Nerve In Conjunction Research Articles

Comparison of the Efficacy of Different Radiofrequency Techniques for the Treatment of Lumbar Facet Joint Pain: Combined with Anatomy.

Lumbar facet pain is generally considered to be one of the major causes of chronic low back pain. Each lumbar facet joint is innervated by the medial branch of the posterior spinal nerve from its own level and above. Radiofrequency (RF) of the medial branch of the posterior branch of the spinal nerve is an effective method for the treatment of lumbar facet pain. RF technology is diverse, including traditional radiofrequency (TRF), pulsed radiofrequency (PRF), cooled radiofrequency (CRF), low-temperature plasma radiofrequency ablation (CA), and other treatment methods. The purpose of this paper is to compare the efficacy of different radiofrequency techniques and to analyze the reasons for this in the context of anatomy. There have been studies confirming the differences in efficacy of different RF techniques. However, most of the studies only compared two RF techniques, not four techniques, TRF, CRF, PRF, and CA, and did not analyze the reasons for the differences in efficacy. This article reviews the differences in the efficacy of the above four RF techniques, clarifies that the differences are mainly due to the inability to precisely localize the medial branch of the posterior branch of the spinal nerve, analyzes the reasons for the inability to precisely localize the posterior branch of the spinal nerve in conjunction with anatomy, and proposes that the development of RF technology for lumbar facet pain requires more in-depth anatomical, imaging, and clinical studies.

Chemical Insights into Topical Agents in Intraocular Pressure Management: From Glaucoma Etiopathology to Therapeutic Approaches.

Glaucoma encompasses a group of optic neuropathies characterized by complex and often elusive etiopathology, involvihttng neurodegeneration of the optic nerve in conjunction with abnormal intraocular pressure (IOP). Currently, there is no cure for glaucoma, and treatment strategies primarily aim to halt disease progression by managing IOP. This review delves into the etiopathology, diagnostic methods, and treatment approaches for glaucoma, with a special focus on IOP management. We discuss a range of active pharmaceutical ingredients used in glaucoma therapy, emphasizing their chemical structure, pharmacological action, therapeutic effectiveness, and safety/tolerability profiles. Notably, most of these therapeutic agents are administered as topical formulations, a critical aspect considering patient compliance and drug delivery efficiency. The classes of glaucoma therapeutics covered in this review include prostaglandin analogs, beta blockers, alpha agonists, carbonic anhydrase inhibitors, Rho kinase inhibitors, and miotic (cholinergic) agents. This comprehensive overview highlights the importance of topical administration in glaucoma treatment, offering insights into the current state and future directions of pharmacological management in glaucoma.

Abstract 14807: Direct Carotid Sinus Nerve Stimulation in Anesthetized Human Subjects

Introduction: Drug resistant hypertension is a growing clinical phenomenon across the world and there is a critical need for alternative therapeutic modalities. Hypothesis: A novel multi-contact electrode designed to interface with the carotid sinus nerve in conjunction with a unique implantation technique can selectively activate the baroreflex causing reversible drops in blood pressure (BP) & heart rate (HR) in anesthetized humans. Methods: Patients undergoing therapeutic operations that necessitated carotid bulb exposure were prospectively enrolled in this IRB approved trial. Using a novel surgical approach, an application specific electrode was placed around the CSN followed by contact interface mapping to identify presumed baroafferent fibers which were selectively stimulated. Outcome measures included change in systolic BP (SBP), diastolic BP (DBP), and HR during and after stimulation. Results: 14 subjects met eligibility criteria. In 13, following correct contact identification, stimulation caused a 23±20mmHg (mean±SD) maximum drop in SBP with associated drops in DPB (11±9mmHg), and HR (10±9bpm). All subjects recovered immediately following stimulation withdrawal. All drops were significant (p<0.001, t-test). In subjects with baseline SBP >120mmHg (n=8), maximum SBP drop was 30±23mmHg, while subjects with baseline SBP <120mmHg (n=5) exhibited a maximum SBP drop of 11±3mmHg. There was evidence of a positive dose (current) response relationship. Conclusions: Using a novel surgical approach and electrode, CSN stimulation in anesthetized human subjects caused a marked drop in BP/HR followed by rapid recovery with stimulation withdrawal. There was evidence of dose dependency.

