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Contralateral C7 transfer combined with acellular nerve allografts seeded with differentiated adipose stem cells for repairing upper brachial plexus injury in rats

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Neural Regeneration Research 2019年第11期14卷 1932-1940页

作者： Jian-Tao Yang Jin-Tao Fang Liang Li Gang Chen Ben-Gang Qin Li-Qiang Gu Department of Microsurgery & Orthopedic Trauma the First Affiliated Hospital of Sun Yat-sen University

Nerve grafting has always been necessary when the contralateral C7 nerve root is transferred to treat brachial plexus injury. Acellular nerve allograft is a promising alternative for the treatment of nerve defects, and results were improved by grafts laden with differentiated adipose stem cells. However, use of these tissue-engineered nerve grafts has not been reported for the treatment of brachial plexus injury. The aim of the present study was to evaluate the outcome of acellular nerve allografts seeded with differentiated adipose stem cells to improve nerve regeneration in a rat model in which the contralateral C7 nerve was transferred to repair an upper brachial plexus injury. Differentiated adipose stem cells were obtained from Sprague-Dawley rats and transdifferentiated into a Schwann cell-like phenotype. Acellular nerve allografts were prepared from 15-mm bilateral sections of rat sciatic nerves. Rats were randomly divided into three groups: acellular nerve allograft, acellular nerve allograft + differentiated adipose stem cells, and autograft. The upper brachial plexus injury model was established by traction applied away from the intervertebral foramen with micro-hemostat forceps. Acellular nerve allografts with or without seeded cells were used to bridge the gap between the contralateral C7 nerve root and C5–6 nerve. Histological staining, electrophysiology, and neurological function tests were used to evaluate the effect of nerve repair 16 weeks after surgery. Results showed that the onset of discernible functional recovery occurred earlier in the autograft group first, followed by the acellular nerve allograft + differentiated adipose stem cells group, and then the acellular nerve allograft group;moreover, there was a significant difference between autograft and acellular nerve allograft groups. Compared with the acellular nerve allograft group, compound muscle action potential, motor conduction velocity, positivity for neurofilament and S100, diameter o

关键词： nerve regeneration peripheral nerve injury brachial plexus injury contralateral C7 nerve root acellular nerve adipose stem cells Schwann cells tissue engineering nerve nerve grafting nerve defect neural regeneration

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Injury to the axillary artery and brachial plexus caused by a closed floating shoulder injury: A case report

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World Journal of Clinical Cases 2018年第15期6卷 1029-1035页

作者： Yu-Chun Chen Zhen Lian Yan-Na Lin Xin-Jia Wang Guan-Feng Yao Department of Orthopedics the Second Affiliated Hospital Shantou University Medical College Department of Rehabilitation Shantou Central Hospital

BACKGROUND A floating shoulder may be associated with catastrophic neurovascular injury and requires a multidisciplinary approach for its management. To maximize the like-lihood of good patient outcomes, this unique injury pattern should be recognized in patients as early as possible. This can be difficult to achieve, however, as there are currently few reports of floating shoulder in the literature, meaning that associated neurovascular injuries may be *** SUMMARY We present here a rare case of floating shoulder with axillary artery injury in a 34 -year-old woman. The patient complained of pain and numbness of her left upper limb after losing control of her motorcycle on a highway and falling from the vehicle 2 h ago. No blood pressure reading could be obtained from her left upper limb and no blood oxygen readings could be obtained from any of her left fingers. Computed tomography angiography and duplex ultrasonography revealed interruption of blood flow through the axillary artery, with distal flow being maintained through collateral arteries. The clinical diagnosis including fracture of the left proximal humerus, the left clavicle, and the left scapula, left axillary artery rupture, and left brachial plexus injury. We successfully performed open reduction and internal fixation of the fracture and vascular repair. The patient showed satisfactory recovery that was observed during 4 -mo *** Emergency surgery can be an effective therapeutic option for the closed floating shoulder with catastrophic axillary artery injury.

