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A novel technique using hydrophilic polymers to promote axonal fusion

Neural Regeneration Research 2016年第4期11卷 525-528页

作者： Ravinder Bamba D.Colton Riley Nathaniel D.Kelm Mark D.Does Richard D.Dortch wesley p.thayer Department of plastic Surgery Vanderbilt University Medical Center Nashville TN USA Department of Surgery Georgetown University Washington DC USA Georgetown University School of Medicine Washington DC USA Vanderbilt University Institute of Imaging Science Nashville TN USA Department of Radiology and Radiological Sciences Vanderbilt University Nashville TN USA

The management of traumatic peripheral nerve injury remains a considerable concern for *** minimal innovations in surgical technique and a limited number of specialists trained to treat peripheral nerve injury,outcomes of surgical intervention have been *** inability to manipulate the pathophysiology of nerve injury（i.e.,Wallerian degeneration） has left scientists and clinicians depending on the slow and lengthy process of axonal regeneration（-1 mm/day）.When axons are severed,the endings undergo calcium-mediated plasmalemmal sealing,which limits the ability of the axon to be primarily *** glycol（pEG） in combination with a bioengineered process overcomes the inability to fuse *** mechanism for pEG axonal fusion is not clearly understood,but multiple studies have shown that a providing a calcium-free environment is essential to the process known as pEG *** proposed mechanism is pEG-induced lipid bilayer fusion by removing the hydration barrier surrounding the axolemma and reducing the activation energy required for membrane fusion to *** review highlights pEG fusion,its past and current studies,and future directions in pEG fusion.

关键词： peripheral nerve injury polyethylene glycol axonal fusion nerve transection traumatic neuropathy

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polyethylene glycol restores axonal conduction after corpus callosum transection

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Neural Regeneration Research 2017年第5期12卷 757-760页

作者： Ravinder Bamba D.Colton Riley Richard B.Boyer Alonda C.pollins R.Bruce Shack wesley p.thayer Department of plastic Surgery Vanderbilt University Medical Center Nashville TN USA Department of Surgery Georgetown University Washington DC USA Georgetown University School of Medicine Washington DC USA

polyethylene glycol（pEG） has been shown to restore axonal continuity after peripheral nerve transection in animal models. We hypothesized that pEG can also restore axonal continuity in the central nervous system. In this current experiment, coronal sectioning of the brains of Sprague-Dawley rats was performed after animal sacrifice. 3Brain high-resolution microelectrode arrays（MEA） were used to measure mean firing rate（MFR） and peak amplitude across the corpus callosum of the ex-vivo brain slices. The corpus callosum was subsequently transected and repeated measurements were performed. The cut ends of the corpus callosum were still apposite at this time. A pEG solution was applied to the injury site and repeated measurements were performed. MEA measurements showed that pEG was capable of restoring electrophysiology signaling after transection of central nerves. Before injury, the average MFRs at the ipsilateral, midline, and contralateral corpus callosum were 0.76, 0.66, and 0.65 spikes/second, respectively, and the average peak amplitudes were 69.79, 58.68, and 49.60 μV, respectively. After injury, the average MFRs were 0.71, 0.14, and 0.25 spikes/second, respectively and peak amplitudes were 52.11, 8.98, and 16.09 μV, respectively. After application of pEG, there were spikes in MFR and peak amplitude at the injury site and contralaterally. The average MFRs were 0.75, 0.55, and 0.47 spikes/second at the ipsilateral, midline, and contralateral corpus callosum, respectively and peak amplitudes were 59.44, 45.33, 40.02 μV, respectively. There were statistically differences in the average MFRs and peak amplitudes between the midline and non-midline corpus callosum groups（p 〈 0.01, p 〈 0.05）. These findings suggest that pEG restores axonal conduction between severed central nerves, potentially representing axonal fusion.

关键词： nerve regeneration polyethylene glycol nerve repair axonal fusion central nerve injury axonal conduction corpus callosum neural regeneration

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ECMO in major burn patients: feasibility and considerations when multiple modes of mechanical ventilation fail

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Burns & Trauma 2017年第2期5卷 134-139页

作者： Jason D. Kennedy wesley thayer Reuben Beuno Kelly Kohorst Avinash B. Kumar Department of Anesthesiology and Critical Care Vanderbilt University Medical Center 121121st Avenue S Suite 526 Nashville TN 37212 USA Department of plastic Surgery Vanderbilt University Nashville TN USA

Background: We report two cases of acute respiratory distress syndrome in burn patients who were successfully managed with good outcomes with extra corporeal membrane oxygenation (ECMO) after failing multiple conventional modes of ventilation, and review the relevant *** presentation: The two patients were a 39-year-old male and 53-year-old male with modified Baux Scores of 79 and 78, respectively, with no known inhalation injury. After the initial modified parkland-based fluid resuscitation and partial escharotomy, both patients developed worsening hypoxemia and acute respiratory distress *** hypoxemia continued to worsen on multiple modes of ventilation including volume control, pressure regulated volume control, pressure control, airway pressure release ventilation and volumetric diffusive *** both cases, the paO2 ≤ 50 mm Hg on a FiO2100% during the trial of mechanical ventilation. The deterioration was rapid (patients on ECMO. Veno-Venous ECMO (V-V ECMO) was successfully initiated following cannulation-under transesophgeal echo guidance—with the dual lumen Avalon? (Maquet, NJ, USA) cannula. ECMO support was maintained for 4 and 24 days, respectively. Both patients were successfully weaned off ECMO and were discharged to rehabilitation following their complex hospital ***: Early ECMO for isolated respiratory failure in the setting on maintained hemodynamics resulted in a positive outcome in our two burn patients suffered from acute respiratory distress syndrome.

关键词： ARDS Burns Extra corporeal membrane oxygenation Rescue ventilation Conventional ventilation failure Veno-venous ECMO

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