Clinical study of age-related sensory innervation of the anterior hard palate

The present study aimed to explore the innervation of the anterior hard palatine and its relationship with individual development stage. Specifically, the effects of anesthesia on patients of different ages were observed, and neurodevelopment in the maxillofacial region was invesitgated. References that are helpful in selecting local anesthesia were provided. A total of 182 patients with mixed dentition were randomly divided into the nasopalatine nerve block and greater palatine nerve block groups. Then, 219 patients with permanent dentition were divided into an adolescent group (13-18 years old) and adult group (over 19 years old), all of whom underwent bilateral greater palatine nerve block. Palatal mucosal pain sensation was tested pre- and post-anesthesia with Von Frey hairs. Among the children with mixed dentition, bilateral greater palatine nerve block tended to result in better anesthetic effects than nasopalatine nerve block (P<0.05), except in the incisive papilla. No difference in anesthetic effect was observed between adolescents and adults (P>0.05). The bilateral greater palatine nerve block was more effective in inducing an anesthestic effect in the anterior hard palatine in mixed dentition than in permanent dentition (over 13 years old; P<0.05). The sensation of the anterior hard palatine seems mainly dominated by the greater palatine nerve until mixed dentition and gradually shifted to the nasopalatine nerve in conjunction with maxillary development and tooth replacement. Hence, the innervation of the anterior hard palatine induce a secondary development during the development of the maxilla.

Discussion of “Phantom Penis: Extrapolating Neuroscience and Employing Imagination for Trans Male Embodiment”

ABSTRACT As described by Straayer, the phantom penis in transgender men combines feelings of loss and potential and may contribute to self-authentication and pleasure following phalloplasty. To align their gender identity with their body, some transgender men choose to undergo a phalloplasty procedure. For the reconstructive surgeon, the goals of phalloplasty typically are summed as an aesthetically pleasing, sensate phallus with both tactile and erogenous sensation that is capable of standing micturition and penetrative intercourse. Many surgical techniques for phalloplasty have been described, with the radial forearm free flap being the most commonly used. To optimize erogenous sensation, nerve coaptation to the dorsal clitoral nerve in conjunction with burying the denuded clitoris at the base of the neophallus is often performed. While surgical technique contributes to sensory recovery, there is likely a complex interplay between physiology, anatomy, endocrinology, and psychology as they pertain to orgasm and sexuality following phalloplasty. The reconstructive surgeon should engage in a shared decision-making approach with their patient and attempt to optimize aesthetic and sensory outcomes in order to facilitate sexual function following surgery.

Fundus image classification methods for the detection of glaucoma: A review.

Glaucoma is a neurodegenerative illness and is considered as a standout amongst the most widely recognized reasons for visual impairment. Nerve's degeneration is an irretrievable procedure, so the diagnosis of the illness at an early stage is an absolute requirement to stay away from lasting loss of vision. Glaucoma effected mainly because of increased intraocular pressure, if it is not distinguished and looked early, it can result in visual impairment. There are not generally evident side effects of glaucoma; thus, patients attempt to get treatment just when the seriousness of malady is advanced altogether. Determination of glaucoma often comprises of review of the basic crumbling of the nerve in conjunction with the examination of visual function capacity. This article shows the persistent illustration of glaucoma, its side effects, and the potential people inclined to this malady. The essence of this article is on different classification methods being utilized and proposed by various scientists for the identification of glaucoma. This article audits a few division and segmentation methodologies that are exceptionally useful for recognizable proof, identification, and diagnosis of glaucoma. The research related to the findings and the treatment is likewise evaluated in this article.

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation.

Pathological neural activity could be treated by directing specific plasticity to renormalize circuits and restore function. Rehabilitative therapies aim to promote adaptive circuit changes after neurological disease or injury, but insufficient or maladaptive plasticity often prevents a full recovery. The development of adjunctive strategies that broadly support plasticity to facilitate the benefits of rehabilitative interventions has the potential to improve treatment of a wide range of neurological disorders. Recently, stimulation of the vagus nerve in conjunction with rehabilitation has emerged as one such potential targeted plasticity therapy. Vagus nerve stimulation (VNS) drives activation of neuromodulatory nuclei that are associated with plasticity, including the cholinergic basal forebrain and the noradrenergic locus coeruleus. Repeatedly pairing brief bursts of VNS sensory or motor events drives robust, event-specific plasticity in neural circuits. Animal models of chronic tinnitus, ischemic stroke, intracerebral hemorrhage, traumatic brain injury, and post-traumatic stress disorder benefit from delivery of VNS paired with successful trials during rehabilitative training. Moreover, mounting evidence from pilot clinical trials provides an initial indication that VNS-based targeted plasticity therapies may be effective in patients with neurological diseases and injuries. Here, I provide a discussion of the current uses and potential future applications of VNS-based targeted plasticity therapies in animal models and patients, and outline challenges for clinical implementation.

