Nerve Impairment Research Articles

Prevalence of impaired upper extremity neural mobility among smart device users during the COVID-19 pandemic.

Both the development of various countries and people's health were impacted by the unforeseen global COVID-19 outbreak. Many countries prefer to do their daily business online. Although it was incredibly useful at the time, it still had a problem that was not properly addressed, especially among the student population. The objective of this study was to examine the prevalence of upper extremity neural mobility among students who were using smart devices during the COVID-19 pandemic. 458 students who had previously taken home-based online classes during the COVID-19 pandemic and used a smart device for more than six hours were included in this study. The study was conducted in three phases. After being examined in the first two stages of the study, a total of 72 people were chosen for the final phase. Peripheral nerve mobility tests were performed on these 72 subjects. This study observed that 15.72% of smart device users have been affected by forward neck posture and impaired peripheral nerve mobility in the cervical spine. The study concludes that forward neck posture is associated with impaired peripheral nerve mobility among smart device users who were in home-based online classes during the COVID-19 pandemic lockdown. Hence, we suggest an appropriate treatment strategy focusing on preventing the forward neck posture through timely analysis and self-care therapies.

Leukocyte transcriptome of Cushing's disease are associated with nerve impairment and psychiatric disorders.

The hypothalamus-pituitary-adrenal (HPA) axis and its end product cortisol is a major response mechanism to stress and plays a critical role in many psychiatric disorders. Cushing's disease (CD) serves as a valuable in vivo "hyperexpression" model to elucidate the effect of cortisol on brain function and mental disorders. Changes in brain macroscale properties measured by magnetic resonance imaging (MRI) have been detailed demonstrated, but the biological and molecular mechanisms underlying these changes remain poorly understood. Here we included 25 CD patients and matched 18 healthy controls for assessment, and performed transcriptome sequencing of peripheral blood leukocytes. Weighted gene co-expression network analysis (WGCNA) was performed to construct a co-expression network of the relationships between genes and we identified a significant module and hub gene types associated with neuropsychological phenotype and psychiatric disorder identified in enrichment analysis. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis preliminarily explored the biological functions of these modules. The WGCNA and enrichment analysis indicated that module 3 of blood leukocytes was enriched in broadly expressed genes and was associated with neuropsychological phenotypes and mental diseases enrichment. GO and KEGG enrichment analysis of module 3 identified enrichment in many biological pathways associated with psychiatric disorders. Leukocyte transcriptome of Cushing's disease is enriched in broadly expressed genes and is associated with nerve impairment and psychiatric disorders, which may reflect some changes in the affected brain.

Severe intraoperative vascular bleeding as main complication of acetabular fractures treated with plate osteosynthesis via the modified Stoppa approach

Acetabular fractures are challenging fractures and finding the best supportive treatment is complex. Many operative treatment options exist – one of them is the plate osteosynthesis via the modified Stoppa approach gaining popularity over the last decades. The purpose of this study is to give an overview of this surgical techniques and its main complications.Patients ≥ 18 years between the years 2016 and 2022 with acetabular fractures in our department received a surgical intervention with plate fixation via the modified Stoppa approach. All protocols and documents during a patient's hospital stay were analyzed to find relevant perioperative complications concerning this operative technique.Between 01/2016 und 12/2022 75 patients with acetabular fractures were treated surgically in the author's institution with a plate osteosynthesis via the modified Stoppa approach. In 26.7 % (n = 20) of all cases, patients were confronted with one or more perioperative complications typical for this operation. Intraoperative venous bleedings were the main complication with 10.6 % (n = 8). Postoperative functional impairment of the obturator nerve and deep vein thrombosis occurred with 2.7 % (n = 2) and 9.3 % (n = 7).This retrospective study shows that plate fixation via the Stoppa approach is a good treatment option because of the excellent intraoperative overview of the fracture, but has its pitfalls and complications. Especially severe vascular bleedings must be taken into account and its management well known.

