Nervous Structures Research Articles

Danggui Sini Decoction normalizes the intestinal microbiota and serum metabolite levels to treat sciatica

Ethnopharmacological relevanceDanggui Sini Decoction (DGSD), which is commonly used to treat sciatica, has been shown to have an analgesic effect, but the underlying mechanisms are unclear. Here, Danggui Sini Decoction was shown to normalize the intestinal microbiota and serum metabolite levels to exert an analgesic effect. Aim of the studyThis study aimed to elucidate the therapeutic effects of DGSD on sciatica and the underlying mechanisms involved. MethodsIn this study, we conducted chronic constriction injury (CCI) model. Mecobalamin and DGSD were administered to CCI rats. Behavioural tests were used to examine the therapeutic effects of the drugs. UHPLC was used to identify DGSD components. 16S rRNA gene sequencing analysis of the intestinal flora was used to analyse the effect of DGSD on the intestinal microbiota. UHPLC‒MS/MS was used to identify blood metabolites. KEGG pathway analysis of differentially abundant metabolites was subsequently conducted. ELISA was used to measure the serum inflammatory factor levels, and correlation analysis between the serum inflammatory factor levels and intestinal microbe abundance was conducted. PCR, western blotting, and immunohistochemical staining were used to validate the results of the KEGG pathway analysis. ResultsAfter CCI, the rats exhibited obvious thermal hyperalgesia; disruption of sciatic nerve structure; increased IL1α, SP, CCL5, and PGE2 levels; decreased IL10 levels in the blood; increased IL1β, IL6, COX2, MMP9, nNOS, and p-NF-κB levels; and decreased IL4 levels in the sciatic nerve. In addition, CCI led to increased abundances of Peptostreptococcaceae, Leuconostocaceae, Christensenellaceae, Akkermansiaceae, Staphylococcaceae, Romboutsia, Marvinbryantia, Turicibacter, Weissella, UCG-005, Christensenellaceae_R-7_group, Akkermansia, Staphylococcus, Romboutsia_ilealis, Weissella_paramesenteroides, and Akkermansia_muciniphila and decreased abundances of Lactobacillaceae, Lactobacillus, Lactobacillus_murinus, and Lactobacillus_johnsonii. Correlation analysis indicated that Turicibacter abundance was most strongly related to IL1α, PGE2, IL10, and CCL5 levels, while norank_o_Coriobacteriales abundance had the weakest relationship with SP levels. KEGG pathway analysis of the differentially abundant metabolites revealed that the ‘NF-kappa B signalling pathway’ was involved in sciatica. DGSD reduced the levels of inflammatory factors, including IL1α, SP, CCL5, PGE2, IL6, COX2, and MMP9, in the blood and sciatic nerve and inhibited nNOS and NF-κB phosphorylation. DGSD improved the abundance of probiotics, including Lactobacillus and Blautia, and lowered the abundance of harmful bacteria, including Romboutsia, Turicibacter, and Weissella. DGSD promoted the repair of the injured sciatic nerve. ConclusionsDGSD can treat sciatica by inhibiting intestinal microbiota disorders induced by CCI in rats, normalizing inflammatory factor levels, and promoting nerve repair.

Key Anatomical Concepts, Landmarks, and Proposed Terminology for Nerve-Sparing Gynecologic Surgery: A Narrative Review

ObjectiveTo synthesize the terminology utilized in nerve-sparing surgical literature and propose standardized and nonconflicting terms to allow for consistent vocabulary. DesignWe performed a literature search on PubMed using the search terms “pelvis” and “nerve-sparing.” Nongynecologic surgery and animal studies were excluded. A narrative review was performed, focusing on nerves, fasciae, ligaments, and retroperitoneal spaces. Terms from included papers were discussed by all authors, who are surgeons versed in nerve-sparing procedures and one anatomist, and recommendations were made regarding the most appropriate terms based on the frequency of occurrence in the literature and the possibility of overlapping names with other structures. Results224 articles were identified, with 81 included in the full-text review. Overall, 48% of articles focused on cervical cancer and 26% on deeply infiltrating endometriosis. Findings were synthesized both narratively and visually. Inconsistencies in pelvic anatomical nomenclature were prevalent across publications. The structure with the most varied terminology was the rectal branch of the inferior hypogastric plexus with 14 names. A standardized terminology for pelvic autonomic nerve structures, fasciae, ligaments, and retroperitoneal spaces was proposed to avoid conflicting terms. ConclusionSurgeons and anatomists should use consistent terminology to facilitate increased uptake of nerve-sparing techniques in gynecologic surgery through a better understanding of surgical technique description. We have proposed a standardized terminology believed to facilitate this goal.

