autologous-nerve-grafting-versus-multiple-nerve-transfers-for-upper

Autologous Nerve Grafting Versus Multiple Nerve Transfers for Upper Trunk Brachial Plexus Injury: A Rat Model Study

Upper trunk (C5-C6) injuries of the brachial plexus impair shoulder abduction and elbow flexion. For C5-C6 ruptures with preserved proximal stumps, nerve ...

Fudan University

NHC Key Laboratory of Hand Reconstruction (Fudan University)

Shanghai Key Laboratory of Peripheral Nerve and Microsurgery

To review the advances in the diagnosis and treatment of obstetric brachial plexus palsy (OBPP).

[ADVANCES IN NERVE RECONSTRUCTION OF OBSTETRIC BRACHIAL PLEXUS PALSY].

Injuries to the upper and middle trunks of brachial plexus result in dysfunction of radial nerves in newborns but do not in adults. We hypothesized that the radial nerve had a lower proportion of myelinated nerve fibers (MNFs) from the lower trunk in newborns than in adults, and in newborns those MNFs were less developed than MNFs in the radial nerve from the middle and upper trunks.

Morphological basis of radial nerve dysfunction in newborns differs from that of no radial nerve dysfunction in adults in C5-C6-C7 injuries to the brachial plexus: a cadaveric study.

In obstetric brachial plexus palsy (OBPP), the operative time window for nerve reconstruction of the intrinsic muscles of the hand (IMH) is much shorter than that of biceps. The reason is that the atrophy of IMH becomes irreversible more quickly than that of biceps. A previous study confirmed that the motor endplates of denervated intrinsic muscles of the forepaw (IMF) were destabilized, while those of denervated biceps remained intact. However, the specific molecular mechanism of regulating the self-repair of motor endplates is still unknown. In this study, we use a rat model of OBPP with right C5-C6 rupture plus C7-C8-T1 avulsion and left side as a control. Bilateral IMF and biceps are harvested at 5 weeks postinjury to assess relative protein and mRNA expression. We also use L6 skeletal myoblasts to verify the effects of signaling pathways regulating acetylcholine receptor (AChR) protein synthesis . The results show that in the OBPP rat model, the protein and mRNA expression levels of NRG-1/ErbB4 and phosphorylation of Akt/mTOR/p70S6K are lower in denervated IMF than in denervated biceps. In L6 myoblasts stimulated with NRG-1, overexpression and knockdown of ErbB4 lead to upregulation and downregulation of AChR subunit protein synthesis and Akt/mTOR/p70S6K phosphorylation, respectively. Inhibition of mTOR abolishes protein synthesis of AChR subunits elevated by NRG-1/ErbB4. Our findings suggest that in the OBPP rat model, lower expression of AChR subunits in the motor endplates of denervated IMF is associated with downregulation of NRG-1/ErbB4 and phosphorylation of Akt/mTOR/p70S6K. NRG-1/ErbB4 can promote protein synthesis of the AChR subunits in L6 myoblasts via phosphorylation of Akt/mTOR/p70S6K.

Neuregulin-1/ErbB4 upregulates acetylcholine receptors via Akt/mTOR/p70S6K: a study in a rat model of obstetric brachial plexus palsy and .

The development of high-performance X-ray detectors requires scintillators with fast decay time, high light yield, stability, and X-ray absorption capacity, which are difficult to achieve in a single material. Here, we present the first example of a lanthanide chalcogenide of LaCsSiS  : 1 % Ce that simultaneously integrates multiple desirable properties for an ideal scintillator. LaCsSiS  : 1 % Ce demonstrates a remarkably low detection limit of 43.13 nGy  s and a high photoluminescence quantum yield of 98.24 %, resulting in a high light yield of 50480±1441 photons/MeV. Notably, LaCsSiS  : 1 % Ce exhibits a fast decay time of only 29.35±0.16 ns, making it one of the fastest scintillators among all lanthanide-based inorganic scintillators. Furthermore, this material shows robust radiation and moisture resistance, endowing it with suitability for chemical processing under solution conditions. To demonstrate the X-ray imaging capacity of LaCsSiS  : 1 % Ce , we fabricated a flexible X-ray detector that achieved a high spatial resolution of 8.2 lp mm . This work highlights the potential of lanthanide chalcogenide as a promising candidate for high-performance scintillators.

Emergence of a Lanthanide Chalcogenide as an Ideal Scintillator for a Flexible X-ray Detector.

To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies.

[Clinical analysis of distal radius core decompression for chronic wrist pain].

Right obstetric brachial plexus injuries (OBPI) often lead to left-handedness before limb function is restored post-surgery. A pertinent question arises about promoting a transition from left to right-handedness. We hypothesized that, with the decrease in neuroplasticity, handedness switching is not only difficult, but also reduces handedness-speech lateralization, impaired motor adaptability, and compromised language proficiency.

Changing handedness after nerve reconstruction in brachial plexus birth palsy.