A Novel Classification of Cervical Spine Trauma in Ankylosing Spondylitis and Corresponding Surgical Outcomes

Currently, there are no reports on the specific classification of cervical spine trauma (CST) in ankylosing spondylitis (AS) based on the trauma mechanism. In this study, we aimed to describe a novel classification of CST in AS with more details, and put forward the corresponding surgical outcomes related to different types, hoping to provide a practical reference for clinical decision-making and academic communication. From January 2008 to December 2021, AS patients who experienced CST were retrospectively reviewed and included. Clinical data including gender, age, reason of trauma, time interval between AS diagnosis and trauma were collected. The American Spinal Injury Association (ASIA) grade system was used to describe patients' neurological status. Based on the combination of surgical experience and follow-up observation, the lower cervical spine trauma in AS patients was divided into three main types, namely single level fracture-dislocation (type 1), spinal cord injury without fracture-dislocation (type 2), and Andersson lesion (type 3). Furthermore, we performed detailed subtypes according to whether cervical spine was completely fused and the location of injury. Meanwhile, according to different approaches, surgical methods mainly included Anterior Cervical Discectomy and Fusion (ACDF), Anterior Cervical Corpectomy and Fusion (ACCF), Posterior Expansive Open-door Cervical Laminoplasty (PEOLP), Posterior Cervical Laminectomy Decompression and Fusion (PCLDF), and their combination. Postoperative general and surgery-related complications were also recorded. A total of 102 patients were enrolled, including 91 males and 11 females, with an average age of 51.9 years. Their average interval time between AS diagnosis and injury was 27.8 years. Patients with high-energy and low-energy trauma were 54 and 48 respectively. There were 79 patients suffering spinal cord nerve impairment after trauma. With regard to the distribution of different types, the number of patients in type 1, type 2, and type 3 were 86, 14, and two, respectively. For different types, PCLDF was the most commonly used surgical method, accounting for 55.9%, while ACCF was only applied for one time. In type 1, the frequencies of ACDF, ACCF, PCLDF, and ACDF+PCLDF were 10.5%, 1.2%, 55.8%, and 32.5%. In type 2, the frequencies of ACDF, PCLDF, ACDF+PCLDF, and PEOLP were 7.1%, 50.0%, 7.1%, 35.8%. Postoperatively, 21 patients achieved neurological function improvement. The incidences of general and surgery-related complications were 19.6% and 5.9%, respectively. All patients achieved bone fusion and durable decompression at the last follow-up. Our novel classification could enrich the scope of CST in AS patients and provide valuable references to the corresponding clinical management. Besides, there are strict indications of different surgical methods, factors like patient's physical condition, trauma type, surgical purpose, and expected efficacy were all required to consider before making a clinical decision.

Establishment of a Rat Model of Infraorbital Neuroinflammation Under CT Guidance.

The aim is to establish a rat model of infraorbital neuroinflammation with less trauma, stable pain, and a long duration of pain. The pathogenesis of trigeminal neuralgia (TN) is not fully clear. There are various models of TN in rats with different disadvantages, such as damaging the surrounding structures and inaccuracy of location for infraorbital nerve (ION). We aim to establish a rat model of infraorbital neuroinflammation with minimal trauma, a simple operation, and accurate positioning under CT guidance to help us study the pathogenesis of trigeminal neuralgia. Thirty-six adult male Sprague Dawley rats (180-220 g) were randomly divided into 2 groups and injected with talc suspension or saline through the infraorbital foramen (IOF) under CT guidance. Mechanical thresholds were measured in the right ION innervation region of 24 rats over 12 postoperative weeks. At 4 weeks, 8 weeks, and 12 weeks after the operation, the inflammatory involvement of the surgical area was evaluated by MRI, and neuropathy was observed using a transmission electron microscope (TEM). The talc group had a significant decrease in the mechanical threshold at 3 days after surgery that continued until 12 weeks post-operation, and the talc group had a significantly lower mechanical threshold than the saline group 10 weeks post-operation. The talc group had significantly impaired trigeminal nerve (TGN) myelin after 8 weeks post-operation. The rat model of infraorbital neuroinflammation established by CT-guided injection of talc into the IOF is a simple operation that results in less trauma, stable pain, and a long duration of pain. Moreover, infraorbital neuroinflammation in peripheral branches of the TGN can cause demyelination of the TGN in the intracranial segment.

