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Glia Feb 2021Schwann cells within the peripheral nervous system possess a remarkable regenerative potential. Current research shows that peripheral nerve-associated Schwann cells... (Review)
Review
Schwann cells within the peripheral nervous system possess a remarkable regenerative potential. Current research shows that peripheral nerve-associated Schwann cells possess the capacity to promote repair of multiple tissues including peripheral nerve gap bridging, skin wound healing, digit tip repair as well as tooth regeneration. One of the key features of the specialized repair Schwann cells is that they become highly motile. They not only migrate into the area of damaged tissue and become a key component of regenerating tissue but also secrete signaling molecules to attract macrophages, support neuronal survival, promote axonal regrowth, activate local mesenchymal stem cells, and interact with other cell types. Currently, the importance of migratory Schwann cells in tissue regeneration is most evident in the case of a peripheral nerve transection injury. Following nerve transection, Schwann cells from both proximal and distal nerve stumps migrate into the nerve bridge and form Schwann cell cords to guide axon regeneration. The formation of Schwann cell cords in the nerve bridge is key to successful peripheral nerve repair following transection injury. In this review, we first examine nerve bridge formation and the behavior of Schwann cell migration in the nerve bridge, and then discuss how migrating Schwann cells direct regenerating axons into the distal nerve. We also review the current understanding of signals that could activate Schwann cell migration and signals that Schwann cells utilize to direct axon regeneration. Understanding the molecular mechanism of Schwann cell migration could potentially offer new therapeutic strategies for peripheral nerve repair.
Topics: Axons; Humans; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Schwann Cells
PubMed: 32697392
DOI: 10.1002/glia.23892 -
Physical Medicine and Rehabilitation... May 2022Ultrasound techniques and peripheral nerve stimulation have increased the interest in peripheral nerve injections for chronic pain. The knowledge of anatomy and nerve... (Review)
Review
Ultrasound techniques and peripheral nerve stimulation have increased the interest in peripheral nerve injections for chronic pain. The knowledge of anatomy and nerve distribution patterns is paramount for optimal use of peripheral nerve blocks in the management of chronic pain conditions. They are an important tool in an interventional pain physician's armamentarium and can be integrated into pain practices effectively to offer patients pain relief.
Topics: Chronic Disease; Chronic Pain; Humans; Nerve Block; Pain Management; Peripheral Nerves
PubMed: 35526981
DOI: 10.1016/j.pmr.2022.02.004 -
The Orthopedic Clinics of North America Apr 2022Tension-free primary digital nerve repair may be unachievable in the presence of a nerve defect and require digital nerve reconstruction. Multiple techniques are... (Review)
Review
Tension-free primary digital nerve repair may be unachievable in the presence of a nerve defect and require digital nerve reconstruction. Multiple techniques are available for reconstruction of a digital nerve defect using conduits, autograft, and allograft. Multiple comparison studies exist in the literature, suggesting similar results with autograft and allograft reconstruction, with several comparison studies suggesting inferior outcomes with conduit repair.
Topics: Humans; Neurosurgical Procedures; Peripheral Nerve Injuries; Peripheral Nerves; Plastic Surgery Procedures; Transplantation, Autologous
PubMed: 35365263
DOI: 10.1016/j.ocl.2021.12.003 -
British Journal of Anaesthesia Apr 2021Rebound pain is a common, yet under-recognised acute increase in pain severity after a peripheral nerve block (PNB) has receded, typically manifesting within 24 h after...
BACKGROUND
Rebound pain is a common, yet under-recognised acute increase in pain severity after a peripheral nerve block (PNB) has receded, typically manifesting within 24 h after the block was performed. This retrospective cohort study investigated the incidence and factors associated with rebound pain in patients who received a PNB for ambulatory surgery.
METHODS
Ambulatory surgery patients who received a preoperative PNB between March 2017 and February 2019 were included. Rebound pain was defined as the transition from well-controlled pain (numerical rating scale [NRS] ≤3) while the block is working to severe pain (NRS ≥7) within 24 h of block performance. Patient, surgical, and anaesthetic factors were analysed for association with rebound pain by univariate, multivariable, and machine learning methods.
RESULTS
Four hundred and eighty-two (49.6%) of 972 included patients experienced rebound pain as per the definition. Multivariable analysis showed that the factors independently associated with rebound pain were younger age (odds ratio [OR] 0.98; 95% confidence interval [CI] 0.97-0.99), female gender (OR 1.52 [1.15-2.02]), surgery involving bone (OR 1.82 [1.38-2.40]), and absence of perioperative i.v. dexamethasone (OR 1.78 [1.12-2.83]). Despite a high incidence of rebound pain, there were high rates of patient satisfaction (83.2%) and return to daily activities (96.5%).
CONCLUSIONS
Rebound pain occurred in half of the patients and showed independent associations with age, female gender, bone surgery, and absence of intraoperative use of i.v. dexamethasone. Until further research is available, clinicians should continue to use preventative strategies, especially for patients at higher risk of experiencing rebound pain.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Autonomic Nerve Block; Cohort Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Peripheral Nerves; Retrospective Studies; Young Adult
PubMed: 33390261
DOI: 10.1016/j.bja.2020.10.035 -
Hand Clinics Aug 2021With the development of newer techniques for symptomatic neuroma treatment, such as regenerative peripheral nerve interface and targeted muscle reinnervation,... (Review)
Review
With the development of newer techniques for symptomatic neuroma treatment, such as regenerative peripheral nerve interface and targeted muscle reinnervation, transposition and coverage techniques often have been referred to as "passive techniques." In spite of its negative connotation, these passive techniques yield positive results in a majority of patients treated. The experienced surgeon has more options than ever before in the prevention and management of problematic neuromas. Critical appraisal of the current literature reveals no single, optimal standard of care. Instead, surgeons have a plethora of useful techniques that can be implemented on a case-by-case basis to optimize outcomes.
