Kudzvora Nhengo Dzako Dzakashandura Unhu Hwako | El Paso, TX.

Kutevera yekumusoro peripheral nerve transection uye kugadziriswa kwekuvhiya, vamwe varwere vanowanazve yakanaka sensorimotor basa asi vamwe vasingaite. Kunzwisisa nzira dzepakati uye dzepakati dzinobatsira pakugadzirisa zvinogona kuita kuti kuvandudzwa kwemishonga mitsva yekurapa. Plasticity inotevera peripheral nerve transection yakaratidzwa mukati meuroaxis mumhando dzemhuka dzekukuvara kwetsinga. Nekudaro, huropi hunochinja hunoitika zvichitevera peripheral nerve transection uye kugadziriswa kwekuvhiya muvanhu hakuna kuongororwa. Uyezve, iyo iyo peripheral nerve regeneration inokanganisa kushanda uye shanduko yehuropi shanduko haina kuzivikanwa. Naizvozvo, isu takabvunza kana shanduko yekushanda ichiperekedzwa negrey uye/kana chena nyaya shanduko yekuchinja uye kana shanduko idzi dzine chekuita nekupora kwekunzwa? Kugadzirisa nyaya idzi dzinokosha isu (i) takaongorora peripheral nerve regeneration; (ii) kuyerwa kushanda kwemagineti resonance imaging brain activation (yeropa okisijeni level inotsamira chiratidzo; BOLD) mukupindura kune vibrotactile stimulus; (iii) akaongorora grey uye chena nyaya structural brain plasticity; uye (iv) inopindirana manzwiro ekudzoreredza matanho ane grey nyaya inoshanduka mune peripheral nerve transection uye kuvhiya kugadzirisa varwere. Kuenzaniswa nemurwere wega wega ane hutano contralesional nerve, transected nerves dzakakanganisa tsinga conduction 1.5 makore mushure me transection uye kugadzirisa, kuitisa nekudzikira amplitude uye yakawedzera latency. Zvichienzaniswa nekutonga kune hutano, peripheral nerve transection uye kuvhiya kugadzirisa varwere vakashandura ropa reokisijeni rinoenderana nechiratidzo chiitiko mu contralesional primary and secondary somatosensory cortices, uye mune seti yenzvimbo dzehuropi dzinozivikanwa se �task positive network. Uye zvakare, kuderedzwa kwegrey nyaya kwakaonekwa munzvimbo dzinoverengeka dzehuropi, kusanganisira iyo contralesional yekutanga uye yechipiri somatosensory cortices, munzvimbo dzakafanana umo ropa reokisijeni rinotsamira kuderedzwa kwechiratidzo kuderedzwa kwakaonekwa. Uyezve, grey kuonda mu-post-central gyrus yakanga yakabatana zvisina kunaka nezviyero zvekunzwa kupora (mechanical uye vibration kuonekwa) ichiratidza hukama hwakajeka pakati pebasa uye chimiro. Pakupedzisira, takaona yakaderedzwa chena nyaya fractional anisotropy murudyi insula munharaunda yairatidzawo kuderedzwa grey nyaya. Izvi zvinopa nzwisiso muuropi plasticity uye chimiro-basa-maitiro hukama zvichitevera kukuvara kwetsinga uye zvine zvakakosha zvekurapa.

Keywords: cortical ukobvu; fMRI; diffusion tensor imaging; plasticity; peripheral nerve kukuvara
Mhedziso: BA=Brodmann nzvimbo; BOLD= zvinoenderana nemwero weokisijeni yeropa; fMRI=inoshanda magineti resonance imaging;
PNIr = peripheral nerve transection uye kugadziriswa kwekuvhiya; S1=primary somatosensory cortex; S2=secondary somatosensory cortex

ziviso

Kutevera nhengo yepamusoro yeperipheral nerve transection uye kugadziriswa kwekuvhiya (PNIr), ?25% yevarwere havana kudzokera kubasa 1.5 makore mushure mekuvhiyiwa (Jaquet et al., 2001). Uyezve, ?57% yevarwere vane kukuvara kwetsinga vari pakati pe16�35 yemakore (McAllister et al., 1996); saka, hupenyu hurefu hwekuremara uye matambudziko ehupfumi hunogona kuperekedza rekumusoro remakumbo nerve transection. Kunzwisisa pakati uye peripheral ramifications yeperipheral nerve kukuvara kunogona kuita kuti kuvandudzwa kwemaitiro matsva ekurapa uye zvirongwa zvekupindira.

