Analysis of Nerve Endings in the Superior Labrum-Biceps Complex by Fluorescence Immunohistochemistry and Confocal Laser Microscopy / Análise de terminações nervosas no complexo labrum-bíceps superior usando imunohistoquímica de fluorescência e microscopia a laser confocal

Abstract Objectives The capsuloligamentous structures of the shoulder work as static stabilizers, together with the biceps and rotator cuff muscles, increasing the contact surface of the glenoid cavity. Free nerve endings and mechanoreceptors have been identified in the shoulder; however, there are a few studies that describe the presence of these nerves in the biceps' insertion. The present study aimed to describe the morphology and distribution of nerve endings using immunofluorescence with protein gene product 9.5 (PGP 9.5) and confocal microscopy. Methods Six labrum-biceps complexes from six fresh-frozen cadavers were studied. The specimens were coronally cut and prepared using the immunofluorescence technique. In both hematoxylin and eosin (H&E) and immunofluorescence, the organization of the connective tissue with parallel collagen fibers was described. Results In the H&E study, vascular structures and some nerve structures were visualized, which were identified by the elongated presence of the nerve cell. All specimens analyzed with immunofluorescence and confocal microscopy demonstrated poor occurrence of morphotypes of sensory corpuscles and free nerve endings. We identified free nerve endings located in the labrum and in the bicipital insertion, and sparse nerve endings along the tendon. Corpuscular endings with fusiform, cuneiform, and oval aspect were identified in the tendon. Conclusion These findings support the hypothesis that the generation of pain in the superior labral tear from Anterior to posterior (SLAP) lesions derives from the more proximal part of the long biceps cord and even more from the upper labrum. Future quantitative studies with a larger number of specimens may provide more information on these sensory systems.

Resumo Objetivos As estruturas capsulo-ligamentares do ombro funcionam como estabilizadores estáticos, juntamente com os músculos do bíceps e do manguito rotador, aumentando a superfície de contato da cavidade glenoide. Terminações nervosas livres e mecanorreceptores foram identificados no ombro; no entanto, existem alguns estudos que descrevem a presença desses nervos na inserção do bíceps. Este estudo teve como objetivo descrever a morfologia e distribuição de terminações nervosas utilizando imunofluorescência com protein gene product 9.5 (PGP 9.5) e microscopia confocal. Métodos Foram estudados seis complexos labrum-bíceps de seis cadáveres congelados frescos. Os espécimes foram cortados coronalmente e preparados pelo método de imunofluorescência. Tanto em hematoxilina e eosina (H&E) quanto em imunofluorescência, foi descrita a organização do tecido conjuntivo com fibras paralelas de colágeno. Resultados No estudo de H&E, foram visualizadas estruturas vasculares e algumas estruturas nervosas, que foram identificadas pela presença alongada da célula nervosa. Todas as amostras analisadas com imunofluorescência e microscopia confocal demonstraram baixa ocorrência de morfotipos de corpúsculos sensoriais e terminações nervosas livres. Identificamos terminações nervosas livres localizadas no labrum, inserção bicipital e terminações nervosas esparsas ao longo do tendão. Terminais corpusculares com aspecto fusiforme, cuneiforme e oval foram identificados no tendão. Conclusão Esses achados corroboram a hipótese de que a geração de dor nas lesões labrais superiores de anterior a posterior (SLAP, na sigla em inglês) deriva da parte mais proximal do cabo longo do bíceps e ainda mais do labrum superior. Estudos quantitativos futuros com um número maior de espécimes podem fornecer mais informações sobre esses sistemas sensoriais.

Tumores neurais na cavidade oral: estudo imuno-histoquímico / Neural tumors in oral cavity: immuno-histokymic study

Introdução: Os tumores neurais são lesões, que têm origem nos nervos periféricos e representam um percentual de 45% dos neoplasmas, que atingem a região de cabeça e pescoço. A alta incidência nessa área é justificada pela quantidade relativamente grande de terminações nervosas periféricas agrupadas. Ainda que sejam de mesma origem neural, sua heterogeneidade microscópica e patogenética lhes conferem um variado padrão de apresentação clínica e histopatológica, diferindo na sua forma de tratamento. O objetivo do presente estudo foi analisar, por meio da técnica imuno-histoquímica, a expressão das proteínas S100 e CD68 em tumores neurais, localizados na cavidade bucal de pacientes atendidos no Serviço de Patologia Bucal da Universidade de Odontologia de Pernambuco. Metodologia: Todos os casos referentes a tumores neurais do Serviço de Patologia oral e maxilofacial da Faculdade de Odontologia de Pernambuco foram revistos. Avaliaram-se dados relativos à idade, ao sexo e à localização anatômica. A técnica imunohistoquímica foi realizada por meio do método estreptavidina-biotina, utilizando-se os anticorpos anti: S100 e CD68. A análise foi feita de forma descritiva, conforme dados da pesquisa. Resultados: foram avaliados 23 casos de tumores neurais da cavidade bucal, 15 neurofibromas, 6 neuromas traumáticos, 1 neurilemoma e 1 neuroma encapsulado em paliçada. Verificou-se que a proteína S100 foi expressa em todos os casos estudados com positividade variada, e a proteína CD68 apresentou expressão positiva em 18 casos (neuroma traumático, neurofibroma). Conclusões: os tumores neurais da cavidade bucal foram considerados raros, visto que ocorreram em apenas 23 casos entre 5.761, ou seja, em 2,3% das lesões biopsiadas da FOP-UPE... (AU)

