Sensory Recovery Research Articles

The CD200/CD200R signaling pathway contributes to spontaneous functional recovery by enhancing synaptic plasticity after stroke

BackgroundSpontaneous functional recovery occurs during the acute phase after stroke onset, but this intrinsic recovery remains limited. Therefore, exploring the mechanism underlying spontaneous recovery and identifying potential strategies to promote functional rehabilitation after stroke are very important. The CD200/CD200R signaling pathway plays an important role in neurological recovery by modulating synaptic plasticity during multiple brain disorders. However, the effect and mechanism of action of the CD200/CD200R pathway in spontaneous functional recovery after stroke are unclear.MethodsIn this study, we used a transient middle cerebral artery occlusion (MCAO) model in rats to investigate the function of CD200/CD200R signaling in spontaneous functional recovery after stroke. We performed a battery of behavioral tests (Longa test, adhesive removal test, limb-use asymmetry test, and the modified grip-traction test) to evaluate sensorimotor function after intracerebroventricular (i.c.v.) injection with CD200 fusion protein (CD200Fc) or CD200R blocking antibody (CD200R Ab) post-stroke. Density and morphology of dendritic spines were analyzed by Golgi staining. Microglia activation was evaluated by immunofluorescence staining. Western blot was used to detect the levels of protein and the levels of mRNA were measured by qPCR.ResultsOur study demonstrated that sensorimotor function, synaptic proteins, and structures were gradually recovered and CD200R was transiently upregulated in ipsilateral cortex after stroke. Synapse-related proteins and dendritic spines were preserved, accompanied by sensorimotor functional recovery, after stereotaxic CD200Fc injection post-stroke. In addition, CD200Fc restrained microglia activation and pro-inflammatory factor release (such as Il-1, Tnf-α, and Il-6) after MCAO. On the contrary, CD200R Ab aggravated sensory function recovery in adhesive removal test and further promoted microglia activation and pro-inflammatory factor release (such as Il-1) after MCAO. The immune-modulatory effect of CD200/CD200R signaling might be exerted partly by its inhibition of the MAPK pathway.ConclusionsThis study provides evidence that the CD200/CD200R signaling pathway contributes to spontaneous functional recovery by enhancing synaptic plasticity via inhibition of microglia activation and inflammatory factor release.

Bilateral transient olfactory bulb edema during COVID-19–related anosmia

An asymptomatic 27-year-old man was diagnosed with coronavirus disease 2019 (COVID-19) by occupational medicine after contagion (reverse transcription polymerase chain reaction [ RT - PCR ]). Four days after the diagnosis, he experienced complete anosmia and dysgeusia.1 On day 7, 1.5T MRI showed signs of bilateral olfactory bulb edema on 3D constructive interference in steady state T2-weighted imaging, demonstrated by severe enlargement2 (left: 73 mm3, right: 64 mm3) and an abnormally high signal intensity (figure). Olfactory clefts showed mild edema. The olfactory pathways, including the cortical projections (fluid-attenuated inversion recovery and diffusion-weighted imaging not shown), were normal. Sensory recovery and negative RT-PCR (positive on days 1, 2, and 10) appeared on day 14. MRI on day 24 confirmed the normalization of olfactory bulb signal and volumes (left: 22 mm3, right: 17 mm3).

The effect of preservation of the supraclavicular nerve on sensation recovery in endoscopic thyroidectomy via a gasless anterior chest approach: A prospective study

BackgroundFactors to sensory change on the neck and chest after endoscopic thyroidectomy were not well studied. The aim of this study was to assess whether preservation of the supraclavicular nerve (SCN) could make a difference. Methods33 cases with the SCN preserved (Group A) and 32 cases with the SCN damaged (Group B) were recruited. Evaluation of tactile sensitivity and pain sensitivity as well as a questionnaire concerning subjective symptoms and quality of life was also administered preoperatively and postoperatively. ResultsSensation in the anterior chest of Group A had milder loss and reached preoperative level within the 1-year follow-up while that of Group B still showed deficit beneath the clavicle. Group A also had smaller proportion of numbness, symptomatic extension, psychological impact in early postoperative time. ConclusionProtection of the SCN can improve sensation recovery in the anterior chest and enhance the quality of life after surgery.