Hazvizivikanwe kuti uropi hunopindura sei kuPNIr muvanhu. Nekudaro, zvidzidzo zvemhuka zvakaratidza kuti mapurasitiki mukati me somatosensory cortex anotanga nekukurumidza achitevera peripheral nerve transection, uye kuti 1 gore mushure mekuzadza nerve transection uye kugadziriswa kwekuvhiya, mepu dzekortical dzine patchy, dzisiri- zvinomiririra zvinomiririra zve transected uye pedyo netsinga (Wall et al. ., 1986). Iyo nzira dzinogonesa kushanda kwepurasitiki dzinofungidzirwa kuti dzinosanganisira kuburitswa kwekare kwekufungidzira kwagara kuripo kubva padyo necortical uye subcortical mazinga, uye kwenguva refu kumera kwemaaxon pamazinga akawanda eiyo neuroaxis, kusanganisira yekutanga somatosensory cortex (S1) (Florence naKaas. , 1995; Hickmott naSteen, 2005).

Zvidzidzo zvekufungidzira zvehuropi hwevanhu zvakatsigira zvakawanikwa kubva kumhando dzemhuka nekuzivikanwa kweakashandurwa anoshanda maMRI activation mepu nekuda kwekukuvara kwemutsipa wepelinha, kugurwa, kuendesa zvigunwe, uye kune varwere vane carpel tunnel syndrome (Lotze et al., 2001; Manduch et al., 2002; Jurkiewicz et al., 2006; Napadow et al., 2006). Uyezve, zvidzidzo zveMRI zvemaitiro zvakangobva kuona grey uye chena nyaya inoshanduka mushure mekukuvadzwa kunorwadza uye mumamiriro ezvinhu akasiyana-siyana, kusanganisira kugurwa kwemakumbo uye kurwadziwa kusingaperi (Apkarian et al., 2004; Draganski et al., 2006; Davis et al., 2008; Geha et al., 2008; Chivabvu, 2008). Grey nyaya shanduko inofungidzirwa kuti ine chekuita nekuchinja kwehukuru hwesero, atrophy uye / kana kurasikirwa kwemaneuron kana glia, nepo chena shanduko shanduko inokonzerwa neaxonal degeneration uye kurasikirwa kwemyelin (Beaulieu, 2002; Chivabvu, 2008).

Nzira ine simba yekutsanangudza nzira dzepathology uye plasticity ndeyekubatanidza inoshanda uye yakarongeka grey uye chena nyaya yekufungidzira maitiro. Isu takambotaura kuti varwere vane nhengo yepamusoro yepamusoro PNIr vakachengetedza zvakadzika somatosensory deficits inopfuurira makore 41.5 mushure mekuvhiyiwa (Taylor et al., 2008a). Kubva pane zvakawanikwa izvi, takafunga kuti varwere ava vaizoratidza kushanda uye kurongeka kwehuropi shanduko munzvimbo dzakakosha somatosensory brain. Nokudaro, muchidzidzo ichi, takafungidzira kuti varwere vePNIr vaizove: (i) kuderedza ropa reokisijeni rinoenderana (BOLD) mhinduro kune vibratory stimulation ye transected nerve territory, munharaunda yeS1 iyo inomiririra yakakuvadzwa yekumusoro uye muchipiri. somatosensory cortex (S2); (ii) kuderedzwa kunoenderana nekortical ukobvu munzvimbo idzi dze contralesional S1 uye S2; (iii) kuwirirana pakati pekuchinja kwekortical ukobvu uye psychophysical zviyero zve somatosensory basa (vibration uye kubata kubatwa kwezviyo); uye (iv) yakaderedzwa fractional anisotropy (chiyero chechinhu chichena kutendeseka) muzvinhu zvichena kudya mukati / kunze kweiyi somatosensory cortical nzvimbo.

