Artificial nerve guidance conduits (NGCs) are synthetic nerve grafts that are capable of providing the structural and nutritional support for nerve regeneration. The ideal NGCs have plenty of requirements on biocompatibility, mechanical strength, topological structure, and conductivity. Therefore, it is necessary to continuously improve the design of NGCs and establish a better therapeutic strategy for peripheral nerve injury in order to meet clinical needs. Although current NGCs have made certain process in the treatment of peripheral nerve injury, their nerve regeneration and functional outcomes on repairing long-distance nerve injury remain unsatisfactory. Herein, we review the nerve conduit design from four aspects, namely raw material selection, structural design, therapeutic factor loading and self-powered component integration. Moreover, we summarize the research progress of NGCs in the treatment of peripheral nerve injury, in order to facilitate the iterative updating and clinical transformation of NGCs.
Humans ; Peripheral Nerve Injuries/therapy* ; Guided Tissue Regeneration ; Nerve Regeneration/physiology* ; Sciatic Nerve

BACKGROUND: Histological and functional recovery after peripheral nerve injury (PNI) is of significant clinical value as delayed surgical repair and longer distances to innervate terminal organs may account for poor outcomes. Low-intensity extracorporeal shock wave therapy (LiESWT) has already been proven to be beneficial for injured tissue recovery on various pathological conditions. The objective of this study was to explore the potential effect and mechanism of LiESWT on PNI recovery. METHODS: In this project, we explored LiESWT's role using an animal model of sciatic nerve injury (SNI). Shockwave was delivered to the region of the SNI site with a special probe at 3 Hz, 500 shocks each time, and 3 times a week for 3 weeks. Rat Schwann cells (SCs) and rat perineurial fibroblasts (PNFs) cells, the two main compositional cell types in peripheral nerve tissue, were cultured in vitro, and LiESWT was applied through the cultured dish to the adherent cells. Tissues and cell cultures were harvested at corresponding time points for a reverse transcription-polymerase chain reaction, Western blotting, and immunofluorescence staining. Multiple groups were compared by using one-way analysis of variance followed by the Tukey-Kramer test for post hoc comparisons. RESULTS: LiESWT treatment promoted the functional recovery of lower extremities with SNI. More nerve fibers and myelin sheath were found after LiESWT treatment associated with local upregulation of mechanical sensitive yes-associated protein (YAP)/transcriptional co-activator with a PDZ-binding domain (TAZ) signaling pathway. In vitro results showed that SCs were more sensitive to LiESWT than PNFs. LiESWT promoted SCs activation with more expression of p75 (a SCs dedifferentiation marker) and Ki67 (a SCs proliferation marker). The SCs activation process was dependent on the intact YAP/TAZ signaling pathway as knockdown of TAZ by TAZ small interfering RNA significantly attenuated this process. CONCLUSION The LiESWT mechanical signal perception and YAP/TAZ upregulation in SCs might be one of the underlying mechanisms for SCs activation and injured nerve axon regeneration.
Animals ; Axons ; Extracorporeal Shockwave Therapy ; Nerve Regeneration ; Peripheral Nerve Injuries/therapy* ; Rats ; Schwann Cells ; Sciatic Nerve ; Signal Transduction

OBJECTIVETo provide basis for strengthening safety of acupoint-injection and increasing clinical therapeutic effect.

METHODSAnalyze and study on the relative articles from the databank of whole articles of Chinese periodicals of CNKI by information retrieval with computer, with acupoint-injection, nerve injury as key words.

RESULTSMost of clinical reports focus on acupoint-injection for treatment of nervous injury induced by trauma and birth injury. The studies indicate that the injuries of the peripheral nerves induced by acupoint-injection can be divided into 3 grades and the injury mechanisms can be divided into 3 classifications. The injuring causes include improper posture of the patients, improper angle and depth of injection and improper medicine selection.

CONCLUSIONAcupoint-injection can be applied more widely as soon as the accomplishment of the standardization of operation.