Comparison of Hypobaric Bupivacaine, With and Without Fentanyl for Patients Undergoing Surgeries around Hip: A Randomized Double Blind Study from North India

Background: Hip surgeries are frequently performed using single shot spinal anesthesia with 15-17.5 mg plain bupivacaine 0.5% which provides surgical anesthesia for 3-4 hours but is difficult to make the patients with hip fractures to lie in lateral decubitus position with the operating side dependent and to make them sit also. Using hypobaric local anesthetic for surgeries around hip, preparation time may be reduced for performing spinal anesthesia and surgery in the same position without waiting for establishment of spinal anesthesia in the supine position. Furthermore, hypobaric local anesthetics can produce more selective block on the operating side and avoid unnecessary paralysis of the nonoperating side potentially resulting in hemodynamic stability and better mobilization of patients during recovery period.Subjects and Methods:In the present study, we compared the anesthetic and hemodynamic effects of hypobaric bupivacaine with and without fentanyl in 100 ASA physical status I and II patients undergoing surgeries around hip. Patients received spinal injection of either 2.5ml (12.5mg) of isobaric bupivacaine with 1.5ml of distilled water (total 4ml) making it hypobaric or 2.5 ml (12.5mg) of isobaric bupivacaine with 1ml of distilled water and 0.5ml(25 µg) of fentanyl (total 4ml) with operative side up, in a double blinded manner. Sensory level and motor block were evaluated on the operative and non-operative sides until regression to L2 and full motor recovery. Hemodynamic changes after spinal injection and the first analgesic request for VAS >3 were noted.Results:Demographic characteristics of both the groups were comparable. Time to maximal fall in MAP and patients requiring vasopressor were similar in both the groups. None of the patients in any of the two group required atropine for bradycardia. Co-administration of fentanyl in hypobaric bupivacaine hastened the onset of sensory block (12±3 vs. 20±9.0, p value <0.001) and the time required was less on the operative side than on the contralateral (non-operative) side in both the groups. The median upper level of block was higher on the operative than on the contralateral side in both the groups. Co-administration of fentanyl in hypobaric bupivacaine prolonged the sensory regression to L2 (298±40 vs. 256±35, p value <0.001). Co-administration of fentanyl had no effect on the time to complete motor recovery as at the end of surgery, all the patients had complete motor recovery on the contralateral (non-operative) side, while none of the patient in any of the two groups had complete motor recovery on the operative side. Time to first analgesic requirement was significantly higher (318±27 vs. 288±28, p value <0.001) with the addition of fentanyl to the hypobaric bupivacaine.Conclusion:So we conclude that the use of hypobaric bupivacaine produces spinal anesthesia with a faster sensory motor recovery on the contralateral (non-operative) side. Co-administration of fentanyl further prolongs the sensory block on the operative side without significantly affecting the motor block, so delays the use of first analgesic without further compromising the systemic hemodynamics.

Sihler's staining of the cutaneous nerves of the leg and its implications for sensory reconstruction.

This study aimed to reveal the entire cutaneous nerve distribution pattern of the leg and provide a morphological basis for sensory reconstruction during skin flap transplantation. Twelve adult cadavers were fixed with formalin, and the whole leg skin with subcutaneous fat was removed close to the muscle surface. The cutaneous nerves were visualized using modified Sihler's staining to reveal the distribution and innervation density of the cutaneous nerves. The saphenous nerve innervated the anterior part, 82.2% of the upper-middle region of the lateral part of the anterolateral leg, and the upper 63.4% of the medial posterior leg. The superficial peroneal nerve innervated 90.1% of the lateral lower one-third of the anterolateral leg. The medial sural cutaneous nerve covered 26.4% of the posterior leg. The lateral sural cutaneous nerve covered 42.3% (approximately 28.6% overlap with the saphenous nerve) of the upper-middle region of the anterolateral and posterolateral leg. The number of branches differed between certain cutaneous nerves in the leg. Communications were observed between the arborizations of the four cutaneous nerves mentioned above. The highest density of primary and secondary nerve branches was observed in the upper one-third of the lateral posterior leg. The upper one-third of the posteromedial leg contained the highest density of intracutaneous nerve branches and highest number of total nerve branches. These results may be used to map sensory regions when designing leg skin flaps for reconstruction surgery to obtain improved sensory recovery.