nzira

Zvidzidzo

Takatsvaga varwere ve27 vane transection yakakwana yepakati uye / kana ulnar nerve yakateverwa nekugadziriswa kwekuvhiya kubva kune vanovhiya vepurasitiki vanobatana neYunivhesiti yeToronto Hand Program pakati paJune 2006 naMay 2008. Kubva muboka guru iri, 14 varwere vasina marwadzo (vakadzi vatatu , 11 varume; 34 ? 10 makore) ane transection yakakwana yekurudyi yepakati uye / kana ulnar nerve yakabatanidzwa muchidzidzo [kudzivisa kuvhiringidzika kwakabatana nekuvapo kwemarwadzo nevarwere vepashure vane marwadzo (n = 6) uye maronda ari kuruboshwe. (n=7) havana kubatanidzwa muongororo iyi]. Vose varwere vakawana microsurgical nerve kugadzirisa zvishoma makore 1.5 vasati vadzidza kunyoresa (nguva yekudzorera yakasiyana kubva ku1.5 kusvika ku8 makore). Mukuwedzera, takatora 14 yezera- uye zvepabonde-inofananidzwa nehutano hwehutano (3 vakadzi, 11 varume; 34 ? 10 makore). Zvidzidzo zvese zvakapa mvumo yakanyorwa ine ruzivo kune nzira dzakatenderwa neUniversity Health Network Research Ethics Board. Zvidzidzo zvese zvaive nerudyi (zvakatemerwa kushandisa Edinburgh handedness inventory: Oldfield, 1971) uye yakanga isina nhoroondo yekukuvara kwetsinga kana kurwadziwa kusingaperi (zvichida zvisati zvaitika kana mushure mekutapudza kwetsinga). Ona Tafura 1 yeruzivo rwehuwandu hwevanhu.

Chigadziro Chekudzidza

Zvidzidzo zvose zvakabatanidzwa mumusangano wekufungidzira waisanganisira: (i) kushanda kwemagnetic resonance imaging (fMRI) mukupindura kune vibrotactile stimuli inoshandiswa kune yakarurama index finger (mukati mechikamu chepakati chetsinga); (ii) yakakwirira-resolution anatomical scan yehuropi hwese, yakawanikwa yekunyoresa mufananidzo uye yekuongorora cortical grey nyaya; uye (iii) maviri diffusion tensor imaging scans yewongororo yewhite matter kuperera. Pamberi pekufungidzira, zvidzidzo zvakarairwa mune yekutanga dhizaini yekuyedza uye nekuyeuchidzwa kuti urambe wakanyarara sezvinobvira mukati menguva yese yekuongororwa.

Zvidzidzo zvaive zvakasununguka kubuda muchidzidzo chero nguva. Mukuwedzera, manzwiro uye motokari yekuongorora yakaitwa kune zvidzidzo zvose (Taylor et al., 2008a). Sezvo kubata uye kubvunda kwekuona zvikumbaridzo zvakabatana nekortical ukobvu tsananguro yenzira idzi inosanganisirwa pazasi (mamwe matanho e psychophysical achataurwa kumwewo).

Vibration Threshold

Zvikumbaridzo zvekuona kuzunguzika zvakatemwa pachishandiswa ruoko rwakabatwa Bio-Thesiometer (Bio-Medical Instrument Company, USA). Chigadzirwa chacho chine 12-mm probe iyo yakaiswa pane distal phalanx yekurudyi index finger (D2). Zvikumbaridzo zvakagadziriswa uchishandisa nzira yemiganhu: iyo amplitude (voltage) yakawedzera zvishoma nezvishoma kusvikira nyaya yakaratidza kuti vakanzwisisa kukurudzira. Vibration zvikumbaridzo zvakawanikwa katatu uye avhareji kukosha kwakaverengwa. Panguva yekuyedzwa kwevibration pachikumbaridzo, zvidzidzo zvakarairwa kuvhara maziso avo uye kuzorora kumashure kweruoko rwavo pane cushion inotsigira.

Mechanical Detection Threshold

Mechanical yekuona zvikumbaridzo zvakatemwa pachishandiswa yakamisikidzwa seti ye von Frey filaments (OptiHair2 Marstock Nervtest, Germany) ine 12 logarithmically spaced calibrated filaments iyo yakaunza masimba kubva pa0.25�512 mN. Iyo yekubata kumeso dhayamita yeese gumi nemaviri filaments yaive ~ 12mm. Miyedzo yakaitwa munhu akavhara maziso uye maoko akagadzikwa pacushion nyoro. Maprobe akaiswa mukukwira akateedzana uye zvidzidzo zvaidiwa kuita mhinduro pese pavainzwa probe ichibata kurudyi D0.4 chigunwe. Iyi nzira yakadzokororwa katatu. Simba reiyo filament rakaonekwa mune angangoita maviri emiyedzo matatu akashumwa sechidzitiro chekuona mechanicha chikumbaridzo.