Introduction: Neural tumors are lesions that originate from peripheral nerves and represent a percentage of 45% of neoplasms that reach the head and neck region. The high incidence in this area is explained by the relatively large number of grouped peripheral nerve endings. Although they are of the same neural origin, their microscopic and pathogenetic heterogeneity give them a varied pattern of clinical and histopathological presentation, as well as differing in their form of treatment. The aim of the present study was to analyze by immunohistochemical technique the expression of S100 and CD68 proteins in neural tumors located in the oral cavity of patients treated at the Oral Pathology Service of the University of Dentistry of Pernambuco. Methodology: All cases referring to neural tumors of the Service of Oral and Maxillofacial Pathology of the School of Dentistry of Pernambuco were reviewed. Data regarding age, sex, and anatomical location were evaluated. The immunohistochemical technique was performed by the streptavidin-biotin method using the anti-S100 and CD68 antibodies. The analysis was made in a descriptive way according to the research data. Results: 23 cases of neural tumors of the buccal cavity, 15 neurofibromas, 6 traumatic neuromas, 1 neurilemoma and 1 palisade encapsulated neuroma were evaluated. It was verified that S100 protein was expressed in all the cases studied with varied positivity, and the CD68 protein showed positive expression in 18 cases (traumatic neuroma, neurofibroma). Conclusions: Neural tumors of the oral cavity were considered rare, since they occurred in only 23 cases among 5,761, that is, 2.3% of FOP-UPE biopsied lesions... (AU)

role of botulinum toxin a in treatment of temporomandibular joint disorders: a review

Temporomandibular joint disorders [TMDs] usually present with symptoms and signs such as pain, mandibular movement, dysfunction, or joint sounds. Botulinum toxin type A [BTX-A] is a biologic toxin which inhibits skeletal muscle through hindering the production of acetylcholine in the nerve endings. This toxin is used for the treatment of hyperactivity of lateral pterygoid muscle and TMD symptoms. This comprehensive review aimed to evaluate the effect of BTX-A injections in the lateral pterygoid muscle on treatment of TMDs symptoms.In this study, online databases including Scopus, Medline, Ebsco, Cochrane, EMBASE, and Google scholar were searched for the keywords [pterygoid muscle] and [Onabotulinumtoxin A]

Twenty-four articles were eligible to be enrolled in the study. In 4 interventional studies and 20 descriptive studies, BTX-A was used for the treatment of TMDs. The dosage and number of injections were different in each study; however, the injection methods were relatively similar. Regardless of the type, number of injections, and dosage, injection of BTX-A in lateral pterygoid seems effective in reducing the click sound and other TMJ-related muscle disorders such as pain, hyperactivity, and dysfunction

Neurogenic pathways in remote ischemic preconditioning induced cardioprotection: Evidences and possible mechanisms

Remote ischemic preconditioning (RIPC) is an intrinsic phenomenon whereby 3~4 consecutive ischemia-reperfusion cycles to a remote tissue (noncardiac) increases the tolerance of the myocardium to sustained ischemiareperfusion induced injury. Remote ischemic preconditioning induces the local release of chemical mediators which activate the sensory nerve endings to convey signals to the brain. The latter consequently stimulates the efferent nerve endings innervating the myocardium to induce cardioprotection. Indeed, RIPC-induced cardioprotective effects are reliant on the presence of intact neuronal pathways, which has been confirmed using nerve resection of nerves including femoral nerve, vagus nerve, and sciatic nerve. The involvement of neurogenic signaling has been further substantiated using various pharmacological modulators including hexamethonium and trimetaphan. The present review focuses on the potential involvement of neurogenic pathways in mediating remote ischemic preconditioning-induced cardioprotection.