The Low Medial Horizontal Osteotomy in Patients With Atypical Ramus Morphology Undergoing Sagittal Split Osteotomy

Sagittal split osteotomy (SSO) of rami with fused cortices or minimal marrow space above the lingula can increase the risk of an unfavorable osteotomy split of the proximal ramus. To reduce the risk of a proximal segment fracture, a recent modification of the SSO places the medial horizontal osteotomy below the lingula. The purpose of the present study was to evaluate the outcomes of SSOs utilizing a low medial horizontal osteotomy in patients with atypical ramus morphologies. The present study was a prospective series composed of patients with atypical proximal ramus anatomy undergoing SSOs. All patients had undergone bilateral SSO for correction of mandibular deformities. The horizontal ramus osteotomy had been placed at or slightly above the mandibular occlusal plane because of atypical ramus morphology (thin ramus with no appreciable marrow space at or above the lingula and/or narrow retromolar ramus width). The outcome variables were an unfavorable split of the proximal or distal segments, nerve location after SSO (proximal or distal segment), and neurosensory recovery of the inferior alveolar nerve (IAN). The sample included 25 patients who had undergone 50 SSOs using a low medial horizontal osteotomy. Their mean age was 19.6±3.2years; 14 patients were female. Of the 25 patients, 22 had a primary diagnosis of craniofacial anomaly; 23 had undergone bimaxillary surgery and 6 had received concomitant genioplasty. No unfavorable fractures of the proximal segment occurred. No intraoperative IAN injuries occurred. The IAN was contained within the proximal segment in 52% of the cases. All the patients achieved functional sensory recovery of the IAN bilaterally by 1year postoperatively. The mean interval to functional sensory recovery was 116days. The low medial horizontal osteotomy is an effective technique for reliable execution of SSOs in morphologically atypical mandibles.

Facial Sensory Restoration After Trigeminal Sensory Rhizotomy by Collateral Sprouting From the Occipital Nerves

Lesioning procedures are effective for trigeminal neuralgia (TN), but late pain recurrence associated with sensory recovery is common. We report a case of recurrence of type 1A TN and recovery of facial sensory function after trigeminal rhizotomy associated with collateral sprouting from upper cervical spinal nerves. A 41-yr-old woman presented 2 yr after open left trigeminal sensory rhizotomy for TN with pain-free anesthesia in the entire left trigeminal nerve distribution. Over 18 mo, she developed gradual recovery of facial sensation migrating anteromedially from the occipital region, eventually extending to the midpupillary line across the distribution of all trigeminal nerve branches. She reported recurrence of her triggered lancinating TN pain isolated to the area of recovered sensation with no pain in anesthetic areas. Nerve ultrasound demonstrated enlargement of ipsilateral greater and lesser occipital nerves, and occipital nerve block restored facial anesthesia and resolved her pain, indicating that recovered facial sensation was provided exclusively by the upper cervical spinal nerves. She underwent C2/C3 ganglionectomy, and ganglia were observed to be hypertrophic. Postoperatively, trigeminal anesthesia was restored with complete resolution of pain that persisted at 12-mo follow-up. This is the first documented case of a spinal nerve innervating a cranial dermatome by collateral sprouting after cranial nerve injury. The fact that typical TN pain can occur even when sensation is mediated by spinal nerves suggests that the disorder can be centrally mediated and late failure after lesioning procedures may result from maladaptive reinnervation.

Contribution of CD137-CD137L pathway in sciatic nerve crush-induced behavioral hypersensitivity and functional reduction