Topics: Humans; Amputation Stumps; Amputation, Surgical; Neuroma; Peripheral Nerves; Nerve Regeneration; Nerve Transfer
PubMed: 34253307
DOI: 10.1016/j.hcl.2021.04.002 -
Operative Neurosurgery (Hagerstown, Md.) Aug 2019
Topics: Aged; Female; Humans; Male; Middle Aged; Neurosurgical Procedures; Peripheral Nerves; Peripheral Nervous System Diseases; Young Adult
PubMed: 31099839
DOI: 10.1093/ons/opz072 -
Clinics in Plastic Surgery Apr 2020Nerve imaging is an important component in the assessment of patients presenting with suspected peripheral nerve pathology. Although magnetic resonance neurography and... (Review)
Review
Nerve imaging is an important component in the assessment of patients presenting with suspected peripheral nerve pathology. Although magnetic resonance neurography and ultrasound are the most commonly utilized techniques, several promising new modalities are on the horizon. Nerve imaging is useful in localizing the nerve injury, determining the severity, providing prognostic information, helping establish the diagnosis, and helping guide surgical decision making. The focus of this article is imaging of damaged nerves, focusing on nerve injuries and entrapment neuropathies.
Topics: Humans; Magnetic Resonance Imaging; Neuroimaging; Peripheral Nerves; Peripheral Nervous System Diseases
PubMed: 32115050
DOI: 10.1016/j.cps.2019.12.003 -
Biofabrication Sep 2022Electroceuticals provide promising opportunities for peripheral nerve regeneration, in terms of modulating the extensive endogenous tissue repair mechanisms between... (Review)
Review
Electroceuticals provide promising opportunities for peripheral nerve regeneration, in terms of modulating the extensive endogenous tissue repair mechanisms between neural cell body, axons and target muscles. However, great challenges remain to deliver effective and controllable electroceuticals via bioelectronic implantable device. In this review, the modern fabrication methods of bioelectronic conduit for bridging critical nerve gaps after nerve injury are summarized, with regard to conductive materials and core manufacturing process. In addition, to deliver versatile electrical stimulation, the integration of implantable bioelectronic device is discussed, including wireless energy harvesters, actuators and sensors. Moreover, a comprehensive insight of beneficial mechanisms is presented, including up-to-dateand clinical evidence. By integrating conductive biomaterials, 3D engineering manufacturing process and bioelectronic platform to deliver versatile electroceuticals, the modern biofabrication enables comprehensive biomimetic therapies for neural tissue engineering and regeneration in the new era.
Topics: Biocompatible Materials; Nerve Regeneration; Nerve Tissue; Peripheral Nerves; Tissue Engineering
PubMed: 35995036
DOI: 10.1088/1758-5090/ac8baa -
Molecular Neurobiology Jan 2023Transcription factors are master regulators of various cellular processes under diverse physiological and pathological conditions. Many transcription factors that are... (Review)
Review
Transcription factors are master regulators of various cellular processes under diverse physiological and pathological conditions. Many transcription factors that are differentially expressed after injury to peripheral nerves play important roles in nerve regeneration. Considering that rapid and timely regrowth of injured axons is a prerequisite for successful target reinnervation, here, we compile transcription factors that mediates axon elongation, including axon growth suppressor Klf4 and axon growth promoters c-Myc, Sox11, STAT3, Atf3, c-Jun, Smad1, C/EBPδ, and p53. Besides neuronal changes, Schwann cell phenotype modulation is also critical for nerve regeneration. The activation of Schwann cells at early time points post injury provides a permissive microenvironment whereas the re-differentiation of Schwann cells at later time points supports myelin sheath formation. Hence, c-Jun and Sox2, two critical drivers for Schwann cell reprogramming, as well as Krox-20 and Sox10, two essential regulators of Schwann cell myelination, are reviewed. These transcription factors may serve as promising targets for promoting the functional recovery of injured peripheral nerves.
Topics: Humans; Myelin Sheath; Nerve Regeneration; Schwann Cells; Peripheral Nerves; Gene Expression Regulation; Axons; Peripheral Nerve Injuries
PubMed: 36261692
DOI: 10.1007/s12035-022-03090-0 -
Handbook of Clinical Neurology 2022Electrophysiological monitoring of the peripheral nervous system during a variety of surgeries provides useful information that supplements and complements preoperative... (Review)
Review
Electrophysiological monitoring of the peripheral nervous system during a variety of surgeries provides useful information that supplements and complements preoperative assessment. Monitoring improves localization and understanding of the underlying pathophysiology of peripheral nerve lesions leading to more rational treatment decisions and improved outcomes. Monitoring is accomplished by adaptation of routine electrodiagnostic techniques (i.e., nerve conduction studies, evoked potentials, and electromyography) with special attention to technical factors including electrical and movement artifact. These techniques have been successfully applied during surgery for entrapment neuropathies, traumatic nerve injury and repair, peripheral nerve tumors, and adjacent structure procedures that risk peripheral nerve injury. A clear understanding of the anatomy and neurophysiology is necessary, as is understanding and performing the difficult technical aspects of these studies to provide accurate information to enhance patient outcome and recovery. As in any intraoperative neurophysiologic monitoring (IONM) setting, constant and accurate communication between the IONM team, surgeon, and anesthesia team is critically important to meet these goals.
Topics: Electromyography; Evoked Potentials, Motor; Evoked Potentials, Somatosensory; Humans; Intraoperative Neurophysiological Monitoring; Neurophysiology; Peripheral Nerves
PubMed: 35772892
DOI: 10.1016/B978-0-12-819826-1.00022-3