Preliminary clinical observation and analysis of structural changes of optic nerve head in glaucoma patients after visual training

Objective: To investigate the effect of virtual reality visual training on remodeling optic nerve structures of glaucoma patients and analyze the influencing factors of visual training effect. Methods: A prospective non-randomized controlled trial was conducted. Glaucoma patients who presented to the Department of Ophthalmology, Beijing Shijitan Hospital between October 2021 and October 2022 were collected and divided into the training group or the control group according to their intentions. The training group accepted 3 months of visual training, while the control group did not. Optical coherence tomography was used to examine the disc edge area, cup volume, disc area, cup-to-disc ratio, and other parameters of the optic disc of both eyes of the patients at enrollment and after 3 months, and the changes of each parameter in the two groups were analyzed. Multivariate analysis was performed in the training group to investigate the effects of sex, age, visual field index, and mean defect on visual disc structure changes during visual training. Results: A total of 53 glaucoma patients (101 eyes) were included in the final analysis, among which the training group consisted of 27 cases (51 eyes), with 19 males and 8 females, and the age range was 48.0 (40.0, 61.0) years old. The control group comprised 26 cases (50 eyes), with 26 males and 11 females, and the age range was 54.0 (38.0, 63.0) years old. Compared with the control group, the deviation of cup volume was -0.006(-0.050, 0.015)mm3 (P<0.05), and the deviation of disc edge area was 0.00(-0.04, 0.05)mm2 (P<0. 05)in the visual training group after 3 months of visual training. The gender (OR=4.217, 95%CI=1.188-14.966) may be the influence factor of rim area. While,the mean defect (OR=1.526, 95%CI=0.245-9.491) was not that influential on rim area change. Conclusions: Visual training can increase the disc area and decrease the optic cup volume of the optic nerve in glaucoma patients. The rim area may be increased more easily after visual training in male glaucoma patients.

Protective Role of MerTK in Diabetic Peripheral Neuropathy via Inhibition of the NF-κB Signaling Pathway.

Diabetic peripheral neuropathy (DPN) impacts patient quality of life. In such patients, increased expression of mer tyrosine kinase (MerTK) has been demonstrated; however, its mechanism of action remains unclear. In this study, type 2 diabetes mellitus (T2DM) and DPN models were established in Sprague Dawley rats via low-dose streptozotocin and a high-fat diet and the mode of action of MerTK was examined. MerTK-specific inhibitors were administered by gavage once daily for 2 weeks. Sciatic nerve conduction velocity and nerve structure were measured. The levels of MerTK, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and relevant biochemical indexes were detected. The study revealed upregulation of MerTK expression in T2DM and more so in DPN groups. Inhibiting MerTK led to reduced nerve conduction velocity and further deterioration of sciatic nerve structure, as evidenced by structural morphology. Concurrently, serum levels of total cholesterol, glycated hemoglobin, and triglyceride significantly increased. Moreover, levels of NF-κB increased in both serum and nerve tissue, alongside a significant rise in TNF-α and IL-1β expressions. MerTK could bind to the inhibitor of kappa B kinase beta (Ikbkb) in Schwann cells, establishing Ikbkb as a precursor to NF-κB activation. Inhibition of MerTK exacerbates neuropathy, indicating its protective role in DPN by suppressing the NF-κB pathway, highlighting a potential new target for its diagnosis and treatment.