Nerve Conduction Testing

Varwere vakapinda mubilateral sensory uye mota nerve conduction zvidzidzo paToronto Western Hospital electromyography (EMG) kiriniki. Nokuda kwekufambisa mutsara wemotokari, electrode inokurudzira yakaiswa paruoko uye pagokora (parutivi) uye electrode yekurekodha yakaiswa pamusoro peabductor pollicis brevis, yekuongorora tsinga dzepakati, kana abductor digiti minimi yekuongorora ulnar nerve. Pakuongorora tsinga dzekunzwa, electrode yekurekodha yakaiswa pachiwoko uye iyo inokurudzira electrode yakaiswa pamadijiti D2, D3 uye D5. Mumwe mukuru, ane ruzivo rweurologist kubva kuToronto Western Hospital EMG Clinic (Dr Peter Ashby) akaongorora kuongororwa kwese kwekiriniki kuti aone kuti tsinga dzipi dzakaratidza mhinduro dzenguva dzose / dzisina kujairika. Sezvo amplitude uye latency nhanho dzinozivikanwa kuti dzinosiyana zvakanyanya pakati pezvidzidzo (nekuda kwezvinhu zvakaita sekuwanda kwekusagadzikana, kudzika kwetsinga uye kukora kweganda remunhu) (Kimura, 2001) tsinga yega yega yemurwere. yakashanda sekutonga kwavo kwekuenzanisa nemaitiro kubva kudivi rakachinjirwa. Mune avo varwere vane detectable nerve conduction responses, paired t-tests yakaitwa kuti iongorore mutsauko we latency kana amplitude matanho pakati pemurwere wega wega transected uye contralesional untrasected nerves.

Imaging Parameters

Data yekufungidzira kwehuropi yakawanikwa pachishandiswa 3T GE MRI system yakarongedzerwa nesere-channel phased array head coil. Zvidzidzo zvakaiswa supine patafura yeMRI uye musoro wega wega waive wakapetwa kuti uderedze kufamba. Huwandu hwehuropi hwefMRI hwakawanikwa pachishandiswa echo planar imaging (28 axial slices, field of view (FOV) = 20 x 20 cm, 64 x 64 matrix, 3.125 x 3.125 x 4mm voxels, echo nguva (TE) = 30 ms, kudzokorora nguva (TR) = 2000 ms). Nguva yekuongorora yaive 5 min uye 8 s (154 mafuremu). Panguva yekuongorora, isingarwadze, 12 Hz vibrotactile stimulus yakaiswa kune distal phalanx yekurudyi D2 uchishandisa bharumu diaphragms inofambiswa nemhepo yakamanikidzwa (Chigadzirwa man- ufactured by Dr Christo Pantev; www.biomag.uni-muenster.de). Stimuli yakaunzwa mumabhuroko e10s akabatana ne20s ekuzorora, kwehuwandu hwegumi mabhuroko ekukurudzira uye gumi mabhuroko ekuzorora. Yekutanga 10 s (10 TRs) yedata yakawanikwa kubva mukumhanya kwega kwega yakaraswa kuti ibvumire fMRI chiratidzo chekuenzanisa. Zvidzidzo zvakarairwa kuti vachengete maziso avo akavharika mukati mekuongorora uye kutarisa pane zvinokurudzira. Uropi hwese hutatu hutatu (8D) yakakwirira-resolution anatomical scan (4 sagittal zvimedu, 3 x 124 cm FOV, 24 x� 24 matrix, 256 x 256 x 1.5 mm mavoxels) yakawanikwa ine T0.94-huremu hunorema 0.94D echoiled echoiled (avhareji yechiratidzo chimwe, flip angle = 1? , TE ?3 ms). Pamusoro pezvo, maviri diffusion tensor imaging scans (20 axial slices, FOV 5 x 38 cm, 24 x 24 matrix, 128 x 128 x 1.875 mm voxels) akawanikwa achitevedza 1.875 nzira ine b-kukosha kwe3smm�23. Kumhanya kwega kwega kwaivewo nemavhoriyamu maviri asina huremu hwekupararira.

