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Motor neuron-specific RhoA knockout delays degeneration and promotes regeneration of dendrites in spinal ventral horn after brachial plexus injury

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Neural Regeneration Research 2023年第12期18卷 2757-2761页

作者： Mi Li Jiawei Xu Ying Zou Jialing Lu Aiyue Ou Xinrui Ma Jiaqi Zhang Yizhou Xu Lanya Fu Jingmin Liu Xianghai Wang Libing Zhou Jiasong Guo Department of Histology and Embryology School of Basic Medical SciencesSouthern Medical UniversityGuangzhouGuangdong ProvinceChina Department of Spine Orthopedics Zhujiang HospitalSouthern Medical UniversityGuangzhouGuangdong ProvinceChina Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering Southern Medical UniversityGuangzhouGuangdong ProvinceChina Key Laboratory of Mental Health of the Ministry of Education Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired IntelligenceGuangdong Province Key Laboratory of Psychiatric DisordersGuangzhouGuangdong ProvinceChina Guangdong-Hong Kong-Macao Institute of CNS Regeneration Ministry of Education CNS Regeneration Collaborative Joint LaboratoryJinan UniversityGuangzhouGuangdong ProvinceChina

Dendrites play irreplaceable roles in the nerve conduction pathway and are vulnerable to various insults.Peripheral axotomy of motor neurons results in the retraction of dendritic arbors,and the dendritic arbor can be re-expanded when reinnervation is allowed.RhoA is a target that regulates the cytoskeleton and promotes neuronal survival and axon regeneration.However,the role of RhoA in dendrite degeneration and regeneration is unknown.In this study,we explored the potential role of RhoA in dendrites.A line of motor neuronal conditional knockout mice was developed by crossbreeding HB9~(Cre+)mice with RhoA~(flox/flox)mice.We established two models for assaying dendrite degeneration and regeneration,in which the brachial plexus was transection or crush injured,respectively.We found that at 28 days after brachial plexus transection,the density,complexity,and structural integrity of dendrites in the ventral horn of the spinal cord of RhoA conditional knockout mice were slightly decreased compared with that in Cre mice.Dendrites underwent degeneration at 7 and 14 days after brachial plexus transection and recovered at 28–56 days.The density,complexity,and structural integrity of dendrites in the ventral horn of the spinal cord of RhoA conditional knockout mice recovered compared with results in Cre mice.These findings suggest that RhoA knockout in motor neurons attenuates dendrite degeneration and promotes dendrite regeneration after peripheral nerve injury.

关键词： brachial plexus conditional knockout degeneration dendrites motor neuron peripheral nerve injury regeneration RhoA spinal cord ventral horn

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An electroencephalography-based human-machine interface combined with contralateral C7 transfer in the treatment of brachial plexus injury

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Neural Regeneration Research 2022年第12期17卷 2600-2605页

作者： Meng Zhang Ci Li Song-Yang Liu Feng-Shi Zhang Pei-Xun Zhang Department of Orthopedics and Trauma Peking University People’s HospitalBeijingChina Key Laboratory of Trauma and Neural Regeneration Peking UniversityBeijingChina National Center for Trauma Medicine BeijingChina

Transferring the contralateral C7 nerve root to the median or radial nerve has become an important means of repairing brachial plexus nerve injury.However,outcomes have been disappointing.Electroencephalography(EEG)-based human-machine interfaces have achieved promising results in promoting neurological recovery by controlling a distal exoskeleton to perform functional limb exercises early after nerve injury,which maintains target muscle activity and promotes the neurological rehabilitation effect.This review summarizes the progress of research in EEG-based human-machine interface combined with contralateral C7 transfer repair of brachial plexus nerve injury.Nerve transfer may result in loss of nerve function in the donor area,so only nerves with minimal impact on the donor area,such as the C7 nerve,should be selected as the donor.Single tendon transfer does not fully restore optimal joint function,so multiple functions often need to be reestablished simultaneously.Compared with traditional manual rehabilitation,EEG-based human-machine interfaces have the potential to maximize patient initiative and promote nerve regeneration and cortical remodeling,which facilitates neurological recovery.In the early stages of brachial plexus injury treatment,the use of an EEG-based human-machine interface combined with contralateral C7 transfer can facilitate postoperative neurological recovery by making full use of the brain’s computational capabilities and actively controlling functional exercise with the aid of external machinery.It can also prevent disuse atrophy of muscles and target organs and maintain neuromuscular junction effectiveness.Promoting cortical remodeling is also particularly important for neurological recovery after contralateral C7 transfer.Future studies are needed to investigate the mechanism by which early movement delays neuromuscular junction damage and promotes cortical remodeling.Understanding this mechanism should help guide the development of neurological rehabilitation strategies for patients with