Structure and Function of Pancreatic Neural Circuitry in Obesity and Diabetes

INTRODUCTION: Pancreatic islets are richly innervated by autonomic nerves which contribute to physiological regulation of islet hormone release and blood glucose. Published studies suggest obesity disrupts pancreatic innervation and may contribute to metabolic dysfunction. However, these studies largely rely on 2D imaging of islets and experiments aimed at assessing the function of pancreatic nerves have not been organ specific. Determining how high-fat diet (HFD) impacts pancreatic nerve structure and function using 3D imaging and organ-specific neuromodulation may provide new insights into the pathophysiology of diabetes and identify novel therapeutic approaches to treat diabetes. METHODS: To test the hypothesis that HFD causes structural changes in pancreatic innervation, C57Bl6 mice were randomized to 1, 4 and 12 week high-fat (HFD) or low-fat diet (LFD) groups. Metabolic phenotyping was determined. Pancreata were cleared and immunolabeled using iDISCO+, imaged by lightsheet (4X) and confocal (10X) microscopy and images were analyzed using Imaris software. To test the effects of HFD on pancreatic nerve function, we used AAV8 delivery of cre-dependent neuromodulatory constructs to activate or silence pancreatic parasympathetic or sympathetic nerves. To modulate pancreatic parasympathetic nerves, we delivered cre-dependent hM3D(Gq) for activation, cre-dependent diphtheria toxin A subunit for silencing, or mCherry (control) into the pancreas of Chat-cre mice. To modulate pancreatic sympathetic nerves, we used pancreatic injection of retrograde AAV delivering cre and celiac injection of cre-dependent hM3Gq (activation), hM4Gi (silencing) or mCherry (control). Mice were fed LFD or HFD for up to 12 weeks and the effects of neuromodulation on glucose metabolism were examined. RESULTS: HFD significantly impaired glucose tolerance, insulin sensitivity and altered plasma insulin and glucagon after 1, 4 and 12 weeks of HFD consumption. HFD consumption significantly altered pancreatic neural structure. Within islets, 1 week of HFD significantly increased sympathetic neural volume. With prolonged HFD, there was significant loss of islet parasympathetic innervation. Reproducing loss of islet parasympathetic innervation impaired glucose tolerance but sympathetic activation did not alter glucose metabolism. Targeted silencing of pancreatic sympathetic innervation or activation of pancreatic parasympathetic innervation significantly improved glucose tolerance in hyperglycemic mice fed HFD. CONCLUSION: Short term HFD causes early rapid changes to islet sympathetic nerves while long term HFD consumption results in loss of pancreatic parasympathetic innervation of the islet. The effects of HFD consumption are improved by inhibiting pancreas-projecting sympathetic fibers or through activation of pancreatic parasympathetic nerves. These studies suggest modulating pancreatic innervation may improve glucose control in obesity. NIH F31 Predoctoral Fellowship (1F31DK129016-01A1, R.H.) ISMMS MSTP T32 (GM007280) NIH (R01NS097184, OT2OD024912, S.S.) American Diabetes Association (ADA #1-17-ACE-31, S.S) Department of Defense (W81XWH-20-1-0345, S.S). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Lumbar Arthrosynovial Cyst: An Unusual Cause of Sciatica

We report the case of a 46-year-old female patient with hyperalgesic sciatica caused by a lumbar arthrosynovial cyst (ASK). Lumbar arthrosynovial cysts are relatively rare degenerative lesions of the spine. They may be completely asymptomatic or cause symptoms through compression of nerve structures. They most often develop at the L4/L5 level, where spinal mobility is greatest. Their aetiopathogenesis is uncertain, but degenerative spinal instability is the determining factor in their development. MRI is the examination of choice for diagnosing these lesions. Conservative treatment is not very effective. Surgical resection of the cyst, with or without arthrodesis, remains the most appropriate treatment option.

Efficacy of PE-PLIF with a novel ULBD approach for lumbar degeneration diseases: a large-channel endoscopic retrospective study

PurposeThis study aims to assess the effectiveness of Percutaneous Endoscopic Posterior Lumbar Interbody Fusion (PE-PLIF) combined with a novel Unilateral Laminotomy for Bilateral Decompression (ULBD) approach using a large-channel endoscope in treating Lumbar Degenerative Diseases (LDD).MethodsThis retrospective analysis evaluates 41 LDD patients treated with PE-PLIF and ULBD from January 2021 to June 2023. A novel ULBD approach, called ‘Non-touch Over-Top’ technique, was utilized in this study. We compared preoperative and postoperative metrics such as demographic data, Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) score, surgical details, and radiographic changes.ResultsThe average follow-up duration was 14.41 ± 2.86 months. Notable improvements were observed postoperatively in VAS scores for back and leg pain (from 5.56 ± 0.20 and 6.95 ± 0.24 to 0.20 ± 0.06 and 0.12 ± 0.05), ODI (from 58.68 ± 0.80% to 8.10 ± 0.49%), and JOA scores (from 9.37 ± 0.37 to 25.07 ± 0.38). Radiographic measurements showed significant improvements in lumbar and segmental lordosis angles, disc height, and spinal canal area. A high fusion rate (97.56% at 6 months, 100% at 12 months) and a low cage subsidence rate (2.44%) were noted.ConclusionsPE-PLIF combined with the novel ULBD technique via a large-channel endoscope offers significant short-term benefits for LDD management. The procedure effectively expands spinal canal volume, decompresses nerve structures, improves lumbar alignment, and stabilizes the spine. Notably, it improves patients' quality of life and minimizes complications, highlighting its potential as a promising LDD treatment option.