fMRI Analysis

Data yakaongororwa pachishandiswa Brainvoyager QX v1.8 (Brain Innovaton, Maastricht, Netherlands). Pre-processing yaisanganisira: 3D motion correction, slice scan-time correction, linear trend kubviswa, high-pass filtering (6 cycles per run), uye spatial smoothing ine 3mm yakazara upamhi pahafu yepamusoro (FWHM) Gaussian kernel. fMRI data seti dzakapindirwa kune 3 x 3 x 1988 mm voxels, yakanyoreswa kune yakakwirira-resolution ana-tomical mufananidzo, uye yakajairwa kune yakajairwa Talairach nzvimbo (Talairach uye Tournoux, 1). MaVoxels anonzi 1 x 1 x 4 mm. Data yakaongororwa pachishandiswa general linear model; iyo modhi yakawanikwa nekubatanidza basa rebhokisi renguva yekukurudzira tactile neyakajairwa haemodynamic mhinduro basa. Kuziva pakati pemapoka akasiyana mumaitiro ekugadzirisa maitiro ekugadzirisa maitiro ekugadzirisa akaitwa nekusiyana: (i) kutonga kwakanaka: kukurudzira 4 kuzorora; (ii) PNIr: kukurudzira 4 kuzorora; uye (iii) hutano hunodzora 50.05 PNIr. Mamepu ekuita akaiswa pachikumbaridzo pamutengo wakagadziriswa weP50.0001 (unobva kune isina kurongeka P120 uye 3mm2009 contiguous voxels sezvakambotaurwa: Taylor naDavis, 11); izvi zvakare zvakasimbiswa nekumhanyisa Monte Carlo Simulation neAlphaSim application yakaitwa muAnalysis yeFunctional Neuroimage (AFNI) software. Kuongorora uku kwaisanganisira varwere ve9 chete avo vakatsigira transection yerudyi yepakati tsinga (n = 2) kana yerudyi yepakati uye ulnar nerve (n = XNUMX) (kureva varwere vatatu vane yakachena ulnar nerve transection havana kuisirwa mukuongororwa uku. )

Cortical Thickness Analysis

Cortical ukobvu kuongororwa kwakaitwa pachishandiswa Freesurfer (http:// surfer.nmr.mgh.harvard.edu); nzira dzakatsanangurwa zvakadzama kune imwe nzvimbo (Dale et al., 1999; Fischl et al., 1999a, b; Fischl naDale 2000). Nenguva pfupi, yakakwirira-resolution T1-yakaremerwa anatomical data seti yakanyoreswa kuTalairach atlas (Talairach uye Tournoux, 1988). Izvi zvakateverwa nekusimba kwemaitiro, kubviswa kwedehenya uye kupatsanurwa kwehemispheres. Zvadaro, iyo chena / grey nyaya (inonzi iyo chena nzvimbo) uye grey / CSF (inonzi iyo pial nzvimbo) miganhu yakaonekwa uye yakakamurwa. Chinhambwe pakati penzvimbo chena nepiyal chakazoverengerwa panzvimbo yega yega yehuropi. Kuti uone mutsauko weboka pakati pevarwere ve14 uye 14 zera / bonde-kunoenderana kudzora, mutsara mutsara wekuongorora wakaitwa pane imwe neimwe pfungwa pahuropi. Sezvo cortical topography yemunhu yakasikwa yakasiyana, 5mm FWHM spatial smoothing kernel yakaiswa pamberi pekuongorora kwenhamba. Dhata inoratidzwa pane yakagadziriswa P50.05 (yakabva kune isina kurongeka P50.0075 uye 102 contiguous vertices); izvi zvakaverengerwa nekumhanyisa Monte Carlo simulation neAlphaSim. Vhetikisi rinomiririra poindi papepa rine mativi maviri, uye, muchidzidzo ichi, chinhambwe chiri pakati pemavheti maviri i0.80mm2.