Abstract The T cell costimulatory molecule CD137L is involved in the development of neuropathic pain following peripheral nerve injury. Previously, our work has shown that absence or neutralization of CD137L reduces hypersensitivity, sensory and functional impairment following a sciatic nerve crush (SNC). CD137L activation utilizes both a CD137-dependent and a CD137-independent pathway. To further determine the contribution of these pathways, we examined pain-like and functional recovery-related behavioral responses following intrathecal injection (IT) of a CD137 neutralizing antibody (αCD137; daily days 3–10) after SNC in male and female B6 mice. Mice were randomly assigned to 1 of 4 groups: PBS, 0.5μg isotype control, 0.1 or 0.5μg of αCD137, and then were evaluated for sensitivity (von Frey, Hargreaves, & cold plantar test), sensory (pin prick assay) and motor (hind limb grip strength, toe spread reflex and toe spacing score) functions before surgery and on post-surgery days 1–77. On post-SNC day 1, all groups showed changes in sensitivity and decreased sensory and motor functions. αCD137 treatment did not alter mechanical, heat or hypersensitivity compared to PBS- or isotype-treated controls. αCD137-treated groups showed faster sensory (pin prick score) and motor functional recovery (toe spread reflex, toe spacing), as well as slightly greater improvement in grip strength test compared to controls. Together, our results indicate partial involvement of the CD137-dependent pathway in SNC-induced sensory and motor function changes following peripheral nerve injury. (Supported by NIH/NINDS R01NS098426 (Cao))

Vasculitis and the peripheral nervous system.

Peripheral neuropathy is a common feature of systemic vasculitis and can also occur when vessel wall inflammation is confined to the vasa nervorum, as a tissue-specific condition-non-systemic vasculitic neuropathy (NSVN). Typically, the clinical picture in both systemic and non-systemic cases is of a lower limb predominant, distal, asymmetric or multifocal neuropathy, which is painful and subacute in onset. For NSVN, nerve biopsy is required to make the diagnosis, and nerve biopsy also has a role when vasculitic neuropathy is suspected and a systemic process has not yet declared itself. Early recognition of the disorder is important, because it is treatable, and without treatment potentially disabling, or even lethal if part of an undiagnosed systemic process. Treatment is generally with combination therapy (glucocorticoid plus other immunosuppressant), after which motor and sensory recovery are likely to occur, albeit slowly, but the patient may be left with chronic neuropathic pain.

Production of fish seasoning powder from snakehead meat (Channa striata) by applying Alcalase and Flavourzyme enzyme mixture

Fish hydrolysate was produced from snakehead meat by applying an enzyme mixture consisting of Alcalase and Flavourzyme with a ratio of 1:3; hydrolysis temperature 55oC; pH 6.5 - 6.9. The results showed that the ratio of enzyme mixture to fish meat of 0.2% and hydrolysis time of 26 h were the optimal hydrolysis conditions. Fish hydrolysate had highest peptide content (26.4 g/L) and nitrogen amino acid content (10.6 g/L), and lowest nitrogen ammonia content (0.257 g/L). Sensory score, protein content, recovery yield and moisture content of fish seasoning powder were 18.9; 17.1%; 42.5% and 4.88%, respectively by mixing radish solution and fish hydrolysate at the ratio of radish solution to fish hydrolysate of 25%:40% and drying at 60oC for 72 h. The product still remained good sensory quality. The moisture content and total aerobic bacteria of product were at acceptable level after 4 weeks stored at ambient temperature.

Cold intolerance and neuropathic pain after peripheral nerve injury in upper extremity.

Cold intolerance and pain can be a substantial problem in patients with peripheral nerve injury. We aimed at investigating the relationships among sensory recovery, cold intolerance, and neuropathic pain in patients affected by upper limb peripheral nerve injury (Sunderland type V) treated with microsurgical repair, followed by early sensory re-education. In a cross-sectional clinical study, 100 patients (male/female 81/19; age 40.5 ± 14.8 years and follow-up 17 ± 5 months, mean ± SD), with microsurgical nerve repair and reconstruction in the upper extremity and subsequent early sensory re-education, were evaluated, using Cold Intolerance Symptoms Severity questionnaire-Italian version (CISS-it, cut-off pathology >30/100 points), CISS questionnaire-12 item version (CISS-12, 0-46 points-grouping: healthy that means no cold intolerance [0-14], mild [15-24], moderate [25-34], severe [35-42], very severe [43-46] cold intolerance), probability of neuropathic pain (DouleurNeuropathique-4; [DN4] 4/10), deep and superficial sensibility, tactile threshold (monofilaments), and two-point discrimination (cutoff S2; Medical Research Council scale for sensory function; [MRC-scale]). A high CISS score is associated with possible neuropathic pain (DN4 ≥ 4). Both a low CISS-it score (ie, < 30) and DN4 < 4 is associated with good sensory recovery (MRC ≥ 2). In conclusion patients affected by upper limb peripheral nerve injuries with higher CISS scores more often suffer from cold intolerance and neuropathic pain, and the better their sensory recovery is, the less likely they are to suffer from cold intolerance and neuropathic pain.

