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Topographical guidance and chemotaxis are crucial factors for peripheral nerve regeneration. This study describes the preparation of highly aligned poly(ε-caprolactone) (PCL) fiber conduits coated with a concentration gradient of nerve growth factor (NGF) (A/G-PCL) using a newly designed electrospinning receiving device. The A/G-PCL conduits are confirmed in vitro to enhance and attract the neurite longitudinal growth of dorsal root ganglion (DRG) neurons toward their high-concentration gradient side. In vivo, the A/G-PCL conduits are observed to direct a longitudinal stronger attraction of axons and migration of Schwann cells in 15 mm rat sciatic nerve defects. At 12 weeks, rats transplanted with A/G-PCL conduits show satisfactory morphological and functional improvements in g-ratio, total number, and area of myelinated nerve fibers as well as the sciatic function index, compound muscle action potentials, and muscle wet weight ratio as compared to aligned PCL fibers conduits with uniform NGF (A/U-PCL). The performance of A/G-PCL is similar to that of autografts. Moreover, mRNA-seq and RT-PCR results reveal that Rap1, MAPK, and cell adhesion molecules signaling pathways are closely associated with axon chemotactic response and attraction. Altogether, by combining structural guidance with axon chemotaxis, the NGF-gradient/ aligned PCL fiber conduits represent a promising approach for peripheral nerve defect repair.

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Objective To compare the clinical efficacy and complications which obtained foraminoplasty at the tip or base of the superior articular process (SAP) for the patients with lateral recess stenosis treated by percutaneous endoscopic lumbar discectomy (PELD). Methods Between January 2015 and January 2016, 156 patients of lumbar disc herniation accompanying with lateral recess stenosis were treated with PELD in five tertiary hospitals and fulfilled the 2-year follow-up. Among them, 78 patients obtained a foraminoplasty at the tip of SAP (group A), and foraminoplasty at the base of SAP was performed in the other 78 cases (group B). Clinical efficacy was evaluated using the visual analog scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and 36-item Short-Form Health Survey (SF-36) score. The intervals of follow-up were scheduled at 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Results Mean operative duration is shorter in group B (55 versus 61 min, P = 0.047). Only one case belonged to group A could not tolerate the neural irritation and required conversion to an open procedure. During the surgery, no dura tears, cauda equina syndrome, or infections were observed. 5 patients experienced transient dysesthesia located at the exiting nerve in group A, while no cases complained dysesthesia in group B. 2 cases who suffered temporary motor weakness all belonged to group A. A total of 5 cases obtained a revision surgery after recurrence in the follow-up, in which 3 patients belonged to group A. Compared to the preoperative data, significant improvements in VAS scores of low back pain and sciatica, ODI, and SF-36 PCS and MC were observed in the follow-up, respectively (P < 0.05, respectively). However, no statistical difference was observed at all time-points after surgery between these two groups (P > 0.05, respectively). Conclusions For the patients of LDH accompanying with lateral recess stenosis, compared with the routine foraminoplasty at the tip of SAP, our modified foraminoplastic technique does not only change place of foraminoplasty to the base of SAP but also simplified puncture process in transforaminal PELD. Although there was no significant difference in symptom relief, the modified foraminoplasty showed the advantages in decreasing the incidence of postoperative neural dysfunction and reducing operation time.

BackgroundDeltoid ligament (DL) rupture is commonly seen in clinical practice; however the need to explore and surgically repair it is still in debate. The objective of the current study is to compare the outcomes of surgical treatment of ankle fracture with or without DL repair.MethodsBetween 2009 and 2015, Seventy-four ankle fractures with DL rupture were identified and followed. Twenty patients were treated with surgical repair of the DL, while 54 were not. The pre- and post-operative medial clear space (MCS) were measured and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) were used for functional evaluation. According to the radiological malreduction of MCS, the odds ratio (OR) and 95% confidence interval (CI) for each potential relative factor were calculated.ResultsThe mean followup time was 53.7 months. The mean MCS preoperatively, postoperatively, and at last followup time were 8.7 ± 2.4 (range, 6.2–14.8) mm, 3.7 ± 0.9 (range, 2.6–6.4) mm, 3.6 ± 1.0 (range, 2.6–6.8) mm, respectively. The mean AOFAS score was 86.4 ± 8.1 (range, 52–100) points, and the mean VAS was 1.4 ± 1.4 (range, 0–7) points. During followup, 14.9% (11/74) cases were found to be malreduced (MCS>5 mm), and 5.4% (4/74) went on to failure. Surgical repair of DL can significantly decrease the postoperative MCS (P<0.05), and can also decrease the malreduction rate (P<0.05). AO/OTA type-C ankle fractures showed a positive correlation with malreduction (OR = 4.38, P = 0.03). In this type of injury, surgical repair of the DL can significantly decrease the malreduction rate (P<0.05). No significant difference was found between the AO/OTA type-B fracture with or without DL repair.ConclusionsSurgical repair of the DL is helpful in decreasing the postoperative MCS and malreduction rate, especially for the AO/OTA type-C ankle fractures.

Objective. Spinal cord injury (SCI) is a devastating neurological disorder caused by trauma. Pathophysiological events occurring after SCI include acute, subacute, and chronic phases, while complex mechanisms are comprised. As an abundant source of natural drugs, Traditional Chinese Medicine (TCM) attracts much attention in SCI treatment recently. Hence, this review provides an overview of pathophysiology of SCI and TCM application in its therapy. Methods. Information was collected from articles published in peer-reviewed journals via electronic search (PubMed, SciFinder, Google Scholar, Web of Science, and CNKI), as well as from master's dissertations, doctoral dissertations, and Chinese Pharmacopoeia. Results. Both active ingredients and herbs could exert prevention and treatment against SCI, which is linked to antioxidant, anti-inflammatory, neuroprotective, or antiapoptosis effects. The detailed information of six active natural ingredients (i.e., curcumin, resveratrol, epigallocatechin gallate, ligustrazine, quercitrin, and puerarin) and five commonly used herbs (i.e., Danshen, Ginkgo, Ginseng, Notoginseng, and Astragali Radix) was elucidated and summarized. Conclusions. As an important supplementary treatment, TCM may provide benefits in repair of injured spinal cord. With a general consensus that future clinical approaches will be diversified and a combination of multiple strategies, TCM is likely to attract greater attention in SCI treatment.