Studies on the function-integrated nanocomposites with well-tuned morphologies have received considerable interest. Here, we reported the preparation of mesoporous carbon nanobowl integrated with stoichiometric γ-FeO and GdPO nanoparticles (Fe-Gd/MCN-B) for morphological advantage exploration. Followed by (i) emulsion-induced interface anisotropic assembly of polydopamine, (ii) solvent evaporation-induced sorption of Wells-Dawson-like heterometallic cluster of {FeGdP} and (iii) temperature-programmed carbonization, Fe-Gd/MCN-B with the size around 200 nm was isolated. Our in-vitro studies revealed that Fe-Gd/MCN-B showed a 63.0 % amplified photoacoustic (PA) signal intensity as compared with its nanospherical analogue of Fe-Gd/MCN-S owing to the enhanced light harvesting and photothermal conversion on the interface of its nanobowl morphology. Furthermore, the combined magnetic resonance (MR) imagining, drug delivery and photothermal treatment efficacy in Fe-Gd/MCN-B were also validated in-vitro. These results demonstrated that the delicate design of the morphology of function-integrated nanocomposites is an available way for enhanced imaging performance.

Tuning the Fe-Gd nanoparticles co-functionalized mesoporous carbon from sphere to nanobowl for advanced bioapplications.

Peripheral nerve injury disrupts communication between the primary motor cortex (M1) and the target muscle, leading to alterations in synaptic plasticity within the lesion projection zone (LPZ). While nerve repair holds the potential to restore this pathway and further modulate synaptic plasticity within the LPZ, the underlying mechanisms remain incompletely understood. In this study, 42 adult male Sprague Dawley rats underwent immediate repair following unilateral median nerve transection and categorized the functional recovery of the affected limb into three phases: the injury phase, recovery phase, and rehabilitation phase, corresponding to stages of muscle non-reinnervation, gradual reinnervation, and completed reinnervation, respectively. Another 12 rats were used as the control group. Our findings revealed that during these phases, excitatory synaptic transmission in M1 layer II/III pyramidal neurons initially decreases, then increases, and ultimately returns to baseline levels. Conversely, inhibitory synaptic transmission initially increases, then decreases, and remains reduced even after full peripheral recovery, accompanied by upregulation of inhibitory synaptic receptors. These findings suggest that excitatory and inhibitory synaptic plasticity play opposing roles in the nerve repair process, with excitatory plasticity primarily involved in short-term responses and inhibitory plasticity contributing to both short-term and long-term modulation.

Dynamic changes of excitatory and inhibitory synapses in layer II/III of the primary motor cortex after peripheral nerve repair.

Exosome-derived CDNF Inhibits Astrocyte and T Cell Activation by Regulating HSPA5 and Promotes Repair and Regeneration after Peripheral Nerve Injury.

The undulating characteristics of nerve fibers and the endoneurium are important factors in resisting traction force. The diagnostic accuracies of magnetic resonance neurography and ultrasonography for nerve injuries are 85.4% and 70.6%, respectively. Epineurial repair is the most commonly used nerve repair technique. Nerve grafts are generally required when the defect exceeds 2 cm. Nerve transfers are primarily indicated for brachial plexus root avulsions or intraforaminal lesions. Painful neuromas can be treated with target muscle reinnervation. Surgery yields reliable results for carpal-tunnel syndrome, cubital-tunnel syndrome, the common peroneal nerve entrapment, and the lateral femoral cutaneous nerve entrapment syndrome. Effective rehabilitation interventions related to the central nervous system include sensory reeducation, cross-modal sensory substitution, motor imagery, and action observation with simultaneous peripheral nerve stimulation.

Article	Year
[ADVANCES IN NERVE RECONSTRUCTION OF OBSTETRIC BRACHIAL PLEXUS PALSY]. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery\| PubMed ID: 29786216	2016
Morphological basis of radial nerve dysfunction in newborns differs from that of no radial nerve dysfunction in adults in C5-C6-C7 injuries to the brachial plexus: a cadaveric study. British journal of neurosurgery\| PubMed ID: 34259110	2021
Neuregulin-1/ErbB4 upregulates acetylcholine receptors via Akt/mTOR/p70S6K: a study in a rat model of obstetric brachial plexus palsy and . Acta biochimica et biophysica Sinica\| PubMed ID: 36331297	2022
Emergence of a Lanthanide Chalcogenide as an Ideal Scintillator for a Flexible X-ray Detector. Angewandte Chemie (International ed. in English)\| PubMed ID: 37249485	2023
[Clinical analysis of distal radius core decompression for chronic wrist pain]. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery\| PubMed ID: 37460177	2023
Changing handedness after nerve reconstruction in brachial plexus birth palsy. Frontiers in neurology\| PubMed ID: 38259660	2023
Tuning the Fe-Gd nanoparticles co-functionalized mesoporous carbon from sphere to nanobowl for advanced bioapplications. Journal of colloid and interface science\| PubMed ID: 39461130	2025
Dynamic changes of excitatory and inhibitory synapses in layer II/III of the primary motor cortex after peripheral nerve repair. Neuroscience\| PubMed ID: 39894437	2025
Exosome-derived CDNF Inhibits Astrocyte and T Cell Activation by Regulating HSPA5 and Promotes Repair and Regeneration after Peripheral Nerve Injury. Applied biochemistry and biotechnology\| PubMed ID: 41504843	2026
[State-of-the-art in peripheral nerve injury diagnosis and therapy]. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery\| PubMed ID: 41539700	2026

Jiayu Sun

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