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The great nerve : the new science of the vagus nerve and how to harness its healing reflexes
\"New science reveals the groundbreaking potential of the vagus nerve to regulate your body's vital systems and heal a wide variety of medical conditions without drugs\"-- Provided by publisher.
BOOK
Cranial nerve vascular compression syndromes of the trigeminal, facial and vago-glossopharyngeal nerves: comparative anatomical study of the central myelin portion and transitional zone; correlations with incidences of corresponding hyperactive dysfunctional syndromes
Objective
The aim of this study was to evaluate the anatomy of the central myelin portion and the central myelin-peripheral myelin transitional zone of the trigeminal, facial, glossopharyngeal and vagus nerves from fresh cadavers. The aim was also to investigate the relationship between the length and volume of the central myelin portion of these nerves with the incidences of the corresponding cranial dysfunctional syndromes caused by their compression to provide some more insights for a better understanding of mechanisms.
Methods
The trigeminal, facial, glossopharyngeal and vagus nerves from six fresh cadavers were examined. The length of these nerves from the brainstem to the foramen that they exit were measured. Longitudinal sections were stained and photographed to make measurements. The diameters of the nerves where they exit/enter from/to brainstem, the diameters where the transitional zone begins, the distances to the most distal part of transitional zone from brainstem and depths of the transitional zones were measured. Most importantly, the volume of the central myelin portion of the nerves was calculated. Correlation between length and volume of the central myelin portion of these nerves and the incidences of the corresponding hyperactive dysfunctional syndromes as reported in the literature were studied.
Results
The distance of the most distal part of the transitional zone from the brainstem was 4.19 ± 0.81 mm for the trigeminal nerve, 2.86 ± 1.19 mm for the facial nerve, 1.51 ± 0.39 mm for the glossopharyngeal nerve, and 1.63 ± 1.15 mm for the vagus nerve. The volume of central myelin portion was 24.54 ± 9.82 mm
3
in trigeminal nerve; 4.43 ± 2.55 mm
3
in facial nerve; 1.55 ± 1.08 mm
3
in glossopharyngeal nerve; 2.56 ± 1.32 mm
3
in vagus nerve.
Correlations (
p
< 0.001) have been found between the length or volume of central myelin portions of the trigeminal, facial, glossopharyngeal and vagus nerves and incidences of the corresponding diseases.
Conclusion
At present it is rather well-established that primary trigeminal neuralgia, hemifacial spasm and vago-glossopharyngeal neuralgia have as one of the main causes a vascular compression. The strong correlations found between the lengths and volumes of the central myelin portions of the nerves and the incidences of the corresponding diseases is a plea for the role played by this anatomical region in the mechanism of these diseases.
Journal Article
Networks of the brain
Olaf Sporns presents an overview of network approaches to neuroscience in which he explores the origins of brain complexity & the link between brain structure & function.
Book
Two-Year Outcomes of Vagal Nerve Blocking (vBloc) for the Treatment of Obesity in the ReCharge Trial
Background
The ReCharge Trial demonstrated that a vagal blocking device (vBloc) is a safe and effective treatment for moderate to severe obesity. This report summarizes 24-month outcomes.
Methods
Participants with body mass index (BMI) 40 to 45 kg/m
2
, or 35 to 40 kg/m
2
with at least one comorbid condition were randomized to either vBloc therapy or sham intervention for 12 months. After 12 months, participants randomized to vBloc continued open-label vBloc therapy and are the focus of this report. Weight loss, adverse events, comorbid risk factors, and quality of life (QOL) will be assessed for 5 years.
Results
At 24 months, 123 (76 %) vBloc participants remained in the trial. Participants who presented at 24 months (
n
= 103) had a mean excess weight loss (EWL) of 21 % (8 % total weight loss [TWL]); 58 % of participants had ≥5 % TWL and 34 % had ≥10 % TWL. Among the subset of participants with abnormal preoperative values, significant improvements were observed in mean LDL (−16 mg/dL) and HDL cholesterol (+4 mg/dL), triglycerides (−46 mg/dL), HbA1c (−0.3 %), and systolic (−11 mmHg) and diastolic blood pressures (−10 mmHg). QOL measures were significantly improved. Heartburn/dyspepsia and implant site pain were the most frequently reported adverse events. The primary related serious adverse event rate was 4.3 %.
