analysis in patients with major depressive disorder and its correlation with duration of disease.&#x0D; Materials and Methods: This case study was conducted in the Department of Physiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka in 2011. 60 patients of both sexes with major depressive disorder (MDD) aged from 20-50 years were included in the study group (Group B). The patients were selected from out and inpatient Department of Psychiatry in Bangabandhu Sheik Mujib Medical University (BSMMU). Group B were divided into B-1 consisting of 30 drug naive MDD patients &amp; B-2 consisting of 30 medicated MDD patients. For comparison age and sex matched 30 apparently healthy subjects (Group A) were also studied. The HRV parameters were recorded by 4 active channels, Polyrite-D machine. For statistical analysis ANOVA, independent sample t-test, chi-square test and Pearson’s correlation coefficient test were performed by using SPSS for windows version-16 as applicable.&#x0D; Results: Mean resting pulse rate, mean heart rate, systolic blood pressure were significantly higher in drug naive and medicated MDD patients in comparison with that of healthy control. Mean R-R interval, Max/Min R-R interval, SDNN, RMSSD, PNN50%, NN50% were significantly lower in this groups of patients. Correlation analysis showed negative correlations of SDNN, RMSSD, PNN50%, NN50% with disease duration which was statistically significant only for SDNN.&#x0D; Conclusion: Sympathovagal imbalance may occur in both drug naive and medicated MDD patients which is associated with higher sympathetic and lower vagal modulation of the heart rate. In addition, parasympathetic nerve function parameters show negative relationship with the duration of disease.&#x0D; Medicine Today 2020 Vol.32(2): 76-80

Application of a modified paramedian lower lip-submandibular approach in maxillary (subtotal) total resection

To investigate the clinical efficacy of a modified paramedian lower lip-submandibular approach for maxillary (subtotal) total resection. Eleven patients of maxillary tumors underwent maxillary (subtotal) total resection through the modified paramedian lower lip-submandibular approach. Clinical follow-up visits were conducted to evaluate appearance restoration, facial nerve functional status, parotid gland functional status, and orbital region complication. During the follow-up period of 6-36 months, the appearance of all 11 patients recovered well. All cases presented hidden scars. No facial nerve and parotid duct injury, lower eyelid edema, lower eyelid ectropion, or epiphora in all cases was observed. Applying modified paramedian lower lip-submandibular approach to maxillary (subtotal) total resection effectively reduces incidence of orbital region complications including lower eyelid edema, lower eyelid ectropion, and epiphora, which often occur to traditional approach. The modified approach produces more subtle scars than other methods and should be applied to treatment of maxillary (subtotal) total resection.

Electric acupuncture plus fire acupuncture improves facial nerve function and anxiety state in patients with obstinate facial palsy

One hundred and ten patients with obstinate facial palsy were randomly divided into study group and control group with 55 cases in each group. Both groups received electropuncture on face acupoints five times a week, the study group received additional acupuncture on Zhongzhen six acupoints, subsequently fire needles were used for Yangbai (GB 14), Quanliao (SI 18), Dicang (ST 4) and Jiachengjiang (Extra) acupoints twice a week. And the treatment courses lasted for four weeks. The House-Brackmann (HB) scale and Self-Rating Anxiety Scale (SAS) were used for evaluation of facial nerve function and anxiety status before and after treatment, respectively. One hundred and four cases completed the treatment in the two groups. Before treatment there were no significant differences in HB and SAS scores between study and control groups (Z=-0.271, P=0.79; Z=-1.689, P=0.09). After 4 weeks of treatment the HB and SAS scores in both group were significantly improved (Z=-5.652, Z=-5.038, all P<0.01; Z=-6.050, Z=-5.332, all P<0.01); however, there were significant differences in HB scale and SAS scores after treatment between two groups (Z=-2.066, Z=-2.884, all P<0.05). The electric acupuncture on face acupoints plus Zhongzhen six acupoints combined with fire acupuncture can effectively improve facial nerve function and anxiety state in patients with obstinate facial palsy. Key words: Facial paralysis; Fire needle; Zhongzhen six acupoints; Electroacupuncture; Anxiety