Factors affecting sensory recovery after thumb reconstruction using a wrap-around flap.

This study evaluated factors affecting sensory restoration after thumb reconstruction using a wrap-around flap in 21 thumbs in patients aged 11 to 50years old. The patients were followed from 12 to 94months after surgery. Static and moving 2-point discrimination of the reconstructed pulp was measured and analysed using multiple regression analysis. According to the univariate and multivariate analyses, the preoperative period, the number of nerve coaptations, and the duration of follow-up all significantly affected sensory recovery. Sensory recovery with more than three coaptations was significantly better than those with less than three coaptations, and the number of nerve coaptations was one of the primary factors influencing sensory recovery. We conclude from this study that the wrap-around flap should be performed soon after injury and that surgeons should try to coaptate three or more nerves to enhance sensory recovery.Level of evidence: IV.

Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation

BackgroundPatient satisfaction after breast reconstruction is dependent on both esthetics and functional outcomes. In an attempt to improve breast sensibility, a sensory nerve coaptation can be performed. The aim of this study was to objectify the sensory recovery in patients who, by chance, underwent bilateral autologous breast reconstruction with one innervated and one non-innervated flap. It must be emphasized that the intention was to coaptate the sensory nerves on both sides.MethodsThe cohort study was carried out in the Maastricht University Medical Center between August 2016 and August 2018. Patients were eligible if they underwent bilateral non-complex, autologous breast reconstruction with unilateral sensory nerve coaptation and underwent sensory measurements using Semmes–Weinstein monofilaments at 12 months of follow-up. Sensory outcomes were compared using t tests.ResultsA total of 15 patients were included, all contributing one innervated and one non-innervated flap. All patients had a follow-up of at least 12 months, but were measured at different follow-up points with a mean follow-up of 19 months. Sensory nerve coaptation was significantly associated with better sensation in the innervated breasts and showed better sensory recovery over time, compared to non-innervated breasts. Moreover, the protective sensation of the skin can be restored by sensory nerve coaptation.ConclusionsThe study demonstrated that sensory nerve coaptation leads to better sensation in the autologous reconstructed breast in patients who underwent bilateral breast reconstruction and, by chance, received unilateral sensory nerve coaptation.

Functional and Physiological Methods of Evaluating Median Nerve Regeneration in the Rat.

The main goal of this investigation is to show how to create and repair different types of median nerve (MN) lesions in the rat. Moreover, different methods of simulating postoperative physiotherapy are presented. Multiple standardized strategies are used to assess motor and sensory recovery using an MN model of peripheral nerve lesion and repair, thus permitting easy comparison of the results. Several options are included for providing a postoperative physiotherapy-like environment to rats that have undergone MN injuries. Finally, the paper provides a method to evaluate the recovery of the MN using several noninvasive tests (i.e., grasping test, pin prick test, ladder rung walking test, rope climbing test, and walking track analysis), and physiological measurements (infrared thermography, electroneuromyography, flexion strength evaluation, and flexor carpi radialis muscle weight determination). Hence, this model seems particularly appropriate to replicate a clinical scenario, facilitating extrapolation of results to the human species. Although the sciatic nerve is the most studied nerve in peripheral nerve research, analysis of the rat MN presents various advantages. For example, there is a reduced incidence of joint contractures and automutilation of the affected limb in MN lesion studies. Furthermore, the MN is not covered by muscle masses, making its dissection easier than that of the sciatic nerve. In addition, MN recovery is observed sooner, because the MN is shorter than the sciatic nerve. Also, the MN has a parallel path to the ulnar nerve in the arm. Hence, the ulnar nerve can be easily used as the nerve graft for repairing MN injuries. Finally, the MN in rats is located in the forelimb, akin to the human upper limb; in humans, the upper limb is the site of most peripheral nerve lesions.

Compensation of Ipsilateral Motor and Sensory Functions by Contralateral Uncrossed Pathway in a Stroke Patient With Half Brain.