Conclusions
vBloc therapy continues to result in medically meaningful weight loss with a favorable safety profile through 2 years.
Trial Registration
https://clinicaltrials.gov/ct2/show/NCT01327976
Journal Article
Nerve growth factor activates autophagy in Schwann cells to enhance myelin debris clearance and to expedite nerve regeneration
: Autophagy in Schwann cells (SCs) is crucial for myelin debris degradation and clearance following peripheral nerve injury (PNI). Nerve growth factor (NGF) plays an important role in reconstructing peripheral nerve fibers and promoting axonal regeneration. However, it remains unclear if NGF effect in enhancing nerve regeneration is mediated through autophagic clearance of myelin debris in SCs.
:
, free NGF solution plus with/without pharmacological inhibitors were administered to a rat sciatic nerve crush injury model.
, the primary Schwann cells (SCs) and its cell line were cultured in normal medium containing NGF, their capable of swallowing or clearing degenerated myelin was evaluated through supplement of homogenized myelin fractions.
: Administration of exogenous NGF could activate autophagy in dedifferentiated SCs, accelerate myelin debris clearance and phagocytosis, as well as promote axon and myelin regeneration at early stage of PNI. These NGF effects were effectively blocked by autophagy inhibitors. In addition, inhibition of the p75 kD neurotrophin receptor (p75
) signal or inactivation of the AMP-activated protein kinase (AMPK) also inhibited the NGF effect as well.
: NGF effect on promoting early nerve regeneration is closely associated with its accelerating autophagic clearance of myelin debris in SCs, which probably regulated by the p75
/AMPK/mTOR axis. Our studies thus provide strong support that NGF may serve as a powerful pharmacological therapy for peripheral nerve injuries.
Journal Article
Magnetic resonance imaging features of COVID-19-related cranial nerve lesions
The complete features of the neurological complications of coronavirus disease 2019 (COVID-19) still need to be elucidated, including associated cranial nerve involvement. In the present study we describe cranial nerve lesions seen in magnetic resonance imaging (MRI) of six cases of confirmed COVID-19, involving the olfactory bulb, optic nerve, abducens nerve, and facial nerve. Cranial nerve involvement was associated with COVID-19, but whether by direct viral invasion or autoimmunity needs to be clarified. The development of neurological symptoms after initial respiratory symptoms and the absence of the virus in the cerebrospinal fluid (CSF) suggest the possibility of autoimmunity.
Journal Article
Repair of peripheral nerve defect with direct gradual lengthening of the nerve stumps: first clinical case series
Background
Repairing large nerve defects remains challenging, and no definitive method has been established. We developed a nerve lengthening device for humans and achieved nerve defect repair through nerve lengthening in three cases. The purpose of this report is to describe the clinical course of three cases treated by nerve lengthening and to discuss its effectiveness in the treatment of nerve defects.
Methods
The target population included males and females aged 20–65 years with peripheral nerve injuries that cannot undergo primary suturing in the limbs were recruited. Three patients were included in this study. The nerve gaps were 13 mm, 15 mm and 100 mm, respectively. We developed a special nerve lengthening device. Starting from postoperative day 1, nerve lengthening was initiated on the proximal and distal ends at a rate of 0.5–1 mm daily (0.25 mm x 2–4 times) using the device. Monthly evaluations post-nerve suturing assessed nerve regeneration, pain, and adverse events. We observed postoperative courses for over 2 years.
Results
There were two radial nerve injury cases and one median nerve injury case. Functional recovery was observed in cases of shorter nerve defects repaired through nerve lengthening. However, significant functional restoration was not attainable for cases of longer nerve defects or those with prolonged post-injury intervals. Furthermore, in chronic cases, it was confirmed that this method could be used to gradually lengthened and repair severed nerves. There were no reports of pain or lengthening-related troubles during nerve lengthening.
Conclusion
It was found that good nerve regeneration can be achieved with short nerve defects. Compared to free nerve grafting, this new treatment is promising as it does not require the sacrifice of healthy nerves from the donor site or leave surgical scars. We demonstrated the potential of nerve lengthening as a new treatment option for nerve defects. This study is registered and published in the Japan Registry of Clinical Trials (Project No. jRCTs032180098,
https://jrct.niph.go.jp/re/reports/detail/17847
). Registration date: 28/01/2019.
Journal Article