关键词： Floating shoulder injury Axillary artery injury Brachial plexus injury Complications of floating shoulder Management of floating shoulder Clavicle fracture Case report

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Glomus tumor of uncertain malignant potential of the brachial plexus: A case report

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World Journal of Clinical Cases 2019年第18期7卷 2815-2822页

作者： Pichaya Thanindratarn Thanapon Chobpenthai Termphong Phorkhar Scott D Nelson Department of Orthopedic Surgery Chulabhorn hospitalHRH Princess Chulabhorn College of Medical ScienceChulabhorn Royal AcademyLak SiBangkok 10210Thailand Department of Orthopedic Surgery Sarcoma Biology LaboratoryDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCA 90024United States Department of Pathology University of CaliforniaLos AngelesCA 90404United States

BACKGROUND Glomus tumor is an uncommon benign tumor usually presenting with a small mass occurring in the dermis or soft tissue of an extremity, especially subungual region. However, intraneural glomus tumor is sporadic. While most of the glomus tumors are benign, atypical glomus tumors with unusual features can be occasionally found, leading to distinctive malignant potential required different therapeutic approaches. Glomus tumor of uncertain malignant potential is one type of atypical glomus tumor with limited criteria for malignancy and without metastasis. CASE SUMMARY Herein, we report a case of a 48-year-old Thai male with a large painful mass in his axilla for one year without apparent neurological deficit. Magnetic resonance imaging showed a large heterogeneous mass encasing entire posterior cord of left brachial plexus and axillary artery. The tumor tissue from core needle biopsy histologically demonstrated the sheets and cords of relatively uniform tumor cells with foamy cytoplasm and round to oval hyperchromatic nuclei without atypia. The mitotic count was 0 per 50 high power field. A final diagnosis of glomus tumor of uncertain malignant potential was rendered. Complete surgical resection was performed, followed by adjuvant radiation due to positive margin. Neither local recurrence nor distant metastasis was observed at 2-year follow up. Unfortunately, postoperative incomplete brachial plexopathy without signs of reinnervation by electromyography was persisted. Later nerve grafting reconstruction was performed, followed by ongoing neurological rehabilitation. CONCLUSION Glomus tumor of uncertain malignant potential is exceedingly rare, especially around brachial plexus. Although the prognosis is good, careful histological diagnosis and treatment are needed to achieve an optimal outcome with lower morbidity.

关键词： Glomus tumor Glomus tumor of uncertain malignant potential Brachial plexus Case report

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Effect of lentiviral vector-mediated overexpression of hypoxia-inducible factor 1 alpha delivered by pluronic F-127 hydrogel on brachial plexus avulsion in rats

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Neural Regeneration Research 2019年第6期14卷 1069-1078页

作者： Tao Wang Li-Ni Zeng Zhe Zhu Yu-Hui Wang Lu Ding Wei-Bin Luo Xiao-Min Zhang Zhi-Wei He Hong-Fu Wu Institute of Stem Cells and Regenerative Medicine Department of PhysiologyGuangdong Medical University Department of Surgery the Third Hospital of Guangdong Medical University (Longjiang Hospital of Shunde District) Hand & Foot Surgery and Reparative & Reconstruction Surgery Center the Second Hospital of Jilin University Department of Scientific Research Center the Seventh Affiliated HospitalSun Yat-Sen University

