[Effect of extract of Ginkgo biloba leaves on expression of inducible nitric oxide synthase after sciatic nerve injury: experiment with rats].

OBJECTIVE: To investigate the effect of extract of Ginkgo biloba leaves (EGb50) on the expression of inducible nitric oxide synthase (iNOS) after sciatic nerve injury. METHODS: 156 male SD rats were randomly divided into 3 groups: experiment group (n=72), undergoing section and anastomosis of sciatic nerve and then gastric perfusion of EGb50 200 mg.kg-1.d-1; injury control group (n=72), undergoing section and anastomosis of sciatic nerve and then gastric perfusion of normal saline daily; and sham operation group (n=12), undergoing sham operation and gastric perfusion of normal saline daily. The rats were killed at different time points: 1, 3, 7, 14, 21, and 28 days after the operation. The sciatic nerve distant to the anastomotic sites with a length of 0.5 cm was cut out to undergo immunohistochemistry and RT-PCR to detect the protein and mRNA expression of iNOS. RESULTS: No obvious iNOS protein and mRNA expression was seen in the sham operation group. 3, 7, 14, and 21 days after operation the mean values of absorbance of iNOS in the sciatic nerve specimens of the experiment group were all significantly lower than those of the injury control group (P<0.05, P<0.01). High mRNA expression of iNOS began to be shown in the sciatic nerve specimens since 1day after the operation and remained at a high level till 7 days after and then began to decrease in the injury control group. The levels of mRNA expression of iNOS in the sciatic nerve specimens 1, 3, and 7 days after the operation of the experiment group were all significantly lower than those of the injury control group (all P<0.01), and there was no significant difference in the levels mRNA expression of iNOS 14, 21, and 28 days after the operation between the experiment group and injury control group (all>0.05). CONCLUSION: The extract of Gingko biloba promotes the regeneration of nervous tissues, probably by inhibiting the expression of iNOS.

Restoration of shoulder abduction by transfer of the spinal accessory nerve to suprascapular nerve through dorsal approach: a clinical study.

BACKGROUND: In recent years, transfer of the spinal accessory nerve to suprascapular nerve has become a routine procedure for restoration of shoulder abduction. However, the operation via the traditional supraclavicular anterior approach often leads to partial denervation of the trapezius muscle. The purpose of the study was to introduce transfer of the spinal accessory nerve through dorsal approach, using distal branch of the spinal accessory nerve, to repair the suprascapular nerve for restoration of shoulder abduction, and to observe its therapeutic effect. METHODS: From January to October 2003, a total of 11 patients with a brachial plexus injury and an intact or nearly intact spinal accessory nerve were treated by transferring the spinal accessory nerve to the suprascapular nerve through dorsal approach. The patients were followed up for 18 to 26 months [mean (23.5 +/- 5.2) months] to evaluate their shoulder abduction and function of the trapezius muscle. The outcomes were compared with those of 26 patients treated with traditional anterior approach. And the data were analyzed by Student's t test using SPSS 10.5. RESULTS: In the 11 patients, the spinal accessory nerves were transferred to the suprascapular nerve through the dorsal approach successfully. Intact function of the upper trapezius was achieved in all of them. In the patients, the location of the two nerves was relatively stable at the level of superior margin of the scapula, the mean distance between them was (4.2 +/- 1.4) cm, both the nerves could be easily dissected and end-to-end anastomosed without any tension. During the follow-up, the first electrophysiological sign of recovery of the infraspinatus appeared at (6.8 +/- 2.7) months and the first sign of restoration of the shoulder abduction at (7.6 +/- 2.9) months after the operation, which were earlier than that after the traditional operation [(8.7 +/- 2.4) months and (9.9 +/- 2.8) months, respectively; P < 0.05]. The postoperative shoulder abduction was 62.8 degrees +/- 12.6 degrees after transfer of the spinal accessory nerve, better than that after the traditional (51.6 degrees +/- 15.7 degrees). All the 11 patients could extend and externally rotate the shoulder almost normally. CONCLUSIONS: The accessory nerve transfer through dorsal approach is a safe and reliable procedure for the treatment of brachial plexus injury. Its postoperative effect is confirmed, which is better than that of the traditional operation.

[Impact of loss of sympathetic innervation on peripheral nerve regeneration: an experimental study with rats].

OBJECTIVE: To investigate the impact of loss of sympathetic innervation on peripheral nerve regeneration. METHODS: Thirty-two SD rats underwent resection of the right middle cervical ganglion and excision and re-anastomosis of bilateral medium nerve, and then were randomly divided into 4 equal groups to undergo the following experiments. One, 2, 3, and 4 weeks later the sensory nerve action potentials (SNAPs) of bilateral medium nerves 5 mm from the anastomotic stoma and the compound muscle action potentials (CMAPs) of bilateral superficial digital flexor muscles were measured with stimulating and recording electrodes. Specimens of the distal part of bilateral medium nerves 5 mm from the anastomotic stoma were collected to calculate the number of modulated fibers by electron microscopy. The tendons of bilateral superior digital flexor muscles were cut ant the wrist, isolated to the terminal points, ligated, and connected to a sensor so as to record the maximum contraction power. The superior digital flexor muscle was completely resected to be weighted. RESULTS: CMAP failed to be recorded 1 week later. The wave amplitude of the nerve at the affected side increased along with time, however, the CMAP wave amplitudes of the affected side were all significantly lower than those of the healthy side (all P < 0.05). The SNAP wave amplitudes of the medium nerve of both sides increased along with the time. The SNAP levels 4 and 8 weeks later of the affected side were both lower than those of the healthy side (both P < 0.05). The number of modulated fibers of the medium nerve increased along with the time, however, the number of the affected side were significantly lower than those of the healthy side (all P < 0.05). Electron microscopy showed degeneration of medulla in bilateral medium nerves 1 week later, and newborn modulated fibers began to be seen since 2 weeks later. However, there were a greater number and more complete structure in the healthy side in comparison with the affected side. The wet weights of bilateral superior digital flexor muscles decreased 2 weeks later and then began to increase gradually. However, the wet weight 4 and 8 weeks later were significantly greater in the healthy side then in the affected side (both P < 0.05). CONCLUSION: Resection of sympathetic nerve is advantageous on nerve regeneration.