Gene Therapy for Hearing Protection / 대한이비인후과학회지

Sensorineural hearing loss (SNHL) does not recover and only few exceptions exist. It is mostly due to the reason that hair cells in the cochlea cannot regenerate once damaged. Therefore, clinical approaches for SNHL mostly rely on the implantable or external device to deliver sound to brain. Despite the advance of technology, current strategy does not replicate the sound perception of naïve inner ear. To overcome this issue, novel trials to protect or rescue hair cells from the ototoxic insults are investigated. One of these is gene therapy. Protective gene therapy has been applied to several ototoxic insults, but some trials have shown negative effect. Gene therapy using neurotrophin, one of the growth factor, has been expected to show protective effect against acoustic overexposure. But unregulated and untargeted expression of Ntf3 revealed adverse effect showing deterioration of nerve ending and synapse. Meanwhile, gene therapies have been adopted and tried for cisplatin ototoxicity. Most of the studies has been shown promising outcome. Also several studies have shown protective effect of gene therapy for aminoglycoside ototoxicity. Recent publication showed that heat-shock protein 70 was effective in preventing aminoglycoside ototoxicity. Furthermore, use of gene therapy expands to the field of cochlear implant, in which it can be used as an enhancer of treatment outcome. Application of neurotrophins resulted in increase of spiral ganglion densities as well as migration of peripheral nervous fibers to the location which would be closer to the electrode when implanted.

Análise dos mecanorreceptores e terminações nervosas livres da banda anterior doligamento glenoumeral inferior com imunofluorescência e microscopia confocal

A banda anterior do ligamento glenoumeral inferior(LGUI), possui uma importante função na estabilidade mecânica do ombro, sendo onsiderado o principal estabilizador estático do ombro, quando o braço encontra-se em abdução e rotação externa. Seis bandas anteriores do LGUI foram cuidadosamente dissecadas para avaliaçãoda morfologiados mecanorreceptorese terminações nervosas livres, buscando compreender a interação do sistema proprioceptivo e mecânico do ombro. Para imunihistoquimica foi utilizado um marcador tipo PGP9.5 (protein gene product)como anticorpo primário e Alexa Fluor 488 como anticorpo secundário, seguido de análise daslâminas pormicroscopia confocal de varredura a laser. Observou-se em todos os ligamentos corpúsculos de Meissnercom diâmetros queentre 30 e 65 μme comprimentos entre 80 e 400 μm,sendo estes descritos pela primeira vez no ligamento glenoumeral inferior;o corpúsculo dePacini, com diâmetro entre 40 e 80 μm e comprimento entre 100 e 180 μme terminações nervosas livres, onde as fibras apresentavam espessura entre 3 e 7 μm e comprimento entre 300 e 700 μm, além de terminações nervosas não classificadas, com formas irregulares, fusiformes e retangulares. Observamos que na banda anterior do ligamento glenoumeral inferior opredomínio de mecanorreceptores de adaptação rápida, tipo Meissner e Pacini. A densidade dos mecanorreceptores foi de aproximadamente 1,1026% ,sendo a densidadede 1,6102% quando a analise foi com profundidade entre 400 e 500 μme de 0,6018%...

The anterior band of the inferior glenohumeral ligament (IGHL) has an important role in the mechanical stability of the shoulder and is considered the main static stabilizer of the shoulder when the arm is in abduction and external rotation. Six anterior bands of IGHL were carefully dissected from the bone attachments to describe the morphology of the mechanoreceptors and free nerve endings and to elucidate the interaction between the proprioceptive system and shoulder mechanics. For immunostaining, a protein gene product 9.5 marker was used as the primary antibody and Alexa Fluor 488 was used as the secondary antibody, followed by image examination using confocal laser scanning microscopy. All the ligament samples contained Meissner corpuscles with a diameter between 30 and 65 μm and length between 80 and 400 μm. This is the first report of these corpuscles in IGHL. Furthermore, these ligaments contained Pacinian corpuscles, with a diameter between 40 and 80 μm and length between 100 and 180 μm, free nerve endings with fiber thickness between 3 and 7 μm and length between 300 and 700 μm, and unclassified nerve endings with irregular, spindle, and rectangular shapes. The mechanoreceptors were approximately 1.2% of the area of the ligament. There was a predominance of Meissner-and Pacini-type rapidly adapting mechanoreceptors.The density ofmechanoreceptorswas approximately 1.1026%, and the densitywhen the analysis was with a depthbetween 400 and 500μmwas 1.6102% and greaterdepthbetween 1500and 1850μm, was 0.6018%...