Glaucoma Disease: A Survey

Glaucoma is a neurodegenerative disease and is considered as one of the most common reasons of blindness. Degeneration of nerves is an irreversible process so early diagnosis of this disease is inevitable to avoid permanent loss of vision. Diagnosis of glaucoma usually consists of inspection of the structural deterioration of nerve in conjunction with the examination of visual function. This article presents a detailed overview of glaucoma, its symptoms and the potential it has to affect the persons. The research work related to its diagnosis and treatment is also reviewed in this article. Keywords: Blindness, degeneration, feature extraction, glaucoma, morphology, pattern matching, prevention, segmentation.

Oligodendrocyte Lineage Cells in Chronic Demyelination of Multiple Sclerosis Optic Nerve.

Reports that chronically demyelinated multiple sclerosis brain and spinal cord lesions contained immature oligodendrocyte lineage cells have generated major interest aimed at the potential for promotion of endogenous repair. Despite the prominence of the optic nerve as a lesion site and its importance in clinical disease assessment, no detailed studies of multiple sclerosis‐affected optic nerve exist. This study aims to provide insight into the cellular pathology of chronic demyelination in multiple sclerosis through direct morphological and immunohistochemical analysis of optic nerve in conjunction with observations from an experimental cat optic nerve model of successful remyelination. Myelin staining was followed by immunohistochemistry to differentially label neuroglia. Digitally immortalized sections were then analyzed to generate quantification data and antigenic phenotypes including maturational stages within the oligodendrocyte lineage. It was found that some chronically demyelinated multiple sclerosis optic nerve lesions contained oligodendroglial cells and that heterogeneity existed in the presence of myelin sheaths, oligodendrocyte maturational stages and extent of axonal investment. The findings advance our understanding of oligodendrocyte activity in chronically demyelinated human optic nerve and may have implications for studies aimed at enhancement of endogenous repair in multiple sclerosis.

Use of axonal projection patterns for the homologisation of cerebral nerves in Opisthobranchia, Mollusca and Gastropoda

IntroductionGastropoda are guided by several sensory organs in the head region, referred to as cephalic sensory organs (CSOs). These CSOs are innervated by distinct nerves. This study proposes a unified terminology for the cerebral nerves and the categories of CSOs and then investigates the neuroanatomy and cellular innervation patterns of these cerebral nerves, in order to homologise them. The homologisation of the cerebral nerves in conjunction with other data, e.g. ontogenetic development or functional morphology, may then provide insights into the homology of the CSOs themselves.ResultsNickel-lysine axonal tracing (“backfilling”) was used to stain the somata projecting into specific nerves in representatives of opisthobranch Gastropoda. Tracing patterns revealed the occurrence, size and relative position of somata and their axons and enabled these somata to be mapped to specific cell clusters. Assignment of cells to clusters followed a conservative approach based primarily on relative location of the cells. Each of the four investigated cerebral nerves could be uniquely identified due to a characteristic set of soma clusters projecting into the respective nerves via their axonal pathways.ConclusionsAs the described tracing patterns are highly conserved morphological characters, they can be used to homologise nerves within the investigated group of gastropods. The combination of adequate number of replicates and a comparative approach allows us to provide preliminary hypotheses on homologies for the cerebral nerves. Based on the hypotheses regarding cerebral nerve homology together with further data on ultrastructure and immunohistochemistry of CSOs published elsewhere, we can propose preliminary hypotheses regarding homology for the CSOs of the Opisthobranchia themselves.

Phrenic Nerve Transfer for Elbow Flexion and Intercostal Nerve Transfer for Elbow Extension

To explore long-term recovery of elbow flexion and extension after transferring the phrenic nerve and intercostal nerves, respectively, in adults with global brachial plexus avulsion injuries. Seven adults with global brachial plexus avulsion injuries had the phrenic nerve transferred to the musculocutaneous nerve (or to the anterior division of upper trunk) and intercostal nerves transferred to the triceps branch of the radial nerve at our hospital 7 to 12 years ago. The results of elbow motor strength testing using the Medical Research Council grading scale, and electrodiagnostic findings using electromyogram examinations, were studied retrospectively. Pulmonary function tests were also performed at final visits. Functional elbow flexion was obtained in most of the 7 cases (M2, 1; M3, 3; M4, 2; and M5, 1) but elbow extension was absent or insufficient in all subjects (M0, 1; M1, 3; and M2, 3). Electrical results showed successful biceps reinnervation in 6 patients and successful triceps reinnervation in 5. No patient experienced breathing problems, and pulmonary function results were within normal range. In the long term, after brachial plexus avulsion injury in most patients who underwent both phrenic nerve and intercostal nerve transfer to achieve elbow flexion and extension eventually obtained satisfactory elbow flexion but poor elbow extension. We recommend against transferring the intercostal nerves to the triceps branch of radial nerve in conjunction with primary phrenic to musculocutaneous nerve transfer. Therapeutic IV.