Sezvo varwere vakaratidza kukanganisa kwakakosha mu somatosensory basa mukati meiyo transected nerve territory, takafungidzira kuti zviyero zve somatosensory function (vibration uye kubata kubata) zvaizoenderana nekortical thickness mu contralesional post-central gyrus (primary and secondary somatosensory cortices). Nokudaro, takaita kuwirirana kuongororwa muboka revarwere pakati pe: (i) cortical thickness uye vibration yekuona chikumbaridzo; uye (ii) cortical ukobvu uye kubata kwekuona zvikumbaridzo. Mumwe murwere haana kupedza psychophysical assessment; saka, kuongorora uku kwaisanganisira 13 PNIr varwere. Mukuwedzera, kuti uone kana paiva nehukama pakati pekortical thickening uye nguva yekudzikinura kuongororwa kwekugadzirisa kwakaitwawo pakati pezviyero zviviri izvi. Kuongorora kwekubatanidza uku kwaingoitwa kune contralesional post-central gyrus nekubatanidza mask (yakatorwa kubva kuFreesurfer's yakavakwa muatlas) mune yakajairika mutsara modhi. A Monte Carlo simulation yakaitwa iyo yaingogumira kune nhamba ye vertices mukati me contralesional post-central gyrus; mifananidzo inoratidzwa neP50.05 yakagadziriswa (yakatorwa kubva kune isina kugadziriswa P50.0075 uye 68 contiguous vertices).

Diffusion Tensor Imaging Analysis

Diffusion tensor image processing yakaitwa neDTiStudio (www.MriStudio.org) uye FSLv.4.0 (www.fmrib.ox.ac.uk/fsl/). Mifananidzo yakatanga kugadziriswa neOtomatiki Image Registration chishandiso chakaitwa muDTiStudio, uchishandisa yekutanga B0 mufananidzo mumutsara wekutanga wakawanikwa setemplate. Iyi nzira inogadzirisa kufamba kwechinyorwa uye eddy-yazvino kukanganisa. Mifananidzo yese yakabva yaongororwa nemeso kuti iongorore mhando yemufananidzo uye kurongeka kweiyo yakaparadzana diffusion tensor imaging inomhanya. Kana artefact yaonekwa, chimedu chakabviswa kusati kwaverengerwa avhareji yeaviri akapatsanurwa tensor imaging inomhanya. Mamepu ega eFA akaverengerwa pachishandiswa DTIFIT chishandiso chakaitwa muFSL. Voxel-wise statistical analysis yakaitwa kuti ione kusiyana kweboka muchidimbu anisotropy uchishandisa Tract Based Spatial Statistics; kuti uwane tsanangudzo yakazara yenzira idzi ona Smith et al. (2006). Muchidimbu, mifananidzo yakanga isiri-mutsara yakanyoreswa kumufananidzo waivavarirwa (MNI152), mufananidzo wairehwa wakabva wagadzirwa kubva mumaseti ese uye chifananidzo ichi chakabva chatetepa kumiririra maturakiti ese aizivikanwa kune zvese zvidzidzo. Chidzidzo chega chega chepamusoro-soro cheanisotropy values ​​chakabva chaiswa paskeleton nekutsvaga muwhite matter perpendicular to each point pawhite matter skeleton. A whole-brain voxel-wise statistical analysis yakabva yaitwa pakati pemapoka (14PNIr uye 14 health controls) uye mifananidzo yaiva uropi hwose hwakagadziridzwa paP50.05. Mukuwedzera, nharaunda yekuongorora kufarira yakaitwa muchena nyaya maturakiti padyo ne contralateral S1, thalamus uye bilateral anterior uye posterior insula. Aya matunhu akasarudzwa sezvaakambove akabatanidzwa mune zvesomatosensation uye nekuti anowirirana nematunhu akaonekwa mufMRI uye cortical ukobvu kuongororwa (CTA) boka rinoongorora. Matunhu ekufarira akakweverwa pawhite matter skeleton sezvinotevera: (i) The contralateral S1 region of interest yakabva pakati pepakati pepakati pe white matter skeleton ye corona-radiata uye skeleton chikamu ichidyisa kupinda post-central gyrus; kuguma pamagumo eturakiti mukati mechikamu chakapihwa.

Munzira z dunhu rekufarira rakatambanudzwa kubva paz=49 kusvika pa57; maturakiti machena anopa nzvimbo yemaoko. (ii) The contralateral thalamus nharaunda yekufarira yaingoitwa kune chena nyaya tracks dzakatenderedza posterior uye medial thalamic nuclei (nuclei inobatanidzwa mune somatosensory function), kubva pa z = �1 kusvika 4. (iii) Insular nzvimbo dzekufarira dzakatorwa mukati memativi maviri. chena nyaya iri padhuze neanterior uye posterior insula zvichienderana nemaitiro akamboburitswa nelebhu yedu (Taylor et al., 2008b). Nharaunda yekufarira yakawedzerwa kubva ku z = 2 kusvika ku8. Fractional anisotropy values ​​yakatorwa kubva kune imwe neimwe yeiyi nzvimbo dzekufarira uye kuongororwa kwakasiyana-siyana kwekusiyana (MANOVA) kwakaitwa uchishandisa Statistical Package yeSocial Sciences v13.0 (SPSS Inc, Chicago), iyo yaisanganisira mafractional anisotropy values ​​kune ese matanhatu matunhu anofarira.

