Background and Objective:Corneal neurotization is a novel surgical technique used to restore corneal sensation in patients with neurotrophic keratopathy.Neurotrophic keratopathy is a disorder characterized by dysfunct...Background and Objective:Corneal neurotization is a novel surgical technique used to restore corneal sensation in patients with neurotrophic keratopathy.Neurotrophic keratopathy is a disorder characterized by dysfunction of the ophthalmic division of the trigeminal nerve,which provides sensory innervation to the cornea.Without sensation,the cornea is at risk of infection,ulceration,perforation,and ultimately,vision loss.Corneal neurotization has emerged as an innovative technique to reinnervate anesthetized corneas by transferring a healthy donor nerve to the affected eye around the corneoscleral limbus.As the field of corneal neurotization rapidly grows,there is a need to synthesize the existing body of literature on corneal neurotization and identify important areas for further research.In this review,we will discuss neurotrophic keratopathy and its current management strategies,followed by an overview of corneal neurotization techniques,outcomes,surgical considerations,and future directions.Methods:PubMed and Google Scholar searches were conducted to retrieve and analyze relevant original papers and reviews on neurotrophic keratopathy and corneal neurotization up until April 2022.Key Content and Findings:Currently,numerous techniques for corneal neurotization exist,including direct nerve transfers,as well as indirect neurotization via interposition nerve grafts.So far,corneal neurotization has been shown to be highly successful in restoring corneal sensation,improving visual acuity,and improving corneal epithelial health.To date,there have been no significant differences in outcomes between direct versus indirect neurotization techniques,different donor nerves,or autologous versus allogeneic interposition grafts.However,there is some evidence that corneal neurotization procedures may be more successful in pediatric patients.Conclusions:Corneal neurotization shows great promise in treating neurotrophic corneas and represents the first management option to date that addresses the underlying pathophysiological mechanism of neurotrophic keratopathy by restoring corneal sensation.As the use of corneal neurotization continues to broaden,additional studies will become important to compare techniques in a systematic manner,with larger sample sizes,as well as standardized outcome measures and follow-up time.展开更多
Neurotic angioedema may be secondary to ACE (Angiotensin-converting enzyme) inhibitor. From a case of neurotic angioedema in a hypertensive man under ACE (Angiotensin-converting enzyme) inhibitor, we expose the clinic...Neurotic angioedema may be secondary to ACE (Angiotensin-converting enzyme) inhibitor. From a case of neurotic angioedema in a hypertensive man under ACE (Angiotensin-converting enzyme) inhibitor, we expose the clinical characteristics typical of the edema and its evolution. A 73-year-old man has consulted for edema of the face and redness of the palmar surface of the hand not pruriginous for 2 days. He has already had conventional anti-edematous treatments but no changes. In the absence of a technical platform, no paraclinical examination was carried out. The cessation of ACE inhibitor and the administration of tranexamic acid were made immediately. Signs regressed within 24 hours. Neurotic angioedema is a diagnostic problem in countries where biological examination is still limited and if practitioners are unaware of the possibility of its occurrence during IEC treatment. While the patient’s prognosis depends on the precocity of management.展开更多
Objective To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. Methods Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent...Objective To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. Methods Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed.Results Functional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves.Conclusions Complete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.展开更多
Norman Mailer has made a profound analysisof the mad logic of the Vietnam war in his Armiesof the Night, a novel of new journalism whichconcludes the schizophrenic environment of Ameri-can society is at the root of th...Norman Mailer has made a profound analysisof the mad logic of the Vietnam war in his Armiesof the Night, a novel of new journalism whichconcludes the schizophrenic environment of Ameri-can society is at the root of this lunatic war: "He (Norman Mailer) came at last to the saddest conclusion ... that the centre of America might be insane. The country had been living with a controlled, even fiercely controlled, schizophrenia which had been deepening with the years. Perhaps the point had now been passed." (AN. 188)Traditional Christianity as a unifying force inlife has been able for many years to keep somekind of sanity. But it may now be on the decline.展开更多