Terminações nervosas e suprimento vascular em tendão semitendíneo de crianças com paralisia cerebral / Nerve endings and vascular supply in semitendinosus tendon of cerebral palsy children

Objetivo: Avaliar a distribuição de substância P (SP) e imunorreatividadedo peptídeo S-100, bem como o suprimento vascular de tecidoscomumente usados como enxertos na reconstrução do ligamentocruzado anterior (LCA). Um segundo objetivo foi comparar a distribuiçãoacima mencionada nos tendões do músculo semitendíneo depacientes com paralisia cerebral (PC) com os tendões do músculosemitendíneo e tendões patelares de pacientes sem PC. Métodos:O primeiro grupo era composto por 14 crianças com paralisia cerebral,com média de idade de 11,7 anos. No momento da operaçãode alongamento dos isquiotibiais, uma amostra de músculo semitendíneofoi retirada para análise. O segundo grupo era composto por20 pacientes tratados por ruptura isolada do LCA do joelho (idademédia de 32 anos). O grupo três era composto por dez pacientescom idade média de 14,3 anos tratado de recorrente luxação dapatela lateral, e de quem foi obtida uma amostra de tendão patelar.Resultado: Não houve diferenças estatisticamente significativas noque diz respeito à quantidade de fibras nervosas imunopositivas queexpressam SP ou S-100 em todos os três grupos de pacientes. Umadiferença significativa foi observada no número de vasos sanguíneosentre músculos semitendíneo do adulto e da criança, mas não entreo músculo semitendíneo e o tendão patelar das crianças. Conclusão:O número de nociceptores, bem como de fibras proprioceptivas, ésemelhante em pacientes com PC e pacientes de uma populaçãoneurologicamente saudável. Nível de Evidência IV, Série de Casos.

Objective: To evaluate the distribution of SP (substance P) andS-100 peptide immunoreactivity, as well as the vascular supplyof tissues commonly used as grafts for anterior cruciate ligament(ACL) reconstruction. A second aim was to compare the abovementioned distribution in the semitendinosus muscle tendonsof cerebral palsy (CP) patients with the semitendinosus muscletendons and patellar tendons of patients without CP. Methods:The first group consisted of 14 children with cerebral palsy witha mean age of 11.7 years old. At the time of hamstring lengtheningoperation, a sample of semitendinosus muscle was takenfor analysis. The second group comprised 20 patients treated forisolated ACL rupture of the knee (mean age 32 years old). Groupthree comprised ten patients in the mean age of 14.3 years oldtreated for recurrent lateral patellar dislocation, and from whoma sample of patellar tendon was obtained. Results: No statisticallysignificant differences were demonstrated with regard to theamount of immunopositive nerve fibers expressing SP or S-100 inall 3 groups of patients. A significant difference was noted in thenumber of blood vessels between the adult and child semitendinosusmuscles, but not between the semitendinosus musclesand patellar tendon of children. Conclusion: The number of nociceptorsas well as proprioceptive fibers is similar in patients withCP and patients from a neurologically healthy population. Levelof Evidence IV, Cases Series.

Accessory mental foramen: A rare anatomical variation detected by cone-beam computed tomography

The mental foramen is a bilateral opening in the vestibular portion of the mandible through which nerve endings, such as the mental nerve, emerge. In general, the mental foramen is located between the lower premolars. This region is a common area for the placement of dental implants. It is very important to identify anatomical variations in presurgical imaging exams since damage to neurovascular bundles may have a direct influence on treatment success. In the hemimandible, the mental foramen normally appears as a single structure, but there are some rare reports on the presence and number of anatomical variations; these variations may include accessory foramina. The present report describes the presence of accessory mental foramina in the right mandible, as detected by cone-beam computed tomography before dental implant placement.

Case-control study on the relationship of chronic low back pain of facet joint origin with the distribution of nerve endings and neuropeptide: a quantitative histological analysis / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the density and distribution of nerve endings and neuropeptide Y (NPY) in lumbar facet joints of patients with low back pain.</p><p><b>METHODS</b>Fifteen patients without low back pain were selected as control group (group A). Facet joint samples in group A were obtained during the operation or lumbar spinal canal tumor they suffered from. Those patients with low back pain were divided into three groups according to their different origins of pain, such as not from facet joint (group B, 15 patients) ,from facet joint only (group C, 20 patients), or from facet joint partially (group D, 20 patients). Different origins were determined by VAS after facet joint block. The density and distribution of nerve ending and neuropeptide in the capsular tissues were analyzed by a modified gold chloride staining and immunochemistry respectively.</p><p><b>RESULTS</b>Compared with the ones in group A and B, the fact joints in group C and D were more inclined to be degenerated and got more nerve endings. NPY was expressed mainly in the facet joint of patients with low back pain in group C and D. In addition, there was a significant relationship between the distribution of nerve endings and NPY expression,while none of them were related with MRI Fujiwara grade of facet joint.</p><p><b>CONCLUSION</b>These results suggest that the number of mechanoreceptors, neural sprouting and secreted peptides in the facet joint capsules vary with the change of mechanical or nociceptive stimulation, which may promote the development of low back pain in return.</p>

