Rehabilitation Training Combined with Jiaji Electroacupuncture Can Promote the Recovery of Muscle Group Function and Improve the Quality of Life in Patients with Upper Limb Peripheral Nerve Injury

This study was designed to probe into the improvement of rehabilitation training combined with Jiaji electroacupuncture intervention on patients with upper limb peripheral nerve injury. A total of 114 patients with peripheral nerve injury of upper limbs in our hospital from August 2017 to November 2019 were collected as the research participants. Among them, 59 in the control group (CG) received rehabilitation training alone, while 65 in the observation group (OG) received rehabilitation training combined with Jiaji electroacupuncture intervention. The therapeutic efficacy, Barthel index, and Fugl–Meyer assessment score, motor nerve conduction velocity, sensory nerve conduction velocity and amplitude, and quality of life (score SF-36) were compared between the two groups before and after treatment. The total effective rate of the OG was markedly higher than that of the CG. After treatment, the Barthel index, Fugl–Meyer assessment score, motor nerve conduction velocity, and sensory nerve conduction velocity and amplitude of the OG were obviously higher than those of the CG, and the SF-36 scores of the OG were higher than those of the CG in 8 dimensions. Rehabilitation training combined with Jiaji electroacupuncture intervention can dramatically promote the recovery of muscle group function and improve the quality of life of patients with upper limb peripheral nerve injury.

Nerve recovery from treatment with a vascularized nerve graft compared to an autologous non-vascularized nerve graft in animal models: A systematic review and meta-analysis

Background Treatment of nerve injuries proves to be a worldwide clinical challenge. Vascularized nerve grafts are suggested to be a promising alternative for bridging a nerve gap to the current gold standard, an autologous non-vascularized nerve graft. However, there is no adequate clinical evidence for the beneficial effect of vascularized nerve grafts and they are still disputed in clinical practice. Objective To systematically review whether vascularized nerve grafts give a superior nerve recovery compared to non-vascularized nerve autografts regarding histological and electrophysiological outcomes in animal models. Material and methods PubMed and Embase were systematically searched. The inclusion criteria were as follows: 1) the study was an original full paper which presented unique data; 2) a clear comparison between a vascularized and a non-vascularized autologous nerve transfer was made; 3) the population study were animals of all genders and ages. A standardized mean difference and 95% confidence intervals for each comparison was calculated to estimate the overall effect. Subgroup analyses were conducted on graft length, species and time frames. Results Fourteen articles were included in this review and all were included in the meta-analyses. A vascularized nerve graft resulted in a significantly larger diameter, higher nerve conduction velocity and axonal count compared to an autologous non-vascularized nerve graft. However, during sensitivity analysis the effect on axonal count disappeared. No significant difference was observed in muscle weight. Conclusion Treating a nerve gap with a vascularized graft results in superior nerve recovery compared to non-vascularized nerve autografts in terms of axon count, diameter and nerve conduction velocity. No difference in muscle weight was seen. However, this conclusion needs to be taken with some caution due to the inherent limitations of this meta-analysis. We recommend future studies to be performed under conditions more closely resembling human circumstances and to use long nerve defects.

Oral Administration of East Asian Herbal Medicine for Peripheral Neuropathy: A Systematic Review and Meta-Analysis with Association Rule Analysis to Identify Core Herb Combinations

This review aimed to comprehensively assess the efficacy and safety of oral East Asian herbal medicine (EAHM) for overall peripheral neuropathy (PN). In addition, an Apriori algorithm-based association rule analysis was performed to identify the core herb combination, thereby further generating useful hypotheses for subsequent drug discovery. A total of 10 databases were searched electronically from inception to July 2021. Randomized clinical trials (RCTs) comparing EAHM with conventional analgesic medication or usual care for managing PN were included. The RCT quality was appraised using RoB 2.0, and the random effects model was used to calculate the effect sizes of the included RCTs. The overall quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation. By analyzing the constituent herb data, the potential association rules of core herb combinations were explored. A total of 67 RCTs involving 5753 patients were included in this systematic review. In a meta-analysis, EAHM monotherapy and combined EAHM and western medicine therapy demonstrated substantially improved sensory nerve conduction velocity, motor nerve conduction velocity, and response rate. Moreover, EAHM significantly improved the incidence rate, pain intensity, Toronto clinical scoring system, and Michigan diabetic neuropathy score. The evidence grade was moderate to low due to the substantial heterogeneity among the studies. Nine association rules were identified by performing the association rule analysis on the extraction data of 156 EAHM herbs. Therefore, the constituents of the herb combinations with consistent association rules were Astragali Radix, Cinnamomi Ramulus, and Spatholobi Calulis. This meta-analysis supports the hypothesis that EAHM monotherapy and combined therapy may be beneficial for PN patients, and follow-up research should be conducted to confirm the precise action target of the core herb.