Hepatic Innervations and Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disorder. Increased sympathetic (noradrenergic) nerve tone has a complex role in the etiopathomechanism of NAFLD, affecting the development/progression of steatosis, inflammation, fibrosis, and liver hemodynamical alterations. Also, lipid sensing by vagal afferent fibers is an important player in the development of hepatic steatosis. Moreover, disorganization and progressive degeneration of liver sympathetic nerves were recently described in human and experimental NAFLD. These structural alterations likely come along with impaired liver sympathetic nerve functionality and lack of adequate hepatic noradrenergic signaling. Here, we first overview the anatomy and physiology of liver nerves. Then, we discuss the nerve impairments in NAFLD and their pathophysiological consequences in hepatic metabolism, inflammation, fibrosis, and hemodynamics. We conclude that further studies considering the spatial-temporal dynamics of structural and functional changes in the hepatic nervous system may lead to more targeted pharmacotherapeutic advances in NAFLD.

PO-01-169 CLINICAL APPLICATION OF A NOVEL 31MM CRYOBALLOON FOR PULMONARY VEIN ISOLATION FOR PAROXYSMAL ATRIAL FIBRILLATION: PROCEDURAL DATA FROM THE FIT ARM OF FROZEN AF

Cryoablation of pulmonary veins (PV)s to treat paroxysmal atrial fibrillation (PAF) is well established, however there are limited choices in balloon sizes for cryoablation. Data have recently been collected on a new cryoballoon system with novel capability to deliver cryoablation in a standard 28mm diameter balloon or an expanded 31mm diameter, using the same catheter. Demonstrate the clinical utility of an expandable diameter cryoballoon, and discuss the potential advantages for occlusion, antral positioning, and lesion size. As part of the FROZEN AF Trial (NCT04133168) 50 patients received PVI ablation to treat PAF with a cryoballon capable of ablation at 28mm or 31mm. Follow-up is continuing, but we present procedural data and clinical application of this balloon. The extension arm of the FROZEN AF trial (NCT04133168) included 50 pts, 46% female and aged 64±13 years, indicated for PV isolation for treatment of PAF. Acute isolation was successful in all pts. Average procedure time was 101±59 min, with LA dwell of 51 min, and fluoroscopy of 7 min. General anesthesia was used in all patients, and the majority (49/50) underwent a single transeptal puncture. The novel 31mm configuration was used in 65% of ablations. In the 198 ablations performed at 31mm, 97.5% achieved a Grade 3 or 4 occlusion. Average nadir temperature was -54.89°C, and average TTI was 44s. In PVs where the first ablation was performed at 31mm the single shot isolation rate was significantly higher than in PVs where the first ablation was performed at 28mm. Data by PV are listed in Table 1. Notably, there was a low rate of phrenic nerve impairment, with only 1 instance of transient paralysis which resolved prior to discharge. Additionally, in a subset of pts at a single center, occlusion was assessed at both 28mm and 31mm, Figure 1. Preliminary landmark-based analysis of a subset of veins suggests that inflation to 31mm results in a marked antral shift of balloon position. The combination of maneuverability and variable size may make this balloon particularly useful in addressing challenges resulting from patient-to-patient variability in PV size and geometry. In particular, the choice between 28 and 31mm diameter in a single device may facilitate obtaining good occlusion, and the more antral positioning of a large balloon may give physicians more discretion as to the size and location of PVI lesions. As, the FROZEN AF trial is ongoing, long-term results in these patients are awaited.Tabled 1Usage, Occlusion and Single Shot Isolation rate of 28 and 31mm Balloon Sizesn Grade 4 Occlusion / N Total Ablation (%)n Single Shot Isolation / N PV (%)Pulmonary Vein28mm31mm28mm31mmLeft superior (LSPV)18 / 23 (78.3)41 / 45 (91.1)2/8 (25%)19/34 (55.9%)Left inferior (LIPV)17 / 19 (89.5)29 / 38 (76.3)4/12 (33.3%)23/30 (76.7%)Left common (LCPV)5 / 7 (71.4)6 / 19 (31.6)0/0 (%)1/8 (12.5%)Left middle (LMPV)1 / 1 (100)-1/1 (100%)0/0 (%)Right superior (RSPV)9 / 18 (50)49 / 56 (87.5)1/5 (20%)27/43 (62.8%)Right inferior (RIPV)21 / 38 (58.3)33 / 37 (89.2)10/24 (41.7%)17/24 (70.8%)Right common (RCPV)1 / 3 (33.3)2 / 3 (66.7)0/1 (0%)0/1 (0%)Total72 / 109 (67.3)160 / 198 (80.8)18/51 (35.3%)87/140 (62.1%)Single shot success in veins where first ablation was performed with specified balloon size. Only ablations with duration > 60s included in ablation counts Open table in a new tab