Associations between Corneal Nerve Structure and Function in a Veteran Population.

Background: We evaluate the relationship between corneal nerve structure and function in a veteran population. Methods: 83 veterans (mean age: 55 ± 5 years) seen at the Miami Veterans Affairs (VA) eye clinic were included in this study. Each individual filled out questionnaires to evaluate ocular symptoms (5-Item Dry Eye Questionnaire, DEQ5; Ocular Surface Disease Index, OSDI) and ocular pain (Numerical Rating Scale, NRS; Neuropathic Pain Symptom Inventory modified for the Eye, NPSI-Eye). The individuals also underwent an ocular surface examination that captured functional nerve tests including corneal sensation, corneal staining, and the Schirmer test for tear production. Corneal sub-basal nerve analysis was conducted using in vivo confocal microscopy (IVCM) images with corneal nerve density, length, area, width, and fractal dimension captured. IVCM and functional corneal metrics from the right eye were examined using correlational and linear regression analysis. Results: Most corneal structural metrics were not related to functional metrics, except for weak correlations between various IVCM metrics and tear production. In addition, corneal nerve fiber area was positively related to corneal sensation (r = 0.3, p = 0.01). On linear regression analyses, only the corneal fractal dimension remained significantly related to tear production (β = -0.26, p = 0.02) and only the corneal nerve fiber area remained significantly related to corneal sensation (β = 0.3, p = 0.01). Conclusions: Most corneal nerve structural metrics did not relate to functional metrics in our veteran population, apart from a few weak correlations between structural metrics and tear production. This suggests that using corneal nerve anatomy alone may be insufficient for predicting corneal function.

ВЛИЯНИЕ ИНФОРМАЦИОННОГО СТРЕССА НА ПСИХИЧЕСКОЕ ЗДОРОВЬЕ НАСЕЛЕНИЯ

The abundance of diverse information accompanied by information noise can be an additional and powerful stressor, especially if the assimilation and processing of this information is carried out in a time-limited environment. Information streams created by gadgets, reflecting the activity of a person in social networks, his communications, his news sources, are not a harmless source of leisure and recreation. They require the inclusion of sensory systems and central nervous system structures, which are very energy-intensive. Manifestations of information fatigue are clinically similar to stress symptoms, and have common neurobiological mechanisms based on adaptation to changes or new challenges. The emergence of new phenomena of interaction with information space and technogenic environment (FOMO) reflects the influence of information transmitted by gadgets on the mental health of the population. Cognitive flexibility, goal-setting, will-based control, priority-setting, and gadget-detox (gadget regulation and informed information consumption) are all necessary skills for successful interaction with and operation of information flows.

A Novel In Vitro Pathological Model for Studying Neural Invasion in Non-Melanoma Skin Cancer.

Neural Invasion (NI) is a key pathological feature of cancer in the colonization of distant tissues, and its underlying biological mechanisms are still scarcely known. The complex interactions between nerve and tumor cells, along with the stroma, make it difficult to reproduce this pathology in effective study models, which in turn has limited the understanding of NI pathogenesis. In this study, we have designed a three-dimensional model of NI squamous cell carcinoma combining human epidermoid carcinoma cells (hECCs) with a complete peripheral nerve segment encapsulated in a fibrine-agarose hydrogel. We recreated two vital processes of NI: a pre-invasive NI model in which hECCs were seeded on the top of the nerve-enriched stroma, and an invasive NI model in which cancer cells were immersed with the nerve in the hydrogel. Histological, histochemical and immunohistochemical analyses were performed to validate the model. Results showed that the integration of fibrin-agarose advanced hydrogel with a complete nerve structure and hECCs successfully generated an environment in which tumor cells and nerve components coexisted. Moreover, this model correctly preserved components of the neural extracellular matrix as well as allowing the proliferation and migration of cells embedded in hydrogel. All these results suggest the suitability of the model for the study of the mechanisms underlaying NI.

