Mapping Motor Neuroplasticity after Successful Surgical Brachial Plexus Reconstruction Using Navigated Transcranial Magnetic Stimulation (nTMS).

Brachial plexus reconstruction (BPR) consists of the complex surgical restoration of nerve structures. To further understand the underlying motor cortex changes and evaluate neuroplasticity after a successful surgery, we performed a navigated transcranial magnetic stimulation (nTMS) study mapping the postoperative motor representation of the formerly plegic arm. We conducted a prospective nTMS study mapping the musculocutaneous nerve as a representative, prominent target of BPR including a patient (n = 8) and a control group (n = 10). Measurements like resting motor threshold (RMT), cortical motor area location, and size were taken. Mathematical analysis was performed using MATLAB 2022, statistical analysis was performed using SPSS 26, and nTMS mapping was performed using the Nexstim NBS 5.1 system. Mapping was feasible in seven out of eight patients. Median RMT on the affected hemisphere was 41% compared to 50% on the unaffected hemisphere and they were 37% and 36% on the left and right hemispheres of the control group. The motor area location showed a relocation of bicep brachii representation at the middle precentral gyrus of the corresponding contralateral hemisphere. Motor area size was increased compared to the control group and the patient's unaffected, ipsilateral hemisphere. Understanding cortical reorganization is important for potential future treatments like therapeutic nTMS. The issue of motor neuroplasticity in patients with brachial plexus lesions is worth exploring in further studies.

Restoring musculocutaneous nerve function in 146 brachial plexus operations - A retrospective analysis.

INTRODUCTION: A brachial plexus lesion is a devastating injury often affecting young, male adults after traffic accidents. Therefore, surgical restoration of elbow flexion is critical for establishing antigravity movement of the upper extremity. We analyzed different methods for musculocutaneous reconstruction regarding outcome. METHODS: We conducted a retrospective analysis of 146 brachial plexus surgeries with musculocutaneous reconstruction performed at our department from 2013 to 2017. Demographic data, surgical method, donor and graft nerve characteristics, body mass index (BMI) as well as functional outcome of biceps muscle based on medical research council (MRC) strength grades before and after surgery were analyzed. Multivariate analysis was performed using SPSS. RESULTS: Oberlin reconstruction was the procedure performed most often (34.2%, n = 50). Nerve transfer and autologous repair showed no significant differences regarding outcome (p = 0.599, OR 0.644 CI95% 0.126-3.307). In case of nerve transfers, we found no significant difference whether reconstruction was performed with or without a nerve graft (e.g. sural nerve) (p = 0.277, OR 0.619 CI95% 0.261-1.469). Multivariate analysis identifies patient age as a strong predictor for outcome, univariate analysis indicates that nerve graft length > 15 cm and BMI of > 25 could lead to inferior outcome. When patients with early recovery (n = 19) are included into final evaluation after 24 months, the general success rate of reconstructions is 62,7% (52/83). CONCLUSION: Reconstruction of musculocutaneous nerve after brachial plexus injury results in a high rate of clinical improvement. Nerve transfer and autologous reconstruction both show similar results. Young age was confirmed as an independent predictor for better clinical outcome. Prospective multicenter studies are needed to further clarify.

Gene expression of human beta defensins-1 and -2 is significantly reduced in non-inflamed keratinized oral tissue of smokers.

OBJECTIVE: The impact of smoking on the local innate immune response in the oral cavity, and, commonly, on oral health is actively discussed in the scientific literature. The aim of the present study was to evaluate possible effects of smoking on gene expression of human beta-defensin-1 and -2 in human gingival tissue. MATERIAL AND METHODS: Biopsies of keratinized gingival tissues were taken from donors (with written informed consent) undergoing routine surgical treatment. Prior to the sample collection, participants with clinically healthy periodontium were classified as smokers (n=9) or non-smokers (n=9). Gingival tissue was homogenized, and total RNA was extracted and analysed by real-time RT-PCR for human beta-defensins-1-, -2-, and interleukins IL-1ß- and IL-6-, as well as GAPDH-mRNA. The data obtained were analysed for significant differences using the Mann-Whitney-U test. RESULTS: hBD-1- and hBD-2-, as well as IL-1ß- and IL-6-mRNA were detected in all gingival samples. Expression of hBD-1 and -2 was significantly reduced by nearly 2.5-fold (p<0.05; Mann-Whitney) in gingival samples of smokers compared to control group specimens (non-smokers). In contrast, no significant differences of the gene expression of IL-6 and IL-1ß were observed in human gingival tissue of smokers and non-smokers. CONCLUSION: The results presented here suggest that expression of human beta-defensins hBD-1 and -2, and, thus, the basal levels of innate immune defense reactions in the oral cavity are reduced by smoking.