Diagnosis and management of muscle pain

Muscle pain is one of the most common, as well as elusive, clinical complaints. Pain can be experienced in muscles by any dysfunction of the muscle itself, peripheral nerves, or central nervous system. Persistent inflammation of the muscle increases nerve endings of the nociceptors and can develop allodynia or hyperalgesia. Myofascial trigger points are formed by perpetuating contraction of the sarcomeres and local ischemia and can result in regional pain. Disorders of the peripheral nervous system can entail muscle pain in the innervated territory. The central nervous system can also modulate or generate muscle pain. Gate-control theory provides an explanation as to how pain can be affected by the nervous system. Fibromyalgia is believed to be related to a lowered pain threshold in the central nervous system. Clinicians, during their diagnostic approach, should not unduly attribute muscle pain to pathology confined to the muscle merely because pain is perceived and evoked from the muscle. Even in cases where abnormalities are confirmed in the muscle, such as myofascial trigger points, clinicians should seek the underlying etiology. In particular, diagnosis of myofascial pain syndrome does not rule out primary musculoskeletal disorders. Rather, arthropathies or radiculopathies are known to frequently involve myofascial pain syndrome, which would not improve unless they are resolved. After accurate diagnosis of muscle pain is obtained, appropriate treatment should be implemented. A multi-disciplinary, individualized approach, including physiotherapy, exercise, education, and behavioral modification, is recommended.

Origem e distribuição do plexo braquial de Saimiri sciureus / Origin and distribution of the brachial plexus of Saimiri sciureus

Os autores descreveram a origem e composição do plexo braquial de quatro Saimiri sciureus, pertencentes ao Centro Nacional de Primatas (Cenp), Ananindeua/PA, os quais foram fixados com formaldeído e dissecados. Os achados revelaram que o plexo braquial desta espécie é constituído por fibras neurais provenientes da união das raízes dorsais e ventrais das vértebras cervicais C4 a C8 e torácica T1, e organizado em quatro troncos. Cada tronco formou um nervo ou um grupo de nervos, cuja origem variou entre os animais; na maioria, foi encontrado o tronco cranial originando o nervo subclávio, o tronco médio-cranial dando origem aos nervos supraescapular, subescapular, parte do radial, e em alguns casos ao nervo axilar, nervo musculocutâneo e ao nervo mediano; o tronco médio-caudal formou parte do nervo radial, e em alguns casos os nervos axilar, nervo musculocutâneo, nervo mediano, nervo toracodorsal, nervo ulnar e nervo cutâneo medial do antebraço, sendo os dois últimos também originados no tronco caudal.

The authors described the origin and composition of the brachial plexus of four Saimiri sciureus, from the National Primate Center (Cenp), Ananindeua/PA, which were fixed with formaldehyde and dissected. Findings revealed that the brachial plexus of this species is composed by nervous fibers from the roots of cervical vertebrae C4 to C8 and thoracic vertebrae T1, and organized into four branchs. Each branch has formed a nerve or a group of nerves, the origin was varied between animals, mostly were found the cranial trunk originate the subclavian nerve; the medium-cranial originate the suprascapular, subscapular, part of radial and in some cases the axillary, musculocutaneous and median nerves; the medium-caudal trunk originate part of radial nerve and in some cases the axillary, musculocutaneous, median, thoracodorsal, ulnar and medial cutaneous of forearm nerves, the last two nerves also originate from the caudal trunk.

Nerve growth factor with fibrin glue in end-to-side nerve repair in rats / Fator de crescimento nervoso em cola de fibrina no reparo término-lateral de nervos em ratos

PURPOSE: To determine the effects of end-to-side nerve repair performed only with fibrin glue containing nerve growth in rats. METHODS: Seventy two Wistar rats were divided into six equal groups: group A was not submitted to nerve section; group B was submitted to nerve fibular section only. The others groups had the nerve fibular sectioned and then repaired in the lateral surface of an intact tibial nerve, with different procedures: group C: ETS with sutures; group D: ETS with sutures and NGF; group E: ETS with FG only; group F: ETS with FG containing NGF. The motor function was accompanied and the tibial muscle mass, the number and diameter of muscular fibers and regenerated axons were measured. RESULTS: All the analyzed variables did not show any differences among the four operated groups (p>0.05), which were statistically superior to group B (p<0.05), but inferior to group A (p>0.05). CONCLUSION: The end-to-side nerve repair presented the same recovery pattern, independent from the repair used, showing that the addition of nerve growth factor in fibrin glue was not enough for the results potentiating.