This study reports a case of motor and sensory function recovery after massive left cerebral infarction in a young man, along with preserved function of the injured hemisphere. He received early rehabilitation therapy in a nerval care unit within 1 wk of surgery, and the rehabilitation lasted for more than 3 yrs. When he gradually recovered from coma, his motor, sensory, and speech functions improved significantly. Two years later, he was able to live independently and returned to work. The findings of functional magnetic resonance imaging, diffusion tensor imaging, somatosensory evoked potential, and motor evoked potential confirmed that there was a strong connection between his right brain and the right limbs. Thus, early rehabilitation is a promising approach for restoring motor and sensory function after massive brain injury or extensive brain tissue damage.

Microsurgical replantation of retrograde avulsion injury of finger skin

Objective To explore the clinical efficacy of microsurgical replantation of retrograde avulsion of finger skin. Methods From June 2013 to June 2018, 12 cases of retrograde avulsion injury of fingers were treated by the repair of fracture dislocation, skin replantation and repair of blood vessels, nerves and tendons. After operation, anti-inflammatory, anticoagulant and antispasmodic treatment were performed. They were absolutely in bed and kept warm. The blood supply, sensation and functional recovery of replanted skin were observed. Results The skin of fingers survived well in 10 cases, and a small amount of skin necrosis and scab formed in 2 cases. The wound healed well after active dressing change and scab removal. The follow-up time ranged from 6 to 12 months. 12 patients had good hand shape, soft skin, sufficient blood supply and good finger function. The total activity of flexion and extension of interphalangeal joint and metacarpophalangeal joint of the affected side were compared with those of the healthy side. According to the evaluation standard of hand function, the results were rated as excellent in 7 cases, good in 2 cases and fair 3 cases. The skin sensation recovered to S4 in 5 cases, S3 in 4 cases, S2 in 2 cases and S1 in 1 case. Conclusion The microsurgical replantation of retrograde avulsion of finger skin can reduce the necrosis rate of avulsion skin and retain the shape and function of finger to the maximum extent, which is a method worthy of reference. Key words: Finger injuries; Microsurgery; Retrograde avulsion injury; Replantation

Subacute reconstruction using flap transfer for complex defects of the upper extremity

BackgroundDespite advances in microsurgical techniques of flap transfer, complex upper extremity trauma reconstruction remains a challenge for surgeons. This study aimed to present the outcomes in using flaps in the subacute reconstruction of complex upper extremity injuries.MethodsFrom July 2013 to December 2016, 35 patients ranging in age from 23 to 69 years with complicated upper extremity traumatic injuries were treated using flap reconstruction in subacute period. The number and causes of injury were 12 machine crush injuries, 18 machine strangulation injuries, two chainsaw accidents, two traffic accidents, and one incident of heavy bruising. Thirty-five patients underwent flap procedures, including 24 anterolateral thigh flaps (68.57%), five latissimus dorsi flaps (14.29%), and six lateral arm flaps (17.14%). Flap sizes ranged from 3 × 4 to 42 × 16 cm2. The mean time of flap reconstruction was 14 days (range 5–29). During postoperative follow-up, flap appearance, sensory recovery, scarring and satisfaction were assessed.ResultsThe overall flap survival rate was 94.3%.Two flaps developed partial necrosis, both of which were later treated with skin grafting. Traumatic wound infections occurred in three patients. All upper limb injuries were completely covered. The follow-up periods ranged from 18 to 62 months with an average of 2.9 months. All skin flap textures were soft with varying degrees of pigmentation. Flap sensory recovery was S1 in three cases, S2 in eight cases, S3 in 15 cases, and S4 in nine cases. There were no donor site complications other than three cases with scar hyperplasia.ConclusionsThe severe upper limb soft tissue defects still achieved satisfactory function and appearance with negligible complications and low amputation rates during the subacute period.