Results

Tafura 1 inopa ruzivo rwehuwandu hwevatori vechikamu muzvidzidzo. Vese varwere ve14 vakatsigira chikamu chakakwana chepakati uye / kana ulnar nerve yakateverwa nekugadzirisa microsurgical kanenge makore 1.5 isati yatanga kudzidza. Nguva kubva pakuvhiyiwa kusvika pakuedzwa yakabva ku1.5 kusvika kumakore masere ane chirevo (?SD) che8? 4.8 years. Varwere uye zvidzoreso hazvina (3? 34 makore mapoka maviri; t = 10; P = 0.04).

Psychophysics

Vibration thresholds yakaverengerwa kubva pazviyero zvese zvitatu sezvo imwe-nzira yakadzokororwa nhanho kuongororwa kwekusiyana (ANOVA) yakaratidza hapana misiyano yakakosha pakati pezviyedzo zvitatu [F (25, 1) = 0.227, P = 0.64]. Vibration uye michina yekuona thresh- olds yakakanganiswa zvakanyanya muvarwere vePNIr zvichienzaniswa nehutano hwehutano (vibration: t = 4.77, P50.001, Fig. 3A; mechanical: t = 3.10, P = 0.005, Fig. 3D).

Nerve Conduction Testing

Amplitude uye latency matanho akawanikwa kubva kumurwere wega wega contralesional nerves akarongedzerwa seakajairwa naane ruzivo neurologist paToronto Western Hospital EMG Clinic. Vapfumbamwe vevarwere ve14 vakapedza kuyedza nerve conduction. Tafura 2 inoratidza avhareji yekuwedzera / kuderera latency uye amplitude data ye sensory nerve conduction kubva pachiwoko kuenda kune abductor pollicis brevis (median) kana abductor digiti minimi (ulnar) tsandanyama uye yekunzwa conduction kubva paruoko kuenda kuD2 (median) uye D5 ( ulnar) zvichienzaniswa nevarwere vese vasina kukuvadzwa contralesional nerve. Pakati pevapfumbamwe, varwere vanomwe vaive nema transections aisanganisira nerve yepakati. Pakati pevanomwe ava, mumwe murwere akanga asina mhinduro inooneka panguva yekuongorora motokari uye mumwe murwere akanga asina mhinduro inooneka panguva yekuedzwa kwekunzwa.

Muvarwere vatanhatu vane mhinduro dzinoonekwa, mota conduction latencies yakawedzera ne43% (t = 6.2; P = 0.002) uye amplitudes yakaderedzwa ne38% (t = �2.6; P = 0.045) apo murwere wega wega zvichienzaniswa nerutivi rwavo rusina kukuvara. Sensory conduction mu median nerves yakaratidzawo kuwedzera kwe26% mu latency (t = 3.9; P = 0.011) uye 73% kuderera kweamplitude (t = �8.0; P = 0.000) kana ichienzaniswa neyakajairika contralesional nerve. Mune varwere vana vane ulnar nerve transections mumwe murwere akanga asina mhinduro inooneka panguva yekuongorora tsinga. Mune avo varwere vane mhinduro, ulnar nerve motor latencies yakanga isina kunyanya kukwidziridzwa (t = 2.8; P = 0.070); zvisinei, amplitudes aive akanyanya
yakadzikira ne41% (t = �5.9; P = 0.010). Sensory test yeurnar nerve yakaratidza kuwedzera kwe27% mu latency (t = 4.3; P = 0.049) asi hapana kuwedzera kukuru kweamplitude (t = 3.5; P = 0.072).