关键词： arm injuries brachial plexus brain-computer interfaces nerve transfer nerve regeneration nerve tissue neurofeedback neurological rehabilitation user-computer interface

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A novel extradural nerve transfer technique by coaptation of C4 to C5 and C7 to C6 for treating isolated upper trunk avulsion of the brachial plexus

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The Journal of Biomedical Research 2018年第4期32卷 298-304页

作者： Kaixiang Yang Shaohua Zhang Dawei Ge Tao Sui Hongtao Chen Xiaojian Cao Department of Orthopaedics the First Affiliated Hospital of Nanjing Medical University

The study aimed to demonstrate the feasibility of an extradural nerve anastomosis technique for the restoration of a C5 and C6 avulsion of the brachial plexus.Nine fresh frozen human cadavers were used.The diameters,sizes,and locations of the extradural spinal nerve roots were observed.The lengths of the extradural spinal nerve roots and the distance between the neighboring nerve root outlets were measured and compared in the cervical segments.In the spinal canal,the ventral and dorsal roots were separated by the dura and arachnoid.The ventral and dorsal roots of C7 had sufficient lengths to anastomose those of C6.The ventral and dorsal of C4 had enough length to be transferred to those of C5,respectively.The feasibility of this extradural nerve anastomosis technique for restoring C5 and C6 avulsion of the brachial plexus in human cadavers was demonstrated in our anatomical study.

关键词： brachial plexus nerve transfer spinal nerve roots extradural anastomosis surgical feasibility study

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Effective background infusion rate of ropivacaine 0.2% for patient-controlled interscalene brachial plexus analgesia after rotator cuff repair surgery

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Chinese Medical Journal 2014年第23期127卷 4119-4123页

作者： Wei Yue Li Min Rong Yulan Guo Xiangyang Department of Anesthesiology Peking University Third Hospital Beijing 100191 China

Background Continuous interscalene nerve block （CISB） is considered to be the most effective method for postoperative analgesia after shoulder surgery with prolonged severe pain.This study was performed to evaluate the minimum effective background infusion rate and the effective background infusion rate of ropivacaine 0.2％ for CISB after arthroscopic rotator cuff repair surgery in 95％ of patients.Methods Patients scheduled for arthroscopic rotator cuff repair surgery under general anesthesia at Peking University Third Hospital were prospectively enrolled from December 2011 to May 2012.Preoperatively,an interscalene catheter （ISC） was placed under the guidance of ultrasound and nerve stimulation in each patient.Consecutively,30 patients with successful nerve block were included.A continuous infusion of ropivacaine 0.2％ with a 5 ml patient-controlled bolus available hourly was started at postoperative anesthesia care unit （PACU） after completion of surgery.The initial background infusion rate was 6 ml/h,which was subsequently varied for each consecutive patient according to the analgesic effects of the previous one.The minimum effective background rate was determined using the Dixon and Massey up-and-down method.The effective background rate in 95％ of patients was calculated using isotonic analysis.Results The minimum effective background rate based on the Dixon and Massey up-and-down method was 2.8 ml/h （95％ CI,2.3-3.3 ml/h）.The effective background rate in 95％ of patients calculated with the isotonic regression analysis was 4.4 ml/h （95％ CI,3.8-6.5 ml/h）.Conclusion The effective background rate for patient-controlled interscalene brachial plexus analgesia after shoulder surgery in 50％ and 95％ of the patients was 2.8 and 4.4 ml/h,respectively.