Prediction of peripheral nerve intrinsic organisation: a pilot study

ABSTRACT Traumatic peripheral nerve injuries (PNI) are debilitating and can leave patients severely limited with drastic changes in quality of life. PNI treatment options are varied; however, only 50% of those patients regain any useful function. The complex intrinsic organisation of nerves is largely contribute to this issue. This research aimed at creating a reliable way of isolating and predicting the location of peripheral nerve fascicles on microscopic images of nerve cross-sections via semantic segmentation and machine learning. Using the Anaconda Python platform, a machine learning algorithm was programmed using a random forest classifier. Training data resulted in a 91% accuracy rate with respect to correctly identifying image pixels as fascicle or not. When the trained model was tested in the real world with unseen data, the results varied. However, the model retained the ability to identify fascicles and isolate them from background. The development of clinically successful PNI treatments has long been hindered by intrinsic nerve structures that machine learning may be able to solve. With further development, this research has the potential to expand and form new frontiers in the field of clinical medicine and drastically improve outcomes of PNI.

FK506 contributes to peripheral nerve regeneration by inhibiting neuroinflammatory responses and promoting neuron survival.

JOURNAL/nrgr/04.03/01300535-202507000-00031/figure1/v/2024-09-09T124005Z/r/image-tiff FK506 (Tacrolimus) is a systemic immunosuppressant approved by the U.S. Food and Drug Administration. FK506 has been shown to promote peripheral nerve regeneration, however, its precise mechanism of action and its pathways remain unclear. In this study, we established a rat model of sciatic nerve injury and found that FK506 improved the morphology of the injured sciatic nerve, increased the numbers of motor and sensory neurons, reduced inflammatory responses, markedly improved the conduction function of the injured nerve, and promoted motor function recovery. These findings suggest that FK506 promotes peripheral nerve structure recovery and functional regeneration by reducing the intensity of inflammation after neuronal injury and increasing the number of surviving neurons.

Utilizing Diagnostic Musculoskeletal Ultrasound in the Evaluation of Cubital Tunnel Syndrome and Ulnar Nerve Pathology.

Cubital Tunnel Syndrome (CTS), is a frequently encountered condition in clinical settings, typically arising from static or dynamic compression of the ulnar nerve. CTS is characterized by the irritation of the ulnar nerve within the cubital tunnel and is a common neuropathic condition that can significantly impact functional abilities and quality of life. This article explores the utility of diagnostic musculoskeletal ultrasound (MSK-US) in the evaluation of the cubital tunnel and the ulnar nerve. The cubital tunnel syndrome, a common entrapment neuropathy of the ulnar nerve, often presents diagnostic challenges. Traditionally, nerve conduction studies and electromyography have been the primary diagnostic tools used to diagnose CTS. Given the superficial nature of the ulnar groove and its adjacent structures, MSK-US imaging known for its non-invasive nature and high-resolution imaging capabilities, has become an increasingly valuable tool in the assessment and management of various musculoskeletal conditions. This article reviews the technical aspects of MSK-US, its advantages in visualizing the ulnar nerve and related structures, and its implications in clinical practice for rehabilitation providers. By integrating MSK-US in the evaluation of CTS, rehabilitation professionals can enhance diagnostic accuracy, tailor interventions, and improve patient outcomes.

Low Anterior Resection Syndrome. Anatomical Changes after Anterior Rectal Resection.

In this editorial, the authors bring to the attention of surgeons a personal point of view with the intention of offering a series of anatomical arguments to explain the high rate of functional complications following ultralow rectal resections, resections dominated by faecal incontinence of various intensities. Having as a starting point the anatomy of the pelvic floor and the posterior perineum, the authors are concerned with the functional outcomes of the sphincter-saving anterior rectal resection, regarding the low and ultralow resection. Technically, a conservative surgery for low rectal cancer has been currently performed. If 25 years ago the abdominoperineal resection was the gold standard for rectal cancer located under 7cm from the anal verge, nowadays the preservation of the anal canal as a partner for colon anastomosis has been accomplished. Progressively, from a desire to preserve the normal passage of stool into the anal canal, as anatomically and physiologically as possible, the distal limit of resection was lowered to 2-4 cm from the anal verge and ultra-low anastomoses were created, within the anal sphincter complex. The stated goal: keep the oncological safety standard and, at the same time, avoid definitive colostomy. Starting from the normal anatomy of the pelvic floor and the anorectal segment, the authors take a look at the alterations of the visceral, muscular, and nerve structures as a consequence of the low anterior resection and, particularly, the ultralow anterior resection. A significant degree of functional outcomes regarding defecation, with the onset of marked disabilities of anal continence, the major consequence being anal incontinence (30-70%), have been noticed. The authors go under review for the main anatomical and physiological changes that accompany anterior rectal resection. Conclusions: Thus, the following questions arise: what is the lower limit of resection to avoid total fecal incontinence? Is total incontinence a greater handicap than colostomy or is it not? The answers cannot be supported by solid arguments at this time, but the need to initiate future studies dedicated to this problem emerges.

