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Jia X, Yang J, Yu C. Intercostal nerve transfer for restoration of the diaphragm muscle function after phrenic nerve transfer in total brachial plexus avulsion. Clin Neurol Neurosurg 2020; 197:106085. [PMID: 32683197 DOI: 10.1016/j.clineuro.2020.106085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022]
Abstract
OBJECT To determine the possibility of innervation of the diaphragm muscle using intercostal nerve after ipsilateral phrenic nerve transfer in total brachial plexus avulsion. METHODS Bilateral phrenic nerves and the 9th intercostal nerves were observed inside the thorax. The point where the phrenic nerve entered the diaphragm muscle (point A), the point where the 9th intercostal nerve gave rise to the cutaneous branch (point B) and crossed the posterior axillary line (point C) and the point where the posterior axillary line met the insertion of the diaphragm muscle (point D) were identified. The distances between points B and C, points A and C and from points A through D to C were recorded respectively. The 9th intercostal nerve was transferred to the distal stump of the phrenic nerve in one patient after phrenic nerve transfer to avulsed brachial plexus. RESULTS The mean distances between points B and C, points A and C and from points A through D to C were 12.20 ± 1.04 cm, 10.32 ± 1.02 cm and 16.43 ± 0.91 cm on the right side respectively, 11.78 ± 1.21 cm, 7.77 ± 0.85 cm and 11.74 ± 1.00 cm on the left side respectively. The 9th intercostal nerve was used to innervate the distal stump of the phrenic nerve in one patient after the phrenic nerve transfer to the avulsed brachial plexus. The diaphragm muscle function partially recovered one year after the operation. CONCLUSION The 9th intercostal nerve can be transferred to the distal stump of the phrenic nerve to restore the diaphragm muscle function according to the anatomical study. The movement of the diaphragm muscle was partially restored in one clinical case.
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Affiliation(s)
- Xiaotian Jia
- Department of Hand Surgery, Huashan Hospital, Fudan University, China; Key Laboratory of Hand Reconstruction, Ministry of Health, China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, China
| | - Jianyun Yang
- Department of Hand Surgery, Huashan Hospital, Fudan University, China; Key Laboratory of Hand Reconstruction, Ministry of Health, China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, China.
| | - Cong Yu
- Department of Hand Surgery, Huashan Hospital, Fudan University, China; Key Laboratory of Hand Reconstruction, Ministry of Health, China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, China
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Lukáčová N, Hricová L, Kisucká A, Papcunová Š, Bimbová K, Bačová M, Pavel J, Marsala M, Vanický I, Dzurjašková Z, Matéffy S, Lukáčová V, Stropkovská A, Gálik J. Is Innervation of the Neuromuscular Junction at the Diaphragm Modulated by sGC/cGMP Signaling? Front Physiol 2020; 11:700. [PMID: 32655417 PMCID: PMC7324717 DOI: 10.3389/fphys.2020.00700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 05/28/2020] [Indexed: 11/15/2022] Open
Abstract
We previously reported NO/sGC signaling in the upper respiratory pathway, receiving input from the respiratory neurons of the brainstem to phrenic motoneurons in the C3–C6 spinal cord. In order to assess whether innervation of the neuromuscular junction (NMJ) at the diaphragm is modulated by sGC/cGMP signaling, we performed unilateral 8-day continuous ligation of the phrenic nerve in rats. We examined sGCβ1 within the lower bulbospinal pathway (phrenic motoneurons, phrenic nerves and NMJs at the diaphragm) and the cGMP level in the contra- and ipsilateral hemidiaphragm. Additionally, we characterized the extent of phrenic nerve axonal degeneration and denervation at diaphragm NMJs. The results of our study show that continuous 8-day phrenic nerve ligation caused a marked increase in sGCβ1 (immunoreactivity and the protein level) in the ipsilateral phrenic motor pool. However, the protein sGCβ1 level in the phrenic nerve below its ligation and the cGMP level in the ipsilateral hemidiaphragm were evidently decreased. Using confocal analysis we discovered a reduction in sGCβ1-IR boutons/synaptic vesicles at the ipsilateral MNJs. These findings are consistent with the marked axonal loss (∼47%) and significant NMJs degeneration in the ipsilateral diaphragm muscle. The remarkable unilateral decrease in cGMP level in the diaphragm and the failure of EMG recordings in the ipsilateral hemidiaphragm muscle can be attributed to the fact that sGC is involved in transmitter release at the diaphragm NMJs via the sGC-cGMP pathway.
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Affiliation(s)
- Nadežda Lukáčová
- Institute of Neurobiology, Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovakia
| | - L'udmila Hricová
- Institute of Neurobiology, Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovakia
| | - Alexandra Kisucká
- Institute of Neurobiology, Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovakia
| | - Štefánia Papcunová
- Institute of Neurobiology, Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovakia
| | - Katarína Bimbová
- Institute of Neurobiology, Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovakia
| | - Mária Bačová
- Institute of Neurobiology, Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovakia
| | - Jaroslav Pavel
- Institute of Neurobiology, Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovakia
| | - Martin Marsala
- Institute of Neurobiology, Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovakia.,Neuroregeneration Laboratory, Department of Anesthesiology, University of California, San Diego, La Jolla, CA, United States
| | - Ivo Vanický
- Institute of Neurobiology, Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovakia
| | - Zuzana Dzurjašková
- Institute of Neurobiology, Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovakia
| | - Stanislav Matéffy
- Diagnostic Center of Pathology in Prešov, Alpha Medical, s.r.o., Martin, Slovakia
| | - Viktória Lukáčová
- Faculty of Economics, Technical University of Košice, Košice, Slovakia
| | - Andrea Stropkovská
- Institute of Neurobiology, Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovakia
| | - Ján Gálik
- Institute of Neurobiology, Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovakia
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