Yüz Felci Hakkında Bilgi Veren Türkçe Web Sitelerinin İçeriği, Okunabilirliği ve Güvenilirliği Üzerine Bir Değerlendirme

Background/Aims: Known as Bell's palsy, is a neurological disorder characterized by partial or complete paralysis of the muscles of the face, results from impairment or dysfunction of the facial nerve. This study aims to evaluate the readability, content, and quality and determine the level of accuracy and reliability of websites in Turkish language that provide information about facial paralysis. Methods: This descriptive, cross-sectional study analyzed the quality, usability, content and readability of Turkish facial paralysis websites using the Ateşman and Bezirci-Yılmaz Readability Formula, reading time, number of images, JAMA Benchmark Criteria, DISCERN Scale and UpToDate topics. Webscore.ai was used to assess aesthetic appeal and user experience. Results: After reviewing 200 websites, 110 Turkish sites about facial paralysis were included in the study. Average reading time was 5.5 minutes. Bezirci-Yılmaz score was 13.8. Ateşman readability levels were moderate. News, blog and "other" sites had the most visual content, followed by Health Professionals (HP) sites. Average quality of sites was poor. Conclusions: The DISCERN scale found 60% of Turkish health websites had poor-to-very poor content quality. UpToDate's benchmarking revealed 58.2% of sites contained less than half of the basic topics. This indicates inadequate, outdated info for facial paralysis patients. State Institutions and Health Related Associations should provide valid, reliable info on modern websites.

Ameliorative Effects of Isoeugenol and Eugenol against Impaired Nerve Function and Inflammatory and Oxidative Mediators in Diabetic Neuropathic Rats.

Diabetic polyneuropathy is characterized by structural abnormalities, oxidative stress, and neuroinflammation. The current study aimed to determine the antinociceptive effects of isoeugenol and eugenol and their combinations in neuropathic pain resulting from streptozotocin (STZ)-induced diabetes and neuroinflammation. Female SD rats were categorized into normal control, diabetic control, and treatment groups. On the 28th day and 45th day, behavioral studies (allodynia and hyperalgesia) were performed to analyze the development and protection of diabetic polyneuropathy. The levels of inflammatory and oxidative mediators, such as superoxide dismutase (SOD), tumor necrosis factor-α (TNF-α), catalase, reduced glutathione, and thiobarbituric acid reactive substances (TBARS), were estimated. In addition, the level of nerve growth factor (NGF) was estimated at the end of the study in different groups. The anti-NGF treatment decreased its upregulation in the dorsal root ganglion significantly. The results showed that isoeugenol, eugenol, and their combination have therapeutic potential against neuronal and oxidative damage induced by diabetes. In particular, both compounds significantly affected behavioral function in treated rats and showed neuroprotection against diabetic neuropathy, and their combination had synergistic effects.

Rhinogenic Optic Neuropathy with No Light Perception Secondary to Onodi Cell Mucocele with Visual Recovery after Optic Nerve Decompression.

Rhinogenic optic neuropathy (RON) results from ethmoid or sphenoid sinus inflammation or infection causing optic nerve impairment.1 Treatment often requires endoscopic surgery and vision restoration occurs in select cases. There is no clear evidence for the benefit of optic nerve decompression (OND) in these situations. We present a unique case of RON caused by an Onodi cell mucocele for which isolated endoscopic mucocele drainage was not enough and further OND was needed to improve vision.

The role of chemokines in type 1 diabetes-associated neuropathy.