As if neurosis has become an epidemic disease,so many of the protagonists in American novelsof the 60s are mentally ill in one way or another:Herzog, with his wide-ranging disordered thoughts,is described psychologica...As if neurosis has become an epidemic disease,so many of the protagonists in American novelsof the 60s are mentally ill in one way or another:Herzog, with his wide-ranging disordered thoughts,is described psychologically as depressive andoccasionally paraniod. Yossarian, the absurdhero of Catch-22, is a manci depressive" withfear of conspired death as his main symptom.Oedina in The Crying of Lot 49 sincerely wishes shewere mentally ill after her long mysterious questafter an underground delivery system which mayeither be a real discovery or a paranoid fantasy.With numerous and murderous crimes on record,Howard Campell, a Nazi propagandist in MotherNight, is on the edge of madness and despair.展开更多
Background:Donor nerve selection is a crucial factor in determining clinical outcomes of facial reanimation.Although dual innervation approaches using two neurotizers have shown promise,there is a lack of evidence-bas...Background:Donor nerve selection is a crucial factor in determining clinical outcomes of facial reanimation.Although dual innervation approaches using two neurotizers have shown promise,there is a lack of evidence-based comparison in the literature.Furthermore,no animal model of dual reinnervation has yet been published.This study aimed to establish such a model and verify its technical and anatomical feasibility by performing dual-innervated reanimation approaches in Wistar rats.Methods:Fifteen Wistar rats were divided into four experimental groups and one control group.The sural nerve was exposed and used as a cross-face nerve graft(CFNG),which was then anastomosed to the contralateral buccal branch of the facial nerve through a subcutaneous tunnel on the forehead.The CFNG,the masseteric nerve(MN),and the recipient nerve were coapted in one or two stages.The length and width of the utilized structures were measured under an operating microscope.Return of whisker motion was visually confirmed.Results:Nine out of the eleven rats that underwent surgery survived the procedure.Whisker motion was observed in all experimental animals,indicating successful reinnervation.The mean duration of the surgical procedures did not differ significantly between the experimental groups,ensuring similar conditions for all groups.Conclusions:Our experimental study confirmed that the proposed reanimation model in Wistar rats is anatomically and technically feasible,with a high success rate,and shows good prospects for future experiments.展开更多
文摘Background and Objective:Corneal neurotization is a novel surgical technique used to restore corneal sensation in patients with neurotrophic keratopathy.Neurotrophic keratopathy is a disorder characterized by dysfunction of the ophthalmic division of the trigeminal nerve,which provides sensory innervation to the cornea.Without sensation,the cornea is at risk of infection,ulceration,perforation,and ultimately,vision loss.Corneal neurotization has emerged as an innovative technique to reinnervate anesthetized corneas by transferring a healthy donor nerve to the affected eye around the corneoscleral limbus.As the field of corneal neurotization rapidly grows,there is a need to synthesize the existing body of literature on corneal neurotization and identify important areas for further research.In this review,we will discuss neurotrophic keratopathy and its current management strategies,followed by an overview of corneal neurotization techniques,outcomes,surgical considerations,and future directions.Methods:PubMed and Google Scholar searches were conducted to retrieve and analyze relevant original papers and reviews on neurotrophic keratopathy and corneal neurotization up until April 2022.Key Content and Findings:Currently,numerous techniques for corneal neurotization exist,including direct nerve transfers,as well as indirect neurotization via interposition nerve grafts.So far,corneal neurotization has been shown to be highly successful in restoring corneal sensation,improving visual acuity,and improving corneal epithelial health.To date,there have been no significant differences in outcomes between direct versus indirect neurotization techniques,different donor nerves,or autologous versus allogeneic interposition grafts.However,there is some evidence that corneal neurotization procedures may be more successful in pediatric patients.Conclusions:Corneal neurotization shows great promise in treating neurotrophic corneas and represents the first management option to date that addresses the underlying pathophysiological mechanism of neurotrophic keratopathy by restoring corneal sensation.As the use of corneal neurotization continues to broaden,additional studies will become important to compare techniques in a systematic manner,with larger sample sizes,as well as standardized outcome measures and follow-up time.