关键词： ropivacaine brachial plexus nerve block dose-response relationship drug

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Recovery of brachial plexus injury after bronchopleural fistula closure surgery based on electrodiagnostic study:A case report and review of literature

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World Journal of Clinical Cases 2022年第30期10卷 11090-11100页

作者： Young-In Go Da-Sol Kim Gi-Wook Kim Yu Hui Won Sung-Hee Park Myoung-Hwan Ko Jeong-Hwan Seo Department of Physical Medicine&Rehabilitation Jeonbuk National University Medical SchoolJeonju 54907South Korea Research Institute of Clinical Medicine of Jeonbuk National University Biomedical Research Institute of Jeonbuk National University HospitalJeonju 54907South Korea

BACKGROUND Axillary thoracotomy and muscle flap are muscle-and nerve-sparing methods among the surgical approaches to bronchopleural fistula(BPF).However,in patients who are vulnerable to a nerve compression injury,nerve injury may occur.In this report,we present a unique case in which the brachial plexus(division level),suprascapular,and long thoracic nerve injury occurred after BPF closure surgery in a patient with ankylosing spondylitis and concomitant multiple joint contractures.CASE SUMMARY A 52-year-old man with a history of ankylosing spondylitis with shoulder joint contractures presented with right arm weakness and sensory impairment immediately after axillary thoracotomy and latissimus dorsi muscle flap surgery for BPF closure.During the surgery,the patient was positioned in a lateral decubitus position with the right arm hyper-abducted for approximately 6 h.Magnetic resonance imaging and ultrasound revealed subclavius muscle injury or myositis with brachial plexus(BP)compression and related neuropathy.An electrodiagnostic study confirmed the presence of BP injury involving the wholedivision level,long thoracic,and suprascapular nerve injuries.He was treated with medication,physical therapy,and ultrasound-guided injections.Ultrasoundguided steroid injection at the BP,hydrodissection with 5%dextrose water at the BP and suprascapular nerve,and intra-articular steroid and hyaluronidase injection at the glenohumeral joint were performed.On postoperative day 194,the pain and arm weakness were resolved,and a follow-up electrodiagnostic study showed marked improvement.CONCLUSION Clinicians should consider the possibilities of multiple nerve injuries in patients with joint contracture,and treat each specific therapeutic target.

关键词： brachial plexus Electrodiagnosis Physical therapy Surgical flaps Thoracotomy Case report

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Structure of the brachial plexus root and adjacent regions displayed by ultrasound imaging

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Neural Regeneration Research 2012年第26期7卷 2044-2050页

作者： Zhengyi Li Xun Xia Xiaoming Rong Yamei Tang Dachuan Xu Institute of Clinical Anatomy Southern Medical University Guangzhou 510515 Guangdong Province China Department of Ultrasound Shenzhen Second People's Hospital Shenzhen 518035 Guangdong Province China Department of Neurology Sun Yat-sen Memorial Hospital Sun Yat-sen University Guangzhou 510120 Guangdong Province China

brachial plexuses of 110 healthy volunteers were examined using high resolution color Doppler ultrasound. Ultrasonic characteristics and anatomic variation in the intervertebral foramen, interscalene, supraclavicular and infraclavicular, as well as the axillary brachial plexus were investigated. Results confirmed that the normal brachial plexus on cross section exhibited round or elliptic hypoechoic texture. Longitudinal section imaging showed many parallel linear hypo-moderate echoes, with hypo-echo. The transverse processes of the seventh cervical vertebra, the scalene space, the subclavian artery and the deep cervical artery are important markers in an examination. The display rates for the interscalene, and supraclavicular and axillary brachial plexuses were 100% each, while that for the infraclavicular brachial plexus was 97%. The region where the normal brachial plexus root traversed the intervertebral foramen exhibited a regular hypo-echo. The display rate for the C5-7 nerve roots was 100%, while those for C8 and T1 were 83% and 68%, respectively. A total of 20 of the 110 subjects underwent cervical CT scan. High-frequency ultrasound can clearly display the outline of the transverse processes of the vertebrae, which were consistent with CT results. These results indicate that high-frequency ultrasound provides a new method for observing the morphology of the brachial plexus. The C~ vertebra is a marker for identifying the position of brachial plexus nerve roots.