Brachial plexus avulsion often results in massive motor neuron death and severe functional deficits of target muscles. However, no satisfactory treatment is currently available. Hypoxia-inducible factor 1α is a critical molecule targeting several genes associated with ischemia-hypoxia damage and angiogenesis. In this study, a rat model of brachial plexus avulsion-reimplantation was established, in which C5–7 ventral nerve roots were avulsed and only the C6 root reimplanted. Different implants were immediately injected using a microsyringe into the avulsion-reimplantation site of the C6 root post-brachial plexus avulsion. Rats were randomly divided into five groups: phosphate-buffered saline, negative control of lentivirus, hypoxia-inducible factor 1α(hypoxia-inducible factor 1α overexpression lentivirus), gel(pluronic F-127 hydrogel), and gel + hypoxia-inducible factor 1α(pluronic F-127 hydrogel + hypoxia-inducible factor 1α overexpression lentivirus). The Terzis grooming test was performed to assess recovery of motor function. Scores were higher in the hypoxia-inducible factor 1α and gel +hypoxia-inducible factor 1α groups(in particular the gel + hypoxia-inducible factor 1α group) compared with the phosphate-buffered saline group. Electrophysiology, fluorogold retrograde tracing, and immunofluorescent staining were further performed to investigate neural pathway reconstruction and changes of neurons, motor endplates, and angiogenesis. Compared with the phosphate-buffered saline group, action potential latency of musculocutaneous nerves was markedly shortened in the hypoxia-inducible factor 1α and gel + hypoxia-inducible factor1α groups. Meanwhile, the number of fluorogold-positive cells and ChAT-positive neurons, neovascular area(labeled by CD31 around av ulsed sites in ipsilateral spinal cord segments), and the number of motor endplates in biceps brachii(identified by α-bungarotoxin) were all visibly increased, as well as the morphology of motor endplate in biceps

关键词： nerve regeneration peripheral nerve injury brachial plexus avulsion hypoxia ischemia hypoxia-inducible factor 1αoverexpression pluronic F-127 motor neurons axonal regeneration angiogenesis neural regeneration

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Neurochemical features of endomorphin-2-containing neurons in the submucosal plexus of the rat colon

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World Journal of Gastroenterology 2015年第34期21卷 9936-9944页

作者： Jun-Ping Li Ting Zhang Chang-Jun Gao Zhen-Zhen Kou Xu-Wen Jiao Lian-Xiang Zhang Zhen-Yu Wu Zhong-Yi He Yun-Qing Li Department of Anatomy Histology and EmbryologyK.K. Leung Brain Research CentreThe Fourth Military Medical University Department of Anatomy Histology and EmbryologyNingxia Medical University Department of Anesthesiology Tangdu HospitalThe Fourth Military Medical University

AIM:To investigate the distribution and neurochemical phenotype of endomorphin-2(EM-2)-containing neurons in the submucosal plexus of the rat ***:The mid-colons between the right and left flexures were removed from rats,and transferred into Kreb's solution. For whole-mount preparations,the mucosal,outer longitudinal muscle and inner circularmuscle layers of the tissues were separated from the submucosal layer attached to the submucosal plexus. The whole-mount preparations from each rat mid-colon were mounted onto seven gelatin-coated glass slides,and processed for immunofluorescence histochemical double-staining of EM-2 with calcitonin gene-related peptide(CGRP),choline acetyltransferase(Ch AT),nitric oxide synthetase(NOS),neuron-specific enolase(NSE),substance P(SP) and vasoactive intestinal peptide(VIP). After staining,all the fluorescence-labeled sections were observed with a confocal laser scanning microscope. To estimate the extent of the co-localization of EM-2 with CGRP,Ch AT,NOS,NSE,SP and VIP,ganglia,which have a clear boundary and neuronal cell outline,were randomly selected from each specimen for this analysis. RESULTS:In the submucosal plexus of the mid-colon,many EM-2-immunoreactive(IR) and NSE-IR neuronal cell bodies were found in the submucosal plexus of the rat mid-colon. Approximately 6 ± 4.2 EM-2-IR neurons aggregated within each ganglion and a few EM-2-IR neurons were also found outside the ganglia. The EM-2-IR neurons were also immunopositive for Ch AT,SP,VIP or NOS. EM-2-IR nerve fibers coursed near Ch AT-IR neurons,and some of these fibers were even distributed around Ch AT-IR neuronal cell bodies. Some EM-2-IR neuronal cell bodies were surrounded by SP-IR nerve fibers,but many long processes connecting adjacent ganglia were negative for EM-2 immunostaining. Long VIP-IR processes with many branches coursed through the ganglia and surrounded the EM-2-IR neurons. The percentages of the EM-2-IR neurons that were also positive for Ch AT,S