Acupuncture Points ; Acupuncture Therapy ; adverse effects ; Humans ; Injections ; Peripheral Nerve Injuries ; Posture

Bone marrow mesenchymal stem cells (BMSCs) possess the potential of self-duplication, multi-directional differentiation, and also the ability to differentiate (in the direction of ectoderm) into neuron and neuroglial cells in vitro as well as to promote the reparation of sciatic nerve injury in vivo, especially for the reparation of the long-segment nerve. Progress in repair of sciatic nerve injury by BMSCs has been reviewed in this article.
Bone Marrow Cells ; cytology ; physiology ; Humans ; Mesenchymal Stromal Cells ; cytology ; physiology ; Nerve Regeneration ; physiology ; Peripheral Nerve Injuries ; physiopathology ; therapy ; Sciatic Nerve ; injuries ; physiology ; Stem Cell Transplantation ; methods

OBJECTIVETo discuss the diagnosis and treatment of peripheral nerve injury in the earthquake.

METHODSFourteen patients with peripheral nerve injury injured in the earthquake were involved the retrospective study. All cases accepted the timely diagnosis and treatment including anastomosis and repair of the nerve and other conservative treatments. Then the therapeutic effects were observed.

RESULTSAll 14 patients got short-term follow-up and attained the improvement in their symptoms of nerve injury.

CONCLUSIONPeripheral nerve injury has a high incidence in the earthquake. Prevention is very important. The timely and effective treatment should be taken according to spot situations and traumatic conditions of casualties in earthquake.

China ; Earthquakes ; Female ; Follow-Up Studies ; Humans ; Male ; Peripheral Nerve Injuries ; Peripheral Nerves ; surgery ; Peripheral Nervous System Diseases ; diagnosis ; prevention & control ; surgery ; therapy ; Retrospective Studies

BACKGROUNDPeripheral nerve injury causes a high rate of disability and a huge economic burden, and is currently one of the serious health problems in the world. The use of nerve grafts plays a vital role in repairing nerve defects. Acellular nerve grafts have been widely used in many experimental models as a peripheral nerve substitute. The purpose of this study was to test the biomechanical properties of acellular nerve grafts.

METHODSThirty-four fresh sciatic nerves were obtained from 17 adult male Wistar rats (age of 3 months) and randomly assigned to 3 groups: normal control group, nerve segments underwent no treatment and were put in phosphate buffered saline (pH 7.4) and stored at 4°C until further use; physical method group, nerve segments were frozen at -196°C and then thawed at 37°C; and chemical method group, nerve segments were chemically extracted with the detergents Triton X-200, sulfobetaine-10 (SB-10) and sulfobetaine-16 (SB-16). After the acellularization process was completed, the structural changes of in the sciatic nerves in each group were observed by hematoxylin-eosin staining and field emission scanning electron microscopy, then biomechanical properties were tested using a mechanical apparatus (Endura TEC ELF 3200, Bose, Boston, USA).

RESULTSHematoxylin-eosin staining and field emission scanning electron microscopy demonstrated that the effects of acellularization, demyelination, and integrity of nerve fiber tube of the chemical method were better than that of the physical method. Biomechanical testing showed that peripheral nerve grafts treated with the chemical method resulted in some decreased biomechanical properties (ultimate load, ultimate stress, ultimate strain, and mechanical work to fracture) compared with normal control nerves, but the differences were not statistically significant (P > 0.05).

CONCLUSIONNerve treated with the chemical method may be more appropriate for use in implantation than nerve treated with the physical method.

Animals ; Biomechanical Phenomena ; Male ; Microscopy, Electron, Scanning ; Peripheral Nerve Injuries ; therapy ; Peripheral Nerves ; physiology ; ultrastructure ; Rats ; Rats, Wistar ; Sciatic Nerve ; physiopathology ; ultrastructure ; Tissue Engineering

BACKGROUNDPulsed radiofrequency (PRF) application to the dorsal root ganglia can reduce neuropathic pain (NP) in animal models, but the effect of PRF on damaged peripheral nerves has not been examined. We investigated the effect of PRF to the rat sciatic nerve (SN) on pain-related behavior and SN ultrastructure following chronic constriction injury (CCI).