关键词： brachial plexus ultrasound anatomical characteristics CT nerve root brachial plexus block neuralregeneration

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Improved C_(3-4) transfer for treatment of root avulsion of the brachial plexus upper trunk Animal experiments and clinical application

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Neural Regeneration Research 2012年第20期7卷 1545-1555页

作者： Lin Zou Xuecheng Cao Jing Li Lifeng Liu Pingshan Wang Jinfang Cai Department of Orthopedics and Traumatic Surgery General Hospital of Jinan Military Command of Chinese PLA Jinan 250031 ShandongProvince China Department of Neurology General Hospital of Jinan Military Command of Chinese PLA Jinan 250031 Shandong Province China

Experimental rats with root avulsion of the brachial plexus upper trunk were treated with the improved C34 transfer for neurotization of 05-6. Results showed that Terzis grooming test scores were significantly increased at 6 months after treatment, the latency of C5-6 motor evoked potential was gradually shortened, and the amplitude was gradually increased. The rate of C3 instead of C5 and the C4 ＋ phrenic nerve instead of C6 myelinated nerve fibers crossing through the anastomotic stoma was approximately 80%. Myelinated nerve fibers were arranged loosely but the thickness of the myelin sheath was similar to that of the healthy side. In clinical applications, 39 patients with root avulsion of the brachial plexus upper trunk were followed for 6 months to 4.5 years after treatment using the improved C3 instead of C5 nerve root transfer and C4 nerve root and phrenic nerve instead of C6 nerve root transfer. Results showed that the strength of the brachial biceps and deltoid muscles recovered to level IIHV, scapular muscle to level Ill-W, latissimus dorsi and pectoralis major muscles to above level Ⅲ, and the brachial triceps muscle to level 0 Ill. Results showed that the improved 03-4 transfer for root avulsion of the brachial plexus upper trunk in animal models is similar to clinical findings and that C3-4 and the phrenic nerve transfer for neurotization of C5-6 can innervate the avulsed brachial plexus upper trunk and promote the recovery of nerve function in the upper extremity.

关键词： brachial plexus cervical plexus upper trunk root avulsion nerve transfer phrenic nerve translational medicine peripheral nerve injury neural regeneration

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Differentiation of endogenous neural stem cells in adult versus neonatal rats after brachial plexus root avulsion injury

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Neural Regeneration Research 2012年第23期7卷 1786-1790页

作者： Bingqi Wang Lei Chen Bin Liu Zhigang Liu Zhixin Zhang Yuehai Pan Liangsong Song Laijin Lu Department of Hand and Foot Surgery First Hospital of Jilin UniversityChangchun 130031Jilin ProvinceChina

An experimental model of brachial plexus root avulsion injury of cervical dorsal C5-6 was established in adult and neonatal rats.Real-time PCR showed that the levels of brain-derived neurotrophic factor,nerve growth factor and neurotrophin-3 in adult rats increased rapidly 1 day after brachial plexus root avulsion injury,and then gradually decreased to normal levels by 21 days.In neonatal rats,levels of the three neurotrophic factors were decreased on the first day after injury,and then gradually increased from the seventh day and remained at high levels for an extended period of time.We observed that greater neural plasticity contributed to better functional recovery in neonatal rats after brachial plexus root avulsion injury compared with adult rats.Moreover, immunohistochemical staining showed that the number of bromodeoxyuridine/nestin-positive cells increased significantly in the spinal cords of the adult rats compared with neonatal rats after brachial plexus root avulsion injury.In addition,the number of bromodeoxyuridine/glial fibrillary acidic protein-positive cells in adult rats was significantly higher than in neonatal rats 14 and 35 days after brachial plexus injury.Bromodeoxyuridine/β-tubulin-positive cells were not found in either adult or neonatal rats.These results indicate that neural stem cells differentiate mainly into astrocytes after brachial plexus root avulsion injury.Furthermore,the degree of neural stem cell differentiation in neonatal rats was lower than in adult rats.