关键词： Endomorphin-2 Submucosal plexus Enteric neuron Col

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Choroid plexus imaging to track neuroinflammation—a translational model for mouse and human studies

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Neural Regeneration Research 2023年第3期18卷 521-522页

作者： Muthuraman Muthuraman Mohammadsaleh Oshaghi Vinzenz Fleischer Dumitru Ciolac Ahmed Othman Sven G.Meuth Gabriel Gonzalez-Escamilla Sergiu Groppa Department of Neurology Focus Program Translational NeuroscienceRhine Main Neuroscience Network(rmn2)University Medical Center of the Johannes Gutenberg University MainzMainzGermany Department of Neuroradiology University Medical Center of the Johannes Gutenberg University MainzMainzGermany Department of Neurology Medical FacultyHeinrich-Heine-UniversityDüsseldorfGermany

The choroid plexus(ChP)is a highly vascularized and secretory tissue in each of the brain ventricles that represents the key structure between the blood and the cerebrospinal fluid(CSF).Besides its essential role in CSF production and brain waste clearance pathways,the ChP also contributes to the regulation of central nervous system(CNS)immunosurveillance(Ghersi-Egea et al.,2018).Indeed,the ChP forming the blood-CSF barrier(BCSFB)regulates the entry of immune cells and solute molecules into the brain and vice *** antigen-specific,autoreactive immune activation occurs in the periphery,inflammatory cells migrate through the brain barriers towards the CNS(Strominger et al.,2018),initiating neuroinflammatory diseases such as multiple sclerosis(MS).

关键词： al. plexus inflammation

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Beyond borders:the choroid plexus-immune communication during neuroinflammation

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Signal Transduction and Targeted Therapy 2024年第11期9卷 4763-4765页

作者： Anaelle Aurelie Dumas AdriàDalmau Gasull Marco Prinz Institute of Neuropathology University of FreiburgFaculty of MedicineFreiburgGermany Signalling Research Centres BIOSS and CIBSS University of FreiburgFreiburgGermany

In their paper published in Cell,1 Xu et *** single-cell sequencing and cell lineage tracing tools combined with two-photon live imaging to characterise the spatiotemporal immune recruitment and infiltration to the choroid plexus(ChP).They provide seminal insights into the communication between specialised ChP epithelial and macrophage populations,which coordinate the stepwise response to inflammation and its resolution.

关键词： inflammation plexus

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Laparoscopic celiac plexus ganglioneuroma resection: A video case report

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World Journal of Gastrointestinal Surgery 2019年第3期11卷 191-197页

作者： Pouya Hemmati Omar Ghanem Juliane Bingener Department of Surgery Mayo Clinic General Surgery Mosaic Life Care

BACKGROUND Ganglioneuromas are mature, benign neurogenic tumors that arise from neural crest-derived cells. Given the rarity of these tumors and their often close proximity to major vessels, there is a paucity of reports in the literature of minimally invasive resections of ganglioneuromas near the celiac plexus. We report a case of laparoscopic resection of a retroperitoneal ganglioneuroma adhering to the portal vein and celiac *** SUMMARY A 27-year-old female was referred to our medical center with a symptomatic retroperitoneal mass. Using high quality preoperative imaging and biopsies, we confirmed the diagnosis of a 4 cm ganglioneuroma abutting the celiac axis, portal vein, and the caudate lobe of the liver. We elected for laparoscopic resection after careful preoperative planning and discussions with the patient. Laparoscopy enhanced visualization of the tumor and its relationships to surrounding vital structures for optimal dissection. Ultrasonic energy devices and adjusting liver retraction to allow for manipulation of the mass facilitated a safe and effective resection in a tight space. There were no operative complications and the patient was discharged home on postoperative day 1 with no residual symptoms upon follow-up. With sufficient experience in laparoscopic surgery and preoperative imaging and diagnostics, a minimally invasive approach for removing this celiac plexus ganglioneuroma was *** In carefully selected patients, laparoscopic ganglioneuroma resection is appropriate, reducing postoperative morbidity, hospital length of stay, and recovery time.