文摘Neurotic angioedema may be secondary to ACE (Angiotensin-converting enzyme) inhibitor. From a case of neurotic angioedema in a hypertensive man under ACE (Angiotensin-converting enzyme) inhibitor, we expose the clinical characteristics typical of the edema and its evolution. A 73-year-old man has consulted for edema of the face and redness of the palmar surface of the hand not pruriginous for 2 days. He has already had conventional anti-edematous treatments but no changes. In the absence of a technical platform, no paraclinical examination was carried out. The cessation of ACE inhibitor and the administration of tranexamic acid were made immediately. Signs regressed within 24 hours. Neurotic angioedema is a diagnostic problem in countries where biological examination is still limited and if practitioners are unaware of the possibility of its occurrence during IEC treatment. While the patient’s prognosis depends on the precocity of management.
基金ThisstudywassupportedbyagrantfromtheChineseNationalNaturalScienceFoundation (No .3 0 0 0 0 170 )
文摘Objective To anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery. Methods Seventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed.Results Functional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves.Conclusions Complete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.
文摘Norman Mailer has made a profound analysisof the mad logic of the Vietnam war in his Armiesof the Night, a novel of new journalism whichconcludes the schizophrenic environment of Ameri-can society is at the root of this lunatic war: "He (Norman Mailer) came at last to the saddest conclusion ... that the centre of America might be insane. The country had been living with a controlled, even fiercely controlled, schizophrenia which had been deepening with the years. Perhaps the point had now been passed." (AN. 188)Traditional Christianity as a unifying force inlife has been able for many years to keep somekind of sanity. But it may now be on the decline.
文摘As if neurosis has become an epidemic disease,so many of the protagonists in American novelsof the 60s are mentally ill in one way or another:Herzog, with his wide-ranging disordered thoughts,is described psychologically as depressive andoccasionally paraniod. Yossarian, the absurdhero of Catch-22, is a manci depressive" withfear of conspired death as his main symptom.Oedina in The Crying of Lot 49 sincerely wishes shewere mentally ill after her long mysterious questafter an underground delivery system which mayeither be a real discovery or a paranoid fantasy.With numerous and murderous crimes on record,Howard Campell, a Nazi propagandist in MotherNight, is on the edge of madness and despair.
基金Grant Agency of Masaryk University,Grant/Award Number:MUNI/11/SUP/01/2020 and MUNI/A/1457/2021。
文摘Background:Donor nerve selection is a crucial factor in determining clinical outcomes of facial reanimation.Although dual innervation approaches using two neurotizers have shown promise,there is a lack of evidence-based comparison in the literature.Furthermore,no animal model of dual reinnervation has yet been published.This study aimed to establish such a model and verify its technical and anatomical feasibility by performing dual-innervated reanimation approaches in Wistar rats.Methods:Fifteen Wistar rats were divided into four experimental groups and one control group.The sural nerve was exposed and used as a cross-face nerve graft(CFNG),which was then anastomosed to the contralateral buccal branch of the facial nerve through a subcutaneous tunnel on the forehead.The CFNG,the masseteric nerve(MN),and the recipient nerve were coapted in one or two stages.The length and width of the utilized structures were measured under an operating microscope.Return of whisker motion was visually confirmed.Results:Nine out of the eleven rats that underwent surgery survived the procedure.Whisker motion was observed in all experimental animals,indicating successful reinnervation.The mean duration of the surgical procedures did not differ significantly between the experimental groups,ensuring similar conditions for all groups.Conclusions:Our experimental study confirmed that the proposed reanimation model in Wistar rats is anatomically and technically feasible,with a high success rate,and shows good prospects for future experiments.