To investigate whether circulating chemokines contribute to the development of diabetic peripheral neuropathy (DPN) in patients with type 1 diabetes (T1D). Fifty-two patients with childhood-onset T1D (mean age 28 ± 4 yrs.; diabetes duration 19.5 ± 5.5 yrs.) and 19 control subjects (mean age 26.5 ± 4.5 yrs.) were included in a cross-sectional analysis of this long-term longitudinal cohort study. A subgroup of 24 patients was followed prospectively for a further 10 yrs. Plasma levels of Th1- (CXCL9, CXCL10 and CXCL11), Th2- (CCL17 and CCL22) and Th17-associated (CXCL8 and CCL20) chemokines were assessed in all subjects. Additionally, the TID patients underwent clinical examination and electroneurography. The frequency of neuropathy was 21% (11/52). Higher levels of CXCL9 levels were found in patients with DPN compared with control subjects (p = .019); by contrast, no difference between patients without DPN and control subjects was seen after adjustment for multiple comparisons. In patients with DPN, CXCL10 correlated negatively with suralis MCV and suralis SNAP (rho -0.966, p < .001 and rho -0.738, p < .001, respectively) and was positively correlated with the vibration perception threshold (rho 0.639, p = .034), while CXCL8 correlated negatively with the cold perception threshold (rho -0.645, p = .032). The frequency of neuropathy increased to 54% (13/24) in the subgroup of 23 TID patients, followed by an additional 10 yrs. Changes in Th1- and Th17-associated chemokines were associated with impaired peripheral sensory nerve function and nerve conduction after long disease duration in childhood-onset T1D.

Axonal transport deficits in the pathogenesis of diabetic peripheral neuropathy.

Diabetic peripheral neuropathy (DPN) is a chronic and prevalent metabolic disease that gravely endangers human health and seriously affects the quality of life of hyperglycemic patients. More seriously, it can lead to amputation and neuropathic pain, imposing a severe financial burden on patients and the healthcare system. Even with strict glycemic control or pancreas transplantation, peripheral nerve damage is difficult to reverse. Most current treatment options for DPN can only treat the symptoms but not the underlying mechanism. Patients with long-term diabetes mellitus (DM) develop axonal transport dysfunction, which could be an important factor in causing or exacerbating DPN. This review explores the underlying mechanisms that may be related to axonal transport impairment and cytoskeletal changes caused by DM, and the relevance of the latter with the occurrence and progression of DPN, including nerve fiber loss, diminished nerve conduction velocity, and impaired nerve regeneration, and also predicts possible therapeutic strategies. Understanding the mechanisms of diabetic neuronal injury is essential to prevent the deterioration of DPN and to develop new therapeutic strategies. Timely and effective improvement of axonal transport impairment is particularly critical for the treatment of peripheral neuropathies.

Factors affecting the severity and prognosis of visual damage in inhalational methanol poisoning.

Inhalational methanol poisoning could cause severe damage to visual function. This study analyzed the prognosis of the correlation between the visual function and the relevant risk factors. In this retrospective study, 14 patients had confirmed inhalational methanol poisoning, resulting in visual impairment in both eyes. The following tests were performed: laboratory tests, best corrected visual acuity (BCVA), intraocular pressure, slit lamp, fundus photography, visual field (VF), pattern visual evoked potential (P-VEP), flash electroretinogram (F-ERG), optical coherence tomography (OCT), and orbital or cranial magnetic resonance imaging (MRI). With active treatment, visual function improved to varying degrees in all 14 cases (28 eyes) in this study. The BCVA of 21 eyes declined to no light perception at the onset; 16 eyes showed different degrees of improvement after treatment, with the final BCVA (LogMar) mainly ranging from 2 to 3, and vision acuity stabilized after the 5th month. The VF pattern in the acute phase was mostly blind. Other VF patterns included the central visual island, large paracentral scotomas, hemipleural VF defects, and the temporal visual island. Retinal nerve fiber layer (RNFL) thickening was observed commonly in the acute phase (146.8 ± 33.2 μm), which subsided in the 1st month, showed dramatic thinning at the 3rd month, and then stabilized in the 5th month after onset. MRI showed that the main sites involved were optic nerve impairment, the optic disk, and retrobulbar segments. The basal ganglia region was the site most involved in the central nervous system (CNS). Inhalational methanol poisoning could lead to severe impairment of visual function, and the prognosis of visual acuity (VA) was highly relevant to the risk factors of duration of toxic exposure, delayed admission, and degree of acidosis.