关键词： Ganglioneuroma Celiac plexus Laparoscopic surgery Case report

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Improvements after mod Quad and triangle tilt revision surgical procedures in obstetric brachial plexus palsy

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World Journal of Orthopedics 2016年第11期7卷 752-757页

作者： Rahul K Nath Chandra Somasundaram Texas Nerve and Paralysis Institute

AIM To compare outcomes of our revision surgical operations in obstetric brachial plexus palsy(OBPP) patients to results of conventional operative procedures at other institutions. METHODS We analyzed our OBPP data and identified 10 female and 10 male children aged 2.0 to 11.8 years(average age 6.5 years), who had prior conventional surgical therapies at other clinics. Of the 20 patients, 18 undergone triangle tilt, 2 had only mod Quad. Among 18 patients, 8 had only triangle tilt and 10 had also mod Quad as revision surgeries with us. We analyzed the anatomical improvements and functional modified Mallet statistically before and after a year post-revision *** Pre-revision surgery average modified Mallet score was 12.0 ± 1.5. This functional score was greatly improved to 18 ± 2.3(P < 0.0001) at least one-year after revision surgical procedures. Radiological scores(PHHA and glenoid version) were also improved significantly to 31.9 ± 13.6(P < 0.001),-16.3 ± 11(P < 0.0002), at least one-year after triangle tilt procedure. Their mean pretriangle tilt(yet after other surgeon's surgeries) PHHA, glenoid version and SHEAR were 14.6 ± 21.7,-31.6 ± 19.3 and 16.1 ± 14.7 *** We demonstrate here, mod Quad and triangle tilt assuccessful revision surgical procedures in 20 OBPP patients, who had other surgical treatments at other clinics before presenting to us for further treatment.

关键词： Revision surgery Obstetric brachial plexus palsy Shoulder movements Joint incongruity Upper limb

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Finger movement at birth in brachial plexus birth palsy

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World Journal of Orthopedics 2013年第1期4卷 24-28页

作者： Rahul K Nath Mohamed Benyahia Chandra Somasundaram Research Division Texas Nerve and Paralysis Institute Houston TX 77030 United States

AIM: To investigate whether the finger movement at birth is a better predictor of the brachial plexus birth ***: We conducted a retrospective study reviewing pre-surgical records of 87 patients with residual obstetric brachial plexus palsy in study 1. Posterior subluxation of the humeral head(PHHA), and glenoid retroversion were measured from computed tomography or Magnetic resonance imaging, and correlated with the finger movement at birth. The study 2 consisted of 141 obstetric brachial plexus injury patients, who underwent primary surgeries and/or secondary surgery at the Texas Nerve and Paralysis Institute. Information regarding finger movement was obtained from the patient's parent or guardian during the initial ***: Among 87 patients, 9(10.3%) patients who lacked finger movement at birth had a PHHA > 40%, and glenoid retroversion 40%, and retroversion <-8° in study 1. The improvement in glenohumeral deformity(PHHA, 31.8% ± 14.3%; andglenoid retroversion 22.0°± 15.0°) was significantly higher in patients, who have not had any primary surgeries and had finger movement at birth(group 1), when compared to those patients, who had primary surgeries(nerve and muscle surgeries), and lacked finger movement at birth(group 2),(PHHA 10.7% ± 15.8%; Version-8.0°± 8.4°, P = 0.005 and P = 0.030, respectively) in study 2. No finger movement at birth was observed in 55% of the patients in this study ***: Posterior subluxation and glenoid retroversion measurements indicated significantly severe shoulder deformities in children with finger movement at birth, in comparison with those lacked finger movement. However, the improvement after triangle tilt surgery was higher in patients who had finger movement at birth.

关键词： Finger movement Triangle tilt surgery Brachial plexus birth palsy Glenohumeral dysplasia Pejorative sign

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