Otorrhea revealing a neglected parapharyngeal foreign: A case report and a literature review

Foreign body removal is a common procedure in Otorhinolaryngological (ORL) practice. It may affect adults as well as children, the nature of the Foreign body varies depending on the situation , for adult it is generally swallowed Foreign Bodies seen in the palatine , piriform sinus and vallecula but for children its due to playground accidents multiple location are possible with varying symptoms depending on the location otorrhea being an unusual symptom. Nevertheless, the parapharyngeal space remains a rare location with the possibility of migration to deep neck spaces2, presenting a danger to the vascular and nervous structure in the region, which presents a challenge during the extraction procedure .

Surgical treatment of degenerative stenotic lesions of the lumbar spine. Own experience of using minimally invasive techniques

Lumbar spinal stenosis is a multifactorial progressive condition mainly affecting older individuals, characterized by narrowing of the natural anatomical pathways passage of nerve structures, resulting in typical clinical symptoms. The disease affects about 103 million people in worldwide with an incidence of absolute lumbar spinal stenosis 19.4% among individuals aged 60-69 years. In the United States, about 600,000 surgical interventions for lumbar spinal stenosis are performed annually. This disease is one of the most common causes of lumbar pain and lower limbs in the elderly individuals, accompanied by claudication and ultimately leading to disability. The main cause of clinical symptoms of the lumbar spinal stenosis is the discrepancy between the sizes of nerve structures and their osteofibrous sheaths, resulting from gradually developing degenerative-dystrophic changes. Objective: To compare the outcomes of surgical treatment of patients with degenerative stenotic lesions of the lumbar spine using open and minimally invasive methods. Materials and methods. The results of surgical treatment of 97 patients with lumbar spinal stenosis aged from 28 to 81 years on the basis of the Department of Minimally Invasive and Laser Spinal Neurosurgery of the State Institution " A.P. Romodanov Neurosurgery Institute, Ukraine", " Neurosurgical Department №20 of Vinnytsia Regional Clinical Psychoneurological Hospital named after Acad. O.I. Yushchenko" of Vinnytsia Regional Council and "Spinex" Medical Center following all clinical research protocols. Patients were divided into four groups depending on the surgical intervention method. Results. The development of concepts regarding the mechanisms of occurrence and treatment methods of lumbar spinal stenosis are highlighted, as well as personal experience of using minimally invasive treatment techniques for this pathology in combination with the use of the ERAS (Enhanced Recovery After Surgery) protocol of perioperative patient management. It was found that the duration of hospital stay for patients with lumbar spinal stenosis statistically significantly desreased when using minimally invasive decompression (p≤0.05) and the ERAS rehabilitation protocol (p≤0.05). When comparing the average length of stay in the hospital of patients of the four groups, a statistically significant (p≤0.05) shorter length of stay in the hospital was observed for patients who underwent minimally invasive decompression using the ERAS rehabilitation protocol. The greatest reduction in pain intensity (according to the Numeric Pain Scale (NPS)) at 6 months post- intervention and rehabilitation was also noted in patients of this group. Conclusions. The use of minimally invasive techniques, the correct choice of surgical procedure volume (interbody fusion is desirable in surgery for degenerative spinal diseases) combined with Enhanced Recovery after Surgery protocol (ERAS) significantly improves postoperative well-being of patients, accelerates patient mobilization, and reduces the length of stay in the hospital.