OBJETIVO: Determinar os efeitos do reparo nervoso término-lateral realizado apenas com cola de fibrina contendo fator de crescimento nervoso em ratos. MÉTODOS: Setenta e dois ratos Wistar foram distribuídos em seis grupos: A - não submetido à secção nervosa; B - secção do nervo fibular (sem reparo); Os outros grupos tiveram o nervo fibular seccionado e então reparado na superfície lateral do nervo tibial intacto, com diferentes procedimentos: C - RNTL com suturas; D - RNTL com suturas e FCN; E - RNTL apenas com CF; F - RNTL com CF contendo FCN. A função motora foi acompanhada e a massa do músculo tibial, o número e o diâmetro das fibras musculares e axônios regenerados foram medidos. RESULTADOS: Não houve diferença entre as variáveis avaliadas nos quatro grupos operados (p>0,05), os quais foram superiores ao grupo B (p<0,05), mas inferiores ao grupo A (p>0,05). CONCLUSÕES: O reparo nervoso término-lateral mostrou o mesmo padrão de recuperação, independente do tipo de reparo utilizado, evidenciando que a adição de fator de crescimento nervoso na cola de fibrina não foi suficiente para a potencialização dos resultados.

The Histologic Mapping of Sensory Innervation in the Human Anterior Cruciate Ligament / 대한스포츠의학회지

Recently, rising curiosity on remnant preservation technique of anterior cruciate ligament (ACL) reconstruction, there is much interested in being and distribution of the mechanoreceptor of ACL. So, we performed histologic analyzing and mapping of sensory nerve fiber of the human ACL in this study. Total of 20 anterior cruciate ligaments were obtained from total knee replacement. Each ACL samples was divided into seven specimens; tibial insertion site, mid transitional site, femoral insertion site, and in between the sites, and total of 140 tissue samples were stained with hematoxylin-eosin and immunohistochemical, and observed with light microscope. Five hundred thirty-four fine neuroparticle structures, Ruffini corpuscles, and free nerve endings were observed in 20 ACL samples. The mean of fibers observed were 1.88, 1.71, 1.15, 1.08, 1.15, 1.55, and 1.82, respectively from tibial insertional site to femoral insertional site. With immunohistochemical stain, S-100 protein was strong positive at nerve cells, but was weak positive or negative at neurofilament. Mapping of sensory nerve distribution were done based on the results. We identified the mechanoreceptor of the human ACL using optical and immunohistochemical methods and mapped the histologic distribution of that.

An Anatomic Study of the Extensor Tendons of the Human Hand

PURPOSE: Hands are the chief organs for physically manipulating the environment, using anywhere from the roughest motor skills to the finest, and since the fingertips contain some of the densest areas of nerve endings on the human body, they are continuously used organ with complex functions, and therefore, often gets injured. To prevent any functional loss, a detailed anatomical knowledge is required to have a perfect surgical treatment. Also it is necessary to have a thorough understanding of arrangements of the human extensor tendons and intertendinous connections when tenoplasty or tendon transfer is required. We performed a study of the arrangements of the human extensor tendons and the configuration of the intertendinous connections over the dorsum of the wrist and hand. METHODS: A total of 58 hands from Korean cadavers were dissected. The arrangements of extensor indicis proprius, extensor digitorum communis, and extensor digiti minimi tendons and intertendinous connections were studied. RESULTS: The most common distribution patterns of the extensor tendons of the fingers were as follows: a single extensor indicis proprius(EIP) tendon which inserted ulnar to the extensor digitorum-index(EDC-index); a single EDC-index; a single EDC-middle; a double EDC-ring; an absent EDC-little; a double extensor digiti minimi(EDM), a single EDC-index(98.3%), a single EDC-middle(62%), a double EDC-ring(50%), and an absent(65.5%) or a single (32.8%) EDC-little. A double(70.6%) EDM tendons were seen. Intertendinous connections were classified into 3 types: type 1 with thin filamentous type, type 2 with a thick filamentous type, and type 3 with a tendinous type subdivided to r shaped 3r type and y shaped 3y type. The most common patterns were type 1 in the 2nd intermetacarpal space, type 2 in the 3rd intermetacarpal space, and type 3r in the 4th intermetacarpal space. And in the present study, we observed one case of the extensor digitorum brevis manus(EDBM) on the boht side. CONCLUSION: A knowledge of both the usual and possible variations of the extensor tendon and the intertendinous connection is useful in the identification and repair of these structures.