关键词： neural stem cells neurotrophic factors brain-derived neurotrophic factor neuroregeneration brachial plexus nerve root avulsion injury neural regeneration

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Subclavian brachial plexus metastasis from breast cancer:A case report

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World Journal of Clinical Cases 2022年第33期10卷 12261-12267页

作者： Zeng Zeng Nan Lin Li-Tao Sun Cong-Xian Chen Department of Ultrasound Medicine Zhejiang Provincial People’s HospitalAffiliated People’s HospitalHangzhou Medical CollegeHangzhou 310000Zhejiang ProvinceChina Plastic Surgery Center Department of Hand&Reconstruct SurgeryZhejiang Provincial People’s HospitalAffiliated People’s HospitalHangzhou Medical CollegeHangzhou 310000Zhejiang ProvinceChina

BACKGROUND The common area of breast cancer metastases are bone,lung and liver.brachial plexus metastasis from breast cancer is extremely rare.We report a case of subclavian brachial plexus metastasis from breast cancer 6 years postoperative,which were detected by ultrasound,magnetic resonance imaging(MRI)and 18Ffluorodeoxyglucose positron emission tomography and computed tomography(FDG-PET/CT).CASE SUMMARY Our study reports a 64-year-old woman who had right breast cancer and underwent radical mastectomy 6 years before.Ultrasound first revealed a soft lesion measuring 38 mm×37 mm which located on the right side of the clavicle to the armpit subcutaneously.The right subclavian brachial plexus(beam level)was significantly thickened,wrapped around by a hypoechoic lesion,the surrounded axillary artery and vein were pressed.MRI brachial plexus scan showed that the right side of brachial plexus was enlarged compared with the left side and brachial plexus bundle in the distance showed a flake shadow.FDG-PET/CT revealed that the right side of brachial plexus nodular appearance with increased FDG metabolism.These results supported brachial plexus metastasis from breast cancer.Ultrasound exam also found many lesions between pectoralis major,deltoid muscle and inner upper arm.The lesion puncture was performed under ultrasound guidance and the tissue was sent for pathology.Pathology showed large areas of tumor cells in fibroblast tissue.Immunohistochemistry showed the following results:A2-1:GATA3(+),ER(+,strong,90%),PR(+,moderate,10%),HER-2(3+),Ki67(+15%),P120(membrane+),P63(-),E-cadherin(+),CK5/6(-).These results were consistent with the primary right breast cancer characteristics,thus supporting lesion metastasis from breast cancer.CONCLUSION The brachial plexus metastasis from breast cancer is uncommon.Ultrasound has great value in detecting brachial plexus metastasis of breast cancer.It is an easy,non-invasive and affordable method.Close attention should be paid to new grown out lesions in those patients who had a histor

关键词： brachial plexus Metastasis Breast Cancer Ultrasound Magnetic resonance imaging 18Ffluorodeoxyglucose positron emission tomography/computed tomography Case report

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Magnetic resonance imaging with three-dimensional fast imaging employing steady-state acquisition with phase-cycled and short T1 inversion recovery pulse sequence for evaluating brachial plexus injury

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Neural Regeneration Research 2011年第14期6卷 1097-1102页

作者： Dianxiu Ning Meiyu Sun Bo Sun Li Zhao Weisheng Zhang Lijun Wang Shaowu Wang Ailian Liu Jianlin Wu Zhijin Lang Di Ning Guanfu Liu Xiaochen Ji Xiufeng Wang Department of Radiology the First Affiliated Hospital of Dalian Medical University Dalian 116011 Liaoning Province China Department of Mathematics Nanjing University Nanjing 210093 Jiangsu Province China Department of Medical Imaging Dalian Medical University Dalian 116044 Liaoning Province China

There is a large amount of fat in the postganglionic segment of the brachial plexus nerve.The use of short T1 inversion recovery pulse sequence may improve signal strength of the brachial plexus postganglionic segment.The present study revealed that the combination of three-dimensional fast imaging employing steady-state acquisition with phase-cycled and short T1 inversion recovery pulse sequence clearly displayed the anatomical morphology and structure of the brachial plexus nerve,together with maximum intensity projection,volume rendering and other three-dimensional reconstruction techniques.Our results suggested that this method is also suitable for providing accurate assessment and diagnosis of the site,severity and scope of brachial plexus injury.

关键词： brachial plexus i-njury magnetic resonance imaging pulse sequence reconstruction

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