The Influence of Oral Stimulation on the Improvement of Sucking Reflex and Weight Gain in Low Birth Weight Infants (LBW) at Bunda Patimah Primary Clinic

LBW suffer from many problems, including hypothermia, respiratory distress syndrome, intracranial hemorrhage, hyperbilirubinemia, and hypoglycemia because the sucking reflex is weak, resulting in insufficient intake. This weakness in sucking is related to the maturity of the baby's nerve structure and the strength of the mouth muscles. Oral motor skills are one of the most important skills a baby has. The aim of this research is to determine the effect of giving oral stimulation on increasing the sucking reflex and increasing the weight of LBW babies. This research uses a type of quantitative research that uses a pre-test and post-test one group design (Notoatmodjo, 2018), with a Quasi-Experimental design without a control group that compares the evaluation results before and after treatment of respondents. Data were collected using Sucking Reflex and BB Increase observation sheets. The statistical test used is the Wilcoxon Signed Rank Test. The measurement results showed that after giving oral stimulation there was an increase in the sucking reflex and an increase in BW (P value = 0.000), namely an increase in the Sucking Reflex of the majority in the strong category as many as 30 people (93.7%), and those in the minority in the weak category as many as 2 people (6.3%). Meanwhile, in weight gain, the majority in the category increased by 28 people (87.5%), and the minority in the category did not increase by 4 people (12.5%). Based on the research that has been carried out, it was concluded that there is an effect of giving oral stimulation on the Sucking Reflex and Increase in Body Weight in LBW.

Case Report on a Supracondylar Process of the Humerus: Morphological and Morphometric analysis

The supracondylar process is a rare anatomical variation characterized by an irregular bone prominence with a variable size. Found in the anteromedial part of the distal region of the humerus, can compress the median nerve and other structures. The aim of this paper was to perform a morphological and morphometric evaluation of this variation in a right dry humerus. Faces, margins, and shape of the process were observed. Measurements was taken from the process and the entire bone. The apex of the process points toward the transition between the trochlea and the humeral capitulum. The bony spicule was 6.24 mm long. The base of the spicule measured 6.80 mm in length and 4.18 mm in width. Longitudinal crests associated with the base of the process and a deep longitudinal depression were observed. The combined longitudinal length of the caudal and cranial crests together was 32.37 mm. The distance from the bone spicule to the medial epicondyle was 65.29 mm. In pathological cases, vascular disturbances, sensory deficits, and decreased muscle strength can be observed. A comprehensive description of this variation is crucial for enhancing current knowledge and awareness in clinical practice, as it aids in accurate diagnosis and treatment.

Anatomical characteristics and structural features of the optic nerve

The review presents literature data about the anatomical structure, morphology and structural features of the optic nerve (ON). Four ON regions are detailed: intraocular, intraorbital, intracanalicular and intracranial. Specifically, the features of the intraocular region are outlined. It is divided into three zones: the surface nerve fiber layer, the prelaminar part and the lamina cribrosa of the sclera, which differ in histological structure and blood supply. The data on the coats of the intraorbital part include the details of the hard (dura mater), arachnoid and the soft (pia mater) coats. Other data represent the morphological structures of the intracanalicular and the intracranial parts of the ON. The distinctive features of blood supply in different ON regions are discussed.The information about the anatomical characteristics and structural features of the ON is important for studying the pathogenesis of the optic nerve´s damage.

The Association between Anatomical Variants of Musculoskeletal Structures and Nerve Compressions of the Lower Limb: A Systematic Review and Meta-Analysis.

Objective: The aim of this study was to describe the main anatomical variants and morphofunctional alterations in the lower limb that compress surrounding nervous structures in the gluteal region, thigh region, and leg and foot region. Methods: We searched the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to October 2023. An assurance tool for anatomical studies (AQUA) was used to evaluate methodological quality, and the Joanna Briggs Institute assessment tool for case reports was also used. Forest plots were generated to assess the prevalence of variants of the gluteal region, thigh, and leg. Results: According to the forest plot of the gluteal region, the prevalence was 0.18 (0.14-0.23), with a heterogeneity of 93.52%. For the thigh region, the forest plot presented a prevalence of 0.10 (0.03-0.17) and a heterogeneity of 91.18%. The forest plot of the leg region was based on seven studies, which presented a prevalence of 0.01 (0.01-0.01) and a heterogeneity of 96.18%. Conclusions: This review and meta-analysis showed that, in studies that analyzed nerve compressions, the prevalence was low in the thigh and leg regions, while in the gluteal region, it was slightly higher. This is mainly due to the PM region and its different variants. We believe that it is important to analyze all the variant regions defined in this study and that surgeons treating the lower limb should be attentive to these possible scenarios so that they can anticipate possible surgical situations and thus avoid surgical complications.