METHODSThe analgesic effect was measured by hindpaw mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL). Twenty rats with NP induced by ligating the common SN were then randomly divided into a PRF treatment group and a sham group. The contralateral SN served as a control. The MWT and TWL were determined again 2, 4, 6, 8, 10, 12, and 14 days after the PRF or sham treatment. On day 14, ipsilateral and contralateral common SNs were excised and examined by electron microscopy.

RESULTSIpsilateral MWT was significantly reduced and TWL significantly shorter compared to the contralateral side 14 days after CCI (both P = 0.000). In the PRF group, MWT was significantly higher and TWL significantly longer 14 days after the PRF treatment compared to before PRF treatment (both P = 0.000), while no such difference was observed in the sham group (P > 0.05). Electron microscopy revealed extensive demyelination and collagen fiber formation in the ipsilateral SN of sham-treated rats but sparse demyelination and some nerve fiber regrowth in the PRF treatment group.

CONCLUSIONSHyperalgesia is relieved, and ultrastructural damage ameliorated after direct PRF treatment to the SN in the CCI rat model of NP.

Animals ; Disease Models, Animal ; Male ; Neuralgia ; Peripheral Nerve Injuries ; therapy ; Pulsed Radiofrequency Treatment ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve ; injuries ; Sciatic Neuropathy ; therapy

OBJECTIVETo observe the difference in the efficacy on traumatic nerve injury among electroacupuncture, warm needling therapy and electroacupuncture plus warm needling therapy and explore the better therapeutic method.

METHODSThe electromyography (EMG) and electroneurography (ENG) of 93 cases showed traumatic nerve injury of moderate damage. According to the single blind randomization principle, they were divided into an electroacupuncture (EA) group, a warm needling therapy (WN) group and an EA plus WN group, 31 cases in each one. The main acupoints were selected from Yangming Meridian and Shaoyang Meridian corresponding to the distribution of damaged nerves. EA, WN and EA plus WN were applied separately. The treatment was given once every day, 15 treatments made one session. After 3 sessions of treatment (45 treatments in total), EMG and ENG were re-checked and the results were analyzed statistically.

RESULTSRegarding the total effective rate and effective rate, it was 96. 8% (30/31) in the EA plus WN group, which was better than 74.2% (23/31) in the EA group and 77. 4% (24/31) in the WN group (P<0. 05). Concerning to the improvements of EMG, the result in the EA plus WN group was 96.8% (30/31), which was better than the other two groups [74. 2%(23/31),74. 2%(23/31)] (P<0. 05). In terms of the recovery of nerve conduction and amplitude, the results in EA plus WN group [(50.9+/-4. 6)m/s,(8. 8+/-2. 9),microVx1 000] were better than the other two groups [(43.7+/-3.1)m/s,(4. 2+/-1. 9)microV X 1 000,(43. 8+/-3. 3)m/s,(4. 5+/-2. 2)microV X 1 000] (P<0. 05).

CONCLUSIONEA combined with WN is a better therapy of acupuncture and moxibustion in the treatment of traumatic nerve injury.

Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Peripheral Nerve Injuries ; therapy ; Treatment Outcome ; Young Adult

Trauma and surgery sometimes cause erectile dysfunction because of injury to pelvic nerves and cavernous nerves of the penis. The ideal treatment is to make the injured nerves regenerate themselves and erectile function recover completely. This paper reviews the recent advances in the studies of erigentes regeneration and plerosis following injury in order to find the best method to enhance erigentes regeneration.
Erectile Dysfunction ; therapy ; Humans ; Male ; Penile Erection ; physiology ; Penis ; innervation ; Peripheral Nerve Injuries ; Regeneration ; Transurethral Resection of Prostate ; adverse effects

Adult ; Female ; Ganglion Cysts ; therapy ; Humans ; Massage ; adverse effects ; Peripheral Nervous System Diseases ; etiology ; Radial Nerve ; injuries