Sequential Compression Device May Cause Peroneal Nerve Palsy

This article presents 2 cases of foot drop after joint replacement surgery that presented after sequential compression device application. In both cases, intact peroneal nerve function was documented by the surgeon in the recovery room prior to sequential compression device application. We believe that excessive pressure over the superficial aspect of the peroneal nerve in conjunction with decreased pain stimulus from analgesia may have contributed to these complications. We maintain sequential compression devices are the current mechanical thromboprophylaxis of choice; however, 4 recommendations are made to minimize the chances of this potential complication. First, precise attention should be given to patients who are short statured, as these patients can be more susceptible to having a sequential compression device improperly placed over the peroneal nerve at the fibular neck. Second, we recommend different size options become more widely available to accommodate varying patient sizes such that placement of the device is ensured to be distal to the fibular neck. Third, when using sequential compression device brands that have hook and look fastener straps, the straps should not be tight on application and frequent skin checks should be made to look for signs of over-compression. Lastly, we recommend considering delaying postoperative application of the sequential compression device until resolution of sensation following spinal or epidural anesthetic.

Complete Femoral Nerve Resection with Soft Tissue Sarcoma: Functional Outcomes

The functional consequences of resecting the femoral nerve in conjunction with soft tissue sarcoma management are not well described. In comparison, sciatic nerve involvement by sarcoma was once considered an indication for amputation, but sciatic resection is now commonly performed as part of a limb-salvage approach. We compared functional outcomes following resection of either the femoral or sciatic nerve in patients with soft tissue sarcoma. We also compared both groups with patients with large thigh sarcomas without nerve involvement. The prospectively collected database from a tertiary referral center for sarcomas was retrospectively reviewed to identify all patients with resection of the femoral nerve performed during wide excision of a soft tissue sarcoma. Patient demographics, treatment, complications, and functional outcomes in the form of the Musculoskeletal Tumor Society (MSTS) 1987 score, MSTS 1993 score, and Toronto Extremity Salvage Score (TESS) were collected. Control groups of sarcoma patients with sciatic nerve resection in the thigh as well as similarly sized tumors in the quadriceps requiring no nerve resections were also analyzed. Ten patients with femoral nerve resections were identified, all women, aged 47-78 years, with large soft tissue sarcomas of varied subtypes. All patients received adjuvant radiotherapy, most preoperatively. Six patients developed fractures during long-term follow-up, four in nonirradiated portions of the skeleton but directly from falls related to absent active knee extensors, and two at least partially attributable to sequelae of radiation. MSTS 1987 hip scores demonstrated one excellent, four good, and five fair results. MSTS 1993 hip scores averaged 71.4 +/- 17.2% and TESS averaged 61.7 +/- 21.8. There were no significant differences between the functional scores for patients with femoral or sciatic nerve resections (P = 1.0). Femoral nerve resection appears more morbid than anticipated. The falls to which patients were prone, even years after surgery, subject them to ongoing long-term risks for fractures and other injuries. These nerve-specific functional implications should be considered when counseling patients in preparation for possible resection of the femoral nerve when it is directly involved by a soft tissue sarcoma.

Thickening and enhancement of multiple cranial nerves in conjunction with cystic white matter lesions in early infantile Krabbe disease

We present serial MR findings in a child ultimately diagnosed with the early infantile form of Krabbe disease. MR showed typical features of Krabbe disease including cerebellar and brainstem hyperintensity, periventricular and deep white matter hyperintensity, and cerebral atrophy. In addition, the combination of both enlargement and enhancement of multiple cranial nerves in conjunction with unusual cystic lesions adjacent to the frontal horns of the lateral ventricles was previously unreported and expands the spectrum of imaging findings in early Krabbe disease.

A clinical test to avoid sural nerve injuries in percutaneous Achilles tendon repairs

Percutaneous repairs of Achilles tendon ruptures has gained popularity due the reduced incidence of wound complications, however its use is still limited by the high incidence of sural nerve injuries associated with these repairs. The only technique described to avoid this adverse event is to surgically expose the nerve peri-operatively. In our study, we describe and validate a clinical technique to identify the sural nerve. The sural nerve was mapped using this technique both clinically and by Ultrasound (US) in a cohort of male subjects with intact Achilles tendons. We demonstrated an excellent correlation between the clinical and US mapping. This study demonstrates an accurate and repeatable clinical technique for mapping the sural nerve in conjunction with percutaneous Achilles tendon repairs.