Effects of tension relaxation by small needle knife on muscle tension and nerve endings after compression of gracilis muscle in rats / 中国骨伤

<p><b>OBJECTIVE</b>To determine the effect of tension relaxation by small needle knife on the muscle tension and morphology changes of nerve terminals when sustained pressure was applied to muscular tissue.</p><p><b>METHODS</b>Rat gracilis muscles were exposed to pressure in vivo at 70 kPa for 2 hours. Sixty rats were divided into three groups: normal, control and experiment group respectively. In all rats except the six normal ones, the lower legs were considered as the control group, and the right left as experiment group. At day 1, 2 and 3, 9 rats from the two groups were randomly selected and sacrificed in order to determine the muscle tension change. At the same time, muscle histology and morphology changes of nerve terminals were observed.</p><p><b>RESULTS</b>Abnormal tension increased in muscles under compression of 70 kPa. At the 1st and 2nd days, there were no significant differences between the two groups. Compared with control group, the tension was lower in experiment group, and there was statistically significant difference (P < 0.01) between the two groups. Exposure of striated muscle tissue to intensive and prolonged compression may pathologically alter its microstructure. Histological evaluation showed that this stiffening accompanied extensive necrotic damage. The changes could not be found in the nerve terminals.</p><p><b>CONCLUSION</b>Deep muscle tissue that undergoes prolonged compression may significantly increase its stiffness during acute injury. Tension relaxation applied by small needle knife can effectively reduce the mechanical load which is harmful to the whole tissue.</p>

The Efficacy of Epidural Ketamine on Shivering during Transurethral Resection of the Prostate under Epidural Anesthesia / 대한배뇨장애요실금학회지

PURPOSE: Ketamine may decrease core-to-peripheral redistribution of heat through direct central sympathetic stimulation and inhibition of norepinephrine uptake into postganglionic sympathetic nerve endings. The purpose of this study was to evaluate the efficacy of epidural ketamine in preventing shivering during transurethral resection of the prostate (TURP) under epidural anesthesia. MATERIALS AND METHODS: Ninety-three male patients scheduled for TURP under epidural anesthesia were enrolled in this study. Patients were randomized into one of three groups. Group 1 consisted of 31 patients who received epidural 0.75% ropivacaine, group 2 consisted of 32 patients who received epidural ketamine (0.2 mg/kg) in addition to 0.75% ropivacaine, and group 3 consisted of 30 patients who received epidural ketamine (0.4 mg/kg) in addition to 0.75% ropivacaine. Shivering and side effects such as hypotension, bradycardia, nausea, and hallucination were recorded during the anesthesia and for 2 hours while in the postanesthetic recovery room. RESULTS: Shivering was statistically more frequent in group 1 than in the other groups. The incidence of sedation was significantly higher in group 3 than in the other groups. The incidences of side effects such as hypotension, bradycardia, and nausea were significantly higher in group 1 than in the other groups. CONCLUSIONS: In this study, epidural ketamine 0.2 mg/kg and 0.4 mg/kg was shown to have a lower incidence of shivering and other side effects except sedation. In patients who undergo TURP under epidural anesthesia, the prophylactic use of low-dose epidural ketamine would be helpful in preventing any adverse effects, including shivering.

Chromaffin cells in the adrenal medulla of the mouse: a morphological study of their innervation

To study the synaptic nerve endings on the adrenaline [A], noradrenaline [NA] and small granular Chromaffin [SGC] cells of the mouse before and after puberty and the possible functional relationship between these cells. Male albino mice bred at the animal house-Jordan University, which aged 5, 10 and 12 days and 5 weeks were used. After sacrifice, the adrenal glands were removed from the animals and processed for examination with a Philips 300 electron microscope. The percentage of SGC cells and the number of synaptic endings on A and NA cells were calculated. All the nerve endings observed are typical in appearance with the cholinergic-type synaptic endings. No evidence of an adrenergic innervation of Chromaffin tissue of the adrenal medulla has been obtained during the present work, though the elongated processes of small granular Chromaffin cell could readily be misinterpreted as adrenergic nerve fibres. The processes of these cells come close to other Chromaffin cells, both A, NA cell and form synapses. Frequent exocytotic figures related to these cells were observed. The present findings suggest that the SGS cells form an intrinsic system that regulates the activity of other chromaffin cells, particularly in the early postnatal period when the extrinsic innervation of the chromaffin cells is not yet fully developed

Effect of Thiazolidinediones Administration on Neurochemical Composition of MPG Neurons Related to Erection in OLETF Rat / 대한해부학회지