An experimental model of peripheral nerve electrical injury in rats

IntroductionAlthough several studies have investigated models of nerve electrical injury, only a few have focused on electrical injury to peripheral nerves, which is a common and intractable problem in clinical practice. Here, we describe an experimental rat model of peripheral nerve electrical injury and its assessment. MethodsA total of 120 animals were subjected to short-term corrective electrostimulation (50 Hz, 1-s duration) applied at varying voltages (control, 65, 75, 100, 125, and 150 V) to the exposed left sciatic nerve. Behavioural testing, electrophysiological measurements, and histopathological observation of the sciatic nerve were conducted at 1-, 2-, 4-, and 8-w follow-ups. ResultsNo functional defects were noted in the groups that received 65-V stimulation at any time point. Sciatic nerve functional defects were found after 2 w in animals that received 75-V stimulation, but function returned to normal after 4 w. In animals that received 100-V and 125-V stimulation, functional defects were observed at 4 w, but had partially recovered by 8 w. Conversely, animals that received 150-V stimulation did not show recovery after 8 w. ConclusionWe presented a model of peripheral nerve electrical injury that avoided the interference of various external factors, such as current instability, compression of the surrounding tissues, and altered blood supply. The model allowed quantitation and ranking of the nerve injury into four degrees. It facilitated effective evaluation of nerve function impairment and repair after injury. It can be used post-surgically to evaluate peripheral nerve impairment and reconstruction and enables translational interpretation of results, which may improve understanding of the mechanisms underlying the progression of peripheral nerve electrical injury.

Cranial nerve involvement in patients with immune-mediated neuropathy: An observational blink reflex study

ObjectiveThis study aimed to assess cranial nerve involvement in a large adult cohort of patients with immune-mediated neuropathy undergoing immunoglobulin treatment by measuring blink reflex R1 latency prolongation in correlation with clinical findings and nerve conduction studies. Methods104 patients underwent blink reflex examination and ulnar nerve conduction studies and were assessed by the Inflammatory Neuropathy Cause and Treatment disability score, the revised Amyotrophic lateral sclerosis functional rating scale (ALSFRS-R) and focused clinical examination. ResultsProlonged R1 latencies were identified in 23 of 104 patients (22.1 %). These patients had more severe functional impairments according to the ALSFRS-R, yet only five clinically presented with bulbar dysfunction, facial- or trigeminal nerve impairment. Overall R1 latency was inversely correlated to ulnar motor conduction velocity. In preliminary follow-up assessments under continuous immunoglobulin treatment, prolonged R1 latencies partially improved. ConclusionsCranial nerve involvement is a common feature in immune-mediated neuropathies and is associated with a more severe disease stage. Here, R1 prolongation was detected less frequently compared to previously reported untreated cohorts. SignificanceBlink reflex studies can detect subclinical cranial nerve involvement in immune-mediated neuropathies. Further studies are needed to evaluate the clinical utility of measuring R1 latency.

LEPROSY NEUROPATHY

Leprosy is a major cause of peripheral neuropathy in developing countries, affecting sensory, motor, and autonomic nerve function. Neuropathy complications can include sensory loss and muscle weakness. Impaired sensory nerve function is often the first symptom encountered in leprosy neuropathy. Early detection and treatment of neuropathy in leprosy are important to prevent disability.

Clinical Features of Peripheral Neurophaty among Onset Type 2 Diabestes Mellitus: A Michigan Neuropathy Screening Instrument (MNSI) Approach

Aims: Neuropathy is one of the complications that can occur in patients with Type 2 Diabetes Mellitus, around 21.3% to 34.5%. Untreated neuropathy can lead to diabetic foot ulcers that can lead to amputation. This can be prevented by conducting early detection using a neuropathy screening instrument. The study aimed to identify neuropathy symptoms through early examination of patients with type 2 diabetes using the Michigan Neuropathy Screening Instrument (MNSI). Method: The descriptive study with a survey was approached in this study. One hundred respondents with type 2 diabetes mellitus were selected using the purposive sampling technique. Results: The results showed that out of 100 patients had clinical symptoms of sensory neuropathy, such as pain and sensitivity disorders in the soles of the feet. In addition, autonomic neuropathy is in the form of cramps in the leg muscles. The level of neuropathy showed that from 100 patients, there were 59 respondents with low risk of neuropathy, 40 respondents with moderate risk, and 1 respondent with severe risk. Conclusion: Patients with Diabetes, primarily Type 2, have various neuropathy symptoms such as impaired nerve function: numbness, burning, and hypersensitivity, which can lead to diabetic foot ulcers. Therefore, early detection of neuropathy prevention is essential.