Analgesic Effect Of Paracetamol As An Adjuvant To Lidocaine For Intravenous Regional Anaesthesia: A Prospective Randomized Study

Background: Intravenous Regional Anaesthesia (IVRA) also known as Biers block is a procedure used to provide regional block in both the upper and lower extremities. This study aims to determine the effects of adding paracetamol to lidocaine for intravenous regional anaesthesia (IVRA). Methods: Forty eligible patients undergoing short upper limb surgery received IVRA were assigned to two groups (n = 20 each): Group X: received lidocaine (3 mg/kg) diluted with normal saline and paracetamol 450 mg to a volume of 40 ml. Group Y: received lidocaine (3 mg/kg) diluted with normal saline a to a volume of 40 ml. Variables measured were: sensory onset and recovery time, visual analogue scale (VAS) scores; intraoperative and at 6 hours postoperatively, tourniquet pain and time to first analgesic requirement. Results: Sensory block onset time among group X was significantly shorter than group Y p= statistically significant. Durations of Sensory block in group X was also significantly longer than group Y p= statistically significant. Twenty minute intraoperatively till 60 minutes, VAS was significantly higher in group Y which required majority 68.4% to receive a single dose of intraoperative fentanyl analgesia compared to 27.6% among Group X. Postoperative VAS was lower among Group X from 2nd -5th hours compared to group Y, p= statistically significant. Similarly, time to first postoperative analgesic requirement was significantly longer in Group X p= statistically significant than group Y. Conclusion: Addition of paracetamol to Lidocaine for IVRA improves quality of analgesia and reduce intra and postoperative analgesic requirement.

Сравнение эффективности восстановления сенсорной фузии при лечении на синоптофоре и жидкокристаллическими очками детей с оперированным содружественным косоглазием

Purpose. This study aims to analyze sensory fusion recovery using method of LCD glasses with alternating occlusion of visual fields and compare its efficacy with orthoptic treatment using synoptophore. Material and methods. Eighty-six patients with prior esotropia, post-operative absence of bifoveal fusion and residual angle of deviation <10° were studied. All patients were hyperopic. All of them underwent synoptophore treatment for 12 months (3–4 courses). Forty-three patients unsuccessful in bifoveal fusion recovery underwent treatment with LCD glasses for 6 hours/day. Results. Bifoveal fusion and binocular vision were significantly more often recovered (P<0,000) by LCD glasses treatment as compared to the synoptofore treatment. The stable bifoveal fusion was formed in 29 (67%) and 16 (18%) children, the unstable one – in 11 (26%) and 17 (20%); the treatment was ineffective in 3 (7%) and 53 (62%) patients, respectively. Binocular vision was obtained in 20 (46%) and 21 (24%) patients, and taking into account the subsequent diplopic treatment in cases with stable sensory fusion in 10 (23%) and 2 (2%), respectively. Parents were more satisfied with the treatment by LCD glasses because of the lack of frequent visits to the hospital. Conclusion. Alternating occlusion of visual fields with LCD glasses is a more effective mean of bifoveal fusion and binocular vision recovery than orthoptic treatment with a synoptophore in patients after successful strabismus surgery.

Noise-induced hearing loss in zebrafish: investigating structural and functional inner ear damage and recovery

Exposure to continuous moderate noise levels is known to impair the auditory system leading to Noise-Induced Hearing Loss (NIHL) in animals including humans. The mechanism underlying noise-dependent auditory Temporary Threshold Shifts (TTS) is not fully understood. In fact, only limited information is available on vertebrates such as fishes, which share homologous inner ear structures to mammals and have the ability to regenerate hair cells. The zebrafish Danio rerio is a well-established model in hearing research providing an unmatched opportunity to investigate the molecular and physiological mechanisms of NIHL at the sensory receptor level. Here we investigated for the first time the effects of noise exposure on TTS and functional recovery in zebrafish, as well as the associated morphological damage and regeneration of the inner ear saccular hair cells.Adult specimens were exposed for 24h to white noise at various amplitudes (130, 140 and 150 dB re. 1 μPa) and their auditory sensitivity was subsequently measured with the Auditory Evoked Potential (AEP) recording technique. Sensory recovery was tested at different times post-treatment (after 3, 7 and 14 days) and compared to individuals kept under quiet lab conditions. Results revealed noise level-dependent TTS up to 33 dB and increase in response latency. Recovery of hearing function occurred within 7 days for fish exposed to 130 and 140 dB noise levels, while fish subject to 150 dB only returned to baseline thresholds after 14 days. Hearing impairment was accompanied by significant loss of hair cells only at the highest noise treatment. Full regeneration of the sensory tissue (number of hair cell receptors) occurred within 7 days, which was prior to functional recovery.We provide first baseline data of NIHL in zebrafish and validate this species as an effective vertebrate model to investigate the impact of noise exposure on the structure and function of the adult inner ear and its recovery process.