The main transmitter substance mediating erection is the nitric oxide released from the vascular endothelial cells of corpus cavernosum and from the nonadrenergic, noncholinergic nerve endings. In addition, some neurotransmitters, such as acetylcholine or vasoactive intestinal polypeptide (VIP), have been reported to play an important role in mediating the erection. Thus, autonomic neuropathy may cause erectile dysfunction, and in reality, it occurs frequently in individuals with diabetes mellitus (DM), in which polyneuropathy, including both peripheral somatic sensorimotor neuropathy and autonomic neuropathy, develops usually. Thiazolidinedione (TZD) is an insulin-sensitizing agent used for the treatment of type 2 DM with insulin resistance, and has been reported to ameliorate nephropathy, decrease plasma glucose level and reduce blood pressure. However, the effect of this drug on the neuropathy related to erectile dysfunction has never been proved. In the present study, to evaluate the effect of TZDs on the neuropathy concerned with erectile dysfunction, we examined neurochemical changes of major pelvic ganglion (MPG) neurons in Otsuka Long Evans Tokushima Fatty (OLETF) rats, genetic models with non-insulin-dependent DM, after TZDs (pioglitazone and rosiglitazone) treatment. Age-matched nondiabetic Long Evans Tokushima Otsuka (LETO) rats were used as controls. Nitric oxide synthase (NOS), tyrosine hydroxylase (TH), VIP, and neuropeptide Y (NPY) contents were measured in MPG neurons of LETO, OLETF and pioglitazone- or rosiglitazone-treated OLETF rats by morphometry. Compared to the corresponding LETO group, number of TH-, NOS- and VIP-immunoreactive (ir) neurons decreased, while that of NPY-ir neurons, which modulate noradrenergic vasoconstriction of penile arteries, increased in the MPG of the OLETF group. After administration of pioglitazone- or rosiglitazone to OLETF rats for 23 weeks, these neurochemical changes were recovered to the control levels of the LETO group, although some variations were accompanied. These results suggest that TZDs treatment may be helpful for the treatment of autonomic neuropathy concerned with erectile dysfunction.

Dolor: la verdadera realidad / Pain: a genuine reality

El dolor es un síntoma frecuente, manifestado por los pacientes en diferentes situaciones, entre las cuales se encuentra la persona hospitalizada en la unidad de cuidado intensivo (UCI). En estas áreas, en ocasiones, el dolor es subvalorado y, por tanto, apenas tratado. Las respuestas psicológicas, hemodinámicas, metabólicas y neuroendocrinas provocadas por un control inadecuado del dolor pueden producir mayor morbilidad e incluso mortalidad. Es por esto que la evaluación del dolor se ha convertido en un reto para los profesionales de la salud, en especial para los enfermeros y las enfermeras ya que son quienes proporcionan cuidado directo y permanente; además, poseen la capacidad de detectar y controlar el dolor y el sufrimiento de los pacientes, como un principio fundamental para su valoración. Con frecuencia se pasa por alto la importancia de un conocimiento integral que permita comprender no solo los cambios fisiológicos sino la influencia del dolor en la vida del paciente y su entorno. Este artículo tiene como objetivo analizar la necesidad de aplicar en la práctica diaria la teoría de los síntomas desagradables, como una herramienta para evaluar el dolor y entender el significado integral de éste, conocer las características que son propias de cada individuo al igual que sus factores fisiológicos, psicológicos y ambientales. Para este fin se revisarán conceptos generales sobre dolor, teorías de mediano rango, y la aplicación de la teoría de síntomas desagradables que permite evaluar de una forma adecuada y oportuna el dolor en los pacientes en situación crítica.

Morphological study on the role of ICC-like cells in detrusor neuro-modulation of rat urinary bladder / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the role of ICC-like cells in bladder neuromodulation in rat urinary bladder.</p><p><b>METHODS</b>14 SD rats and 1 guinea pig were sacrificed in this study. The ultra structural relationships among interstitial cells, nerves and detrusor smooth muscle cells (DSMCs) of urinary bladder were investigated by transmission electron microscopy (TEM). c-kit immunofluorescence was used to identify ICC-like cells in SD rat urinary bladder and the structural relationship between ICC-like cells and nerve terminals was studied by immunofluorescence (double-label).</p><p><b>RESULTS</b>Gap junction between ICC-like cells and DSMCs was confirmed by TEM. ICC-like cells were very close apposition with nerve terminals under TEM. ICC-like cells were identified to exist in sub-urothelium layer, along the longitude of smooth muscle bundles and among detrusor smooth muscle in SD rat urinary bladder by c-kit immunofluorescence. Double-labeled tissue with c-kit and PGP9.5 antibodies also showed that ICC-like cells were very close apposition with nerve terminals in SD rat bladder.</p><p><b>CONCLUSIONS</b>Morphological study indicated that ICC-like cells in rat urinary bladder may play an important role in detrusor neuromodulation. Further study on function will be helpful for elucidating the mechanism of bladder neuromodulation clearly.</p>