[Etiologic investigation of chronic granulomatous inflammation of hand by polymerase chain reaction and DNA sequencing].

OBJECTIVE: To explore the causative pathogens in littoral hand infections which exhibited chronic granulomatous inflammation, the relationship between chronic granulomatous inflammation and mycobacteria and to discuss the prospects of PCR in clinical application for diagnosis of granulomatous inflammation. METHOD: With 16S-rDNA as the target sequence, Nest-PCR was used to detect mycobacteria directly from 37 cases of chronic granulomatous inflammations, and identified them by gene sequencing. RESULTS: Twenty-four of 37 cases were positive for mycobacteria by Nest-PCR, in which 17 were M.marinum, 1 M.chelonae, 2 M.avium, 2 M.kansasii, and 2 M.tubercular through gene sequencing. CONCLUSIONS: Nest-PCR combining gene sequencing proved to be a liable and sensitive method to detect Non-tubercular mycobacteria (NTM) in fresh tissue. NTM is the major factor of hand specific chronic infections other than tubercular. Pathological changes are difficult to differentiate TB from NTM and bacterial evidence was necessary.

[The etiological study, diagnose and therapy of hand special chronic infections in littoral area].

OBJECTIVE: To explore the etiological factors of hand special chronic infections and their relationship with tuberculosis, and to give evidence for clinical diagnosis as well as treatments. METHODS: From 2002 to 2004 pathologic inspection, acid-fast stain, bacterial cultication, mycobacterial cultivation were performed in all 29 cases of hand special chronic infections. RESULTS: All cases showed granulomatous lesions in pathological appearance, 2 positive in acid-fast stain, 12 positive in bacteria cultivation, and 1 nocardiosis, 1 staphylococcus epidermidis, 7 M.marinum, 1 M.tuberculosis, 1 M.fortuitum, 1 M.kansasii. CONCLUSIONS: Non-tuberculo-mycobacterium (NTM) especially M.marinum are far more important as the major factor than tuberculosis and other bacterial in hand special chronic infections. Bacteria cultivation should be routine examined for all cases.

[Diagnosis and treatment of upper arm radial neuritis by ultrasonography].

OBJECTIVE: To evaluate the application of ultrasonography in diagnosis and treatment of the upper arm radial neuritis. METHODS: From 2005.12 to 2011.7, 10 patients of the upper arm radial neuritis were selected and included 6 males and 4 females with an average age of 32 years old ranging from 20 to 40 years. The course of disease ranged from 4 months to 2 years. All patients feel pain on the outside of upper arm. Medical examination showed Tinel's sign masculine, and the muscle force included extension of wrist and fingers were reduced. Upper arm radial neuritis were diagnosed by clinical sign and medical examination. All patients underwent ultrasonography examination, electrophysiology examination and operation. The ultrasonography were compared to the results of electrophysiology examination,and ultrasonography were compared to intra-operative findings and pathology examination. RESULTS: The ultrasound images showed average diameter of affected limb radial nerve were (0.29+/-0.04) cm, average area were (0.23+/-0.05) cm2, and all of these were greater than uninjured side. Ultrasonograghic findings and orientation of radial neuritis were consistent with intra-operative findings,and the results of ultrasonography were consistent with the results of pathology examination. CONCLUSION: Ultrasonography examination provide morphological evidence for the diagnosis and treatment of the upper arm radial neuritis.

[Early microsurgical treatment of upper obstetrical brachial plexus injury].

OBJECTIVE: To search for the operation timing and methods for obstetrical brachial plexus injury (OBPI). METHODS: Thirty-two children with upper OBPI were treated by microsurgical procedure from October 1997 to April 2001. The average age of patients was 10 months, ranged from 3 months to 24 months; of them, 19 were below 6 months while 13 were over 6 months. Surgical procedure included neurolysis(n = 12), coaptation after resection of the neuroma without function (n = 7), phrenic nerve transfer to anterior cord of upper trunk or musculocutaneous nerve (n = 7) and intercostal nerves transfer to musculocutaneous nerve(n = 6). The children underwent operation with microsurgical technique and 7/0 or 9/0 nylon was used for nerve suture. RESULTS: Thirty cases were followed up for 21 months postoperatively; the excellent and good rate was 76.7% (23/30). The results of the children under 6 months were better than those over 6 months. CONCLUSION: The microsurgical operation might be considered at the age of 3-6 month infants who had shown little or no improvement in elbow flexion. Neurolysis and nerve coaptation are superior to neurotization. The appropriate procedure should be selected according to the findings of exploration.