Electrophysiological assessment of peripheral nerves and neuro-muscular junctions in patients following self-poisoning with paraquat

Paraquat is neurotoxic. We aimed to study the electrophysiological effects of peripheral nerves and neuromuscular junction (NMJ) in the survivors of paraquat poisoning. A cohort study was conducted on patients following paraquat poisoning. Controls were recruited. The assessments were performed around one and six weeks after the exposure. Motor nerve conduction velocity (MNCV), amplitude of compound muscle action potential (CMAP), sensory nerve conduction velocity (SNCV), F-wave studies, cardiovascular response to different stimuli, sympathetic skin response (SSR) studies, and exercise modified supramaximal slow repetitive stimulation (RNS) and electromyography (EMG) were performed. There were 28 (21 males) patients and 56 controls. The mean (SD) age of the patients and the controls were 29 (12) and 31 (11) years. Significant impairment at the first assessment in the SNCV of ulnar nerve, amplitude of ulnar nerve CMAP on distal stimulation, and F-wave occurrence in median, ulnar and tibial nerves; change of systolic blood pressure three minutes after standing and SSR amplitude ( vs controls) was observed. All parameters reverted to normal at six weeks after the exposure. There was electrophysiological evidence for somatic nerve, autonomic, and NMJ dysfunction following acute paraquat poisoning which was not seen at six weeks after the exposure.

NEUROPHYSIOLOGICAL EFFECT OF LOW LEVEL LASER THERAPY ON ULNAR NERVE

Low level laser therapy is widely used in managing pain and inflammation in musculoskeletal ailments. Its effect on Peripheral nervous system and its function is not yet clearly studied. Objective: To analyze the neurophysiological effect of Low level laser irradiation on ulnar nerve MATERIALS AND METHODS: Sixty healthy subjects with age group between 20-30 years of both genders were recruited in this experimental study design.. The procedure was clearly explained to the subjects and informed consent was obtained. They were assigned randomly to either Ga. As.Laser group or Sham laser group. All the subject’s were positioned in supine lying with the irradiated dominant hand kept at 135 degrees of flexion. Ground electrode was placed over the thenar eminence. The subject's skin (electrode placement area) was degreased for proper transmission of laser. Nerve conduction velocity was recorded Antidromically. A 904nm diode laser was used to irradiate the skin overlying the ulnar nerve behind the medial epicondyle of the humerus for 20 secs. The laser was set to deliver continuous energy at 4.0 J/cm².Antidromically action potential, peak to peak amplitude, onset latency, nerve conduction velocity was recorded before and after irradiation of the ulnar nerve. RESULT: The study revealed that there was a significant difference in onset Latency (P=0.0021) but there was no significant difference in Nerve conduction velocity (P=0.2738) and PPA (P=1.0000) between laser group and sham laser group. CONCLUSIONS: Low level laser irradiation of skin overlying the ulnar nerve resulted in a significant increase in latency in this study. This increase in latency corresponds to a decrease in sensory nerve conduction velocity and could help explain the alleged pain relieving effects of low level laser irradiation.

Tacrolimus Significantly Improved the Outcome of CIDP Patients With Autoantibodies Against Paranodal Proteins

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated disabling neuropathy. CIDP with antibodies against the paranodal proteins has a low prevalence, poor prognosis and treatment difficulty. Moreover, there is currently a lack of data on the application of immunosuppressive agents. In this retrospective observational study, we aimed to evaluated the response to tacrolimus (a immunosuppressor with high efficacy) in CIDP with autoantibodies against paranodal proteins by reviewing 5 patients received daily tacrolimus. One patient started tacrolimus treatment at the first episode and eventually achieved full clinical remission without relapse. Four patients experienced worsening during corticosteroids tapering. They gradually improved after adding oral tacrolimus except one patient relapsed again due to tacrolimus discontinuation. Moreover, 3 patients were successfully withdrawn from corticosteroids and 2 patients took corticosteroids at low maintenance dose (10mg/d) after tacrolimus treatment. Furthermore, decreased nerve conduction velocity and action potential amplitudes gradually returned to a normal level after tacrolimus and corticosteroids treatment. In conclusions, tacrolimus significantly improved the outcome of CIDP patients with autoantibodies against paranodal proteins by preventing relapses, reducing corticosteroids dependence and enhancing nerve repair. Combination therapy with corticosteroids and tacrolimus may be an effective therapeutic regimen.

The Effect of Local Cooling at the Elbow on Nerve Conduction Velocity and Motor Unit Behaviour: An Exploration of a Novel Neurological Assessment

Background: This study aimed to determine the effects of a standard therapeutic cooling protocol using crushed ice on the elbow to explore if changes in the motor unit (MU) firing rates in the first dorsal interosseous (FDI) muscle are comparable to known changes in sensory and motor nerve conduction velocity (NCV) due to a regional temperature drop around a peripheral nerve. Methods: Twelve healthy individuals were assessed before cooling, immediately after cooling, and 15 min of rewarming. Assessments included two standard non-invasive nerve conduction velocity tests and a non-invasive investigation of the MU firing rates using surface electromyography decomposition (dEMG). Results: Repeated ANOVAs showed significant differences in the MU firing rates and NCV between time points (p = 0.01 and p < 0.001). All measures showed significant differences between pre and post cooling and between pre-cooling and 15 min of passive re-warming, however, no changes were seen between post cooling and rewarming except in the sensory NCV, which increased but did not return to the pre-cooled state. Conclusions: This current study showed a significant, temporary, and reversible reduction in ulnar NCV across the elbow in healthy subjects, which was associated with a significant decrease in mean MU firing rates in the FDI muscle.