The transnasal endoscopic approach for resection of clival tumors: a single-center experience

Clival tumors present challenging entities regarding their treatment options. Due to their proximity to critical neurovascular structures, the operative goal of gross total tumor resection is rendered more difficult by a high risk of neurological deficits. Retrospective cohort study of patients treated for clival neoplasms through a transnasal endoscopic approach between 2009 and 2020. Assessment of preoperative clinical status, length of operation, number of approaches, pre- and postoperative radiotherapy, and the clinical outcome. Presentation and clinical correlation with our new classification. In total, 59 transnasal endoscopic operations were performed on 42 patients over 12 years. Most lesions were clival chordomas; 63% of the lesions did not reach the brainstem. Cranial nerve impairment was present in 67% of the patients, and 75% of the patients with cranial nerve palsy improved after surgical treatment. Interrater reliability for our proposed tumor extension classification showed a substantial agreement (Cohen’s κ = 0.766). The transnasal approach was sufficient to achieve a complete tumor resection in 74% of the patients. Clival tumors exhibit heterogeneous characteristics. Depending on clival tumor extension, the transnasal endoscopic approach can present a safe surgical technique for upper and middle clival tumor resection, with a low risk of perioperative complications and a high rate of postoperative improvement.

Vitamin D3 Promotes Structural and Functional Recovery After Vincristine-Induced Peripheral Neuropathy in Rats: An Experimental Study.

Background Vincristine-induced peripheral neuropathy (VIPN) is a distal axonopathy characterized by the loss of distal myelinated axons. This study aimed to assess the potential neuroregenerative roles of vitamin D3 using functional and electron microscopic analyses in a rat model of VIPN. Methodology A total of 40female Wistar rats were randomly divided into four main groups: Group 1 (control, n = 10), Group 2 (vincristine, n =10), Group 3 (vincristine + vitamin D3, n = 10), and Group 4 (vincristine + vehicle, n = 10). Vincristine was administered intraperitoneally at a dose of 0.15 mg/kg, for two weeks, to induce peripheral neuropathy. Following successful induction, vitamin D3 (500 IU/kg/day) and vehicle treatments were applied weekly over four weeks. Structural (electron microscopic analysis) and functional analysis (von Frey test, pinch test, and electrophysiological analysis) were performed to assess functional recovery after peripheral nerve impairment. Results Withdrawal responses to mechanical allodynia and pinch tests were significantly higher in the vitamin D3-treated group (P< 0.05). The electrophysiological analysis also supported these results. Electron microscopic evaluation revealed that the remyelinated nerve fibers in the vitamin D3-treated group (Group 3) had thick myelin sheaths and normal axonal morphology. Conclusions Our study demonstrated that vitamin D3 could promote functional and structural recovery in a rat model of VIPN. Further studies should be conducted to elucidate the underlying mechanisms by which vitamin D3 exerts its regenerative effects in VIPN, using alternative administration protocols.

Evaluation of preoperative visual pathway impairment in patients with non-functioning pituitary adenoma using diffusion tensor imaging coupled with optical coherence tomography.

Optic chiasma compression and associated visual impairment induced by a non-functioning pituitary adenoma (NFPA) is commonly assessed by the optic disk and retina but is inadequate to understand the entire visual pathway impairment. We aim to evaluate the use of optical coherence tomography (OCT) coupled with diffusion tensor imaging (DTI) for the preoperative evaluation of visual pathway impairment. Fifty-three patients with NFPA (categorized into mild and heavy compression subgroups) were subjected to OCT to calculate the thickness of the circumpapillary retinal nerve fiber layer (CP-RNFL), macular ganglion cell complex (GCC), macular ganglion cell layer (GCL), and macular inner plexus layer (IPL), as well as to DTI to calculate the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values. Compared to mild compression, heavy compression caused decreased FA value, increased ADC value of several segments of the visual pathway, thin temporal CP-RNFL, and quadrant macular GCC, IPL, and GCL. Average CP-RNFL thickness, inferior-macular inner-ring IPL and GCC thicknesses, inferior CP-RNFL thickness, and superior CP-RNFL thickness were the best indicators of the impairment of the optic nerve, optic chiasma, optic tract, and optic radiation, respectively. DTI and OCT parameters can effectively evaluate visual pathway impairment and are beneficial for the objective preoperative evaluation of visual pathway impairment in patients with NFPA.