Transpositioning and repositioning the inferior alveolar and mental nerves in conjunction with endosteal implant reconstruction.

Without the benefit of the computed tomographic scan with three-dimensional reformatted imaging, this procedure would be difficult if not impossible to carry out. The end-point results would not be as valid. It is also not indicated to place any type of granular allograft and/or any one of the alloplast materials in this area, as it could prove to irritate the exposed neurovascular bundle. I have also found that, in most instances, the residual bone from the osteotomy site is not sufficient to replace at the termination of the procedure. However, if it is sufficient, then it would be necessary to thin down the medial aspect of the cortical plate in repositioning it, as it would then prevent excessive pressure or crushing of the nerve against the surface of the implant(s). Procedures such as onlay or saddle grafting can be offered to the patient as an alternative to these nerve procedures. However, a second surgical site is then required as well as, in some cases, staging of the procedure, thus increasing treatment time and the number of procedures for the patient. Lastly, adequate soft tissue coverage over the graft is often difficult, if not impossible to achieve.

A multiple-channel cochlear implant. An evaluation using an open-set word test.

Multiple-channel electrical stimulation of the hearing nerve in conjunction with speechreading has helped two post-lingually deaf patients with total hearing losses understand running speech in every day situations. This has been confirmed using open-set phonetically balanced word tests, where the patients achieved 60% and 40% scores with isolated-words, and 80% and 73% for phonemes-in-isolated words. The tests also showed that the cochlear implant improved word recognition by a factor of four in one patient and two in another, compared with speechreading alone. The speech processor used, extracted the voicing frequency and energy, and the frequency and energy of the dominant spectral peak in the mid-frequency range. The parameters for voicing determined the rate of stimulation for all electrodes, and the parameters for the dominant spectral peak in the mid-frequency range determined the site of electrode stimulation and current level.

The influence of facial-nerve sacrifice in surgery of malignant parotid tumors.

Malignant parotid tumors in 224 patients were dealth with surgically at the Mayo Clinic between 1940 and 1969. The clinical histories, including follow-up of 5 years or more in every case, were reviewed with particular attention to sacrifice of the facial nerve in conjunction with the excision of tumor. This was done in 65 cases. High-grade malignancy necessitated nerve sacrifice; other frequent indications were preoperative facial-nerve paralysis, pain, and rapid growth of the tumor. Over the 30-year review period, the trend was toward more radical surgery, often including nerve sacrifice, and away from local excision and radiotherapy. Nerve grafting or anastomosis of a sacrificed nerve was seldom performed in an attempt to lessen the cosmetic defect of facial paralysis. Later reconstructive procedures are favored.

Relation of afferent nerve excitability to impulse generation in the frog spindle.

AbstractThe excitability properties of the sensory nerve and its finer branches in muscle spindle have been studied in isolated preparations using electrical stimulation of the nerve in conjunction with controlled extension of the spindle. Characteristic differences in recovery cycle were demonstrated between the trunk fibre and the intracapsular branches. The excitability of the afferent nerve was modified by stretch; during stretching there was a rise in excitability and a shortening of the recovery cycle in direct relation to the amount of stretch. These changes were related to the underlying receptor potential and to local currents in the nerve. In the aftermath of stretch the excitability of the nerve as tested with electrical shocks was raised This was in contrast to the depression in mechanical sensitivity as revealed by a test stretch. When an extra impulse was elicited by an electrical shock in the course of sustained stretch the succeeding spike train was shifted, its general pattern being unchanged. It appears that the interjected spike transiently wipes out the currents leading up to the generation of the succeeding spike and resets the impulse generating process. Considerations of the functional properties of the afferent fibre and its branches as found in the present study suggest that the sensory system of the muscle spindle acts in synchrony during stretch.

TENSILE STRENGTH OF HUMAN NERVES

GRAFTS of peripheral nerves across long gaps, except for the facial and the short finger nerves, were a dismal failure in the recent war, as they had been before. This was true of fresh homologous grafts (Spurling and associates1) and of our own attempts with dehydrated frozen grafts (Nulsen, Lewey and Van Wagenen). This sad experience, together with the urgent need of some kind of nerve repair, focused attention on the possibility of end to end sutures after extensive mobilization and transposition of the corresponding nerves in conjunction with maximal flexion of the extremities. Encouraging results with this procedure were reported by Naffziger,3Platt,4Platt and Bristow,5Babcock,6Forrester-Brown7and, lately, Highet and Holmes.8The last two authors followed the course of 42 patients operated on during this war at the Oxford Nerve Center for gaps of 1.5 to 11 cm. in practically