Inoshanda Plasticity MuPrimary Somatosensory Cortex

Mamepu eMRI anoshanda akaverengerwa kubva kuvarwere ve11 PNIr vane kurudyi median nerve transections (varwere vane ulnar nerve transections havana kuverengerwa kubva mukuongororwa uku) uye 11 yezera- uye zvepabonde-inofananidzwa nekutonga kwehutano. Kubva Fig. 1A, zviri pachena kuti varwere vePNIr vane zvishoma zvishoma kushandiswa, zvichienzaniswa nekutonga kwehutano, munharaunda yeS1 inoenderana neBrodmann nzvimbo 2 (BA2) (Talairach uye Tournoux, 1988) uye S2 (ona Tafura 3 kuti uwane mamwe mashoko) . Avhareji yemhinduro dzinechekuita nezviitiko kubva munzvimbo idzi dzekufarira dzinoratidza yakadzikira BOLD mhinduro mukati mevarwere� kuruboshwe BA2 uye kuruboshwe S2 (Fig. 1B neC, zvichiteerana). Zvinoshamisa kuti, vibrotactile stimulation muvarwere yakagadzirisa chikamu chepamusoro-soro che-post-central gyrus (zvichida BA1 / 3) (Talairach uye Tournoux, 1988) (Fig. 1A uye Tafura 3). Avhareji inoenderana nechiitiko (Fig. 1D) inoratidza kuti hutano hunodzora hwaive nekuita kushoma munzvimbo ino. Uyezve, varwere vaive nekuita zvakanyanya mumatunhu ehuropi pamwe chete anozivikanwa sebasa rakanaka network (asterisk muFig. 1). Ona Tafura 3 yerunyorwa ruzere rwebasa rakanaka nzvimbo dzehuropi dzakaitwa. Iyi network inosanganisira lateral prefrontal, lateral parietal, premotor uye inferior temporal cortices (Table 3): nzvimbo dzeuropi dzinoshandiswa panguva yekuita basa rinoda kutarisirwa uye kudzvinyirirwa kana kusashanda panguva yekuzorora kana mabasa asina kuziva kana kuti anonetsa (Fox et. al., 2005; DeLuca et al., 2006; Seminowicz naDavis 2007).

Yakaderedzwa Grey Matter MuPrimary Somatosensory Cortex Cortex Inoenderana Nekunzwa Kudzoreredza

Cortical thickness analysis muvarwere vose ve14 uye 14 yezera / zvepabonde-inofananidzwa nehutano hwehutano hwakaratidza huwandu hwakawanda hwekortical thinning muboka rePNIr (Fig. 2 uye Tafura 4). Kunyanya, varwere vaive ne13% �22% kuderedzwa kwekortical thickness kuruboshwe (contralesional) S1, S2, pregenual anterior cingulate gyrus, ventrolateral prefrontal cortex uye kurudyi anterior insula, anterior/posterior mid cingulate gyrus uye paracentral lobule. Sezvineiwo, nzvimbo dzegrey kutetepa mukati meiyo post-central gyrus inopindirana nematunhu akaderedzwa BOLD anotevera vibrotactile stimulation (Table 4). Sezvo taive neruzivo rwekare rwevarwere "kushaikwa kwekunzwa uye nguva yekudzorera (kureva nguva kubva pakugadzirisa microsurgical), isu takazobvunza kana varwere cortical ukobvu mumashure-yepakati gyrus yakabatana nemanzwiro avo emagetsi uye vibration yekuona zvikumbaridzo, kana neavo kupora nguva. Ongororo iyi yakaratidza kudyidzana kwakashata pakati pecortical ukobvu uye kudengenyeka kwezvikumbaridzo munzvimbo inobatanidza BA1/2 neS2 (P50.001, r=?0.80 uye ?0.91, yeBA1/2 neS2, zvakateerana; Fig. 3 uye Tafura 5) ) Mukuwedzera, michina yekuona zvikumbaridzo yakabatanidzwawo zvakashata nekortical ukobvu mune imwe nzvimbo yepamusoro yeBA2 uye imwe nzvimbo yeS2 (P50.001, r = ?0.83 uye? 0.85). Nekudaro, isu hatina kuona hukama hwakakosha pakati penguva yekudzoreredza uye cortical ukobvu. Naizvozvo, mune post-central gyrus cortical kuonda kwaibatanidzwa nekunyanya kuomarara kwekunzwa. Nekudaro, isu hatina kuona hukama hwakakosha pakati penguva yekudzoreredza uye cortical ukobvu. Zvekare, pakanga paine kunyorerana pakati peiyo cortical kuonda munzvimbo dzine hukama zvisina kunaka nekuzunguza uye matunhu anoratidza boka fMRI neCTA zvisirizvo.

White Matter Abnormalities Kutevera Nerve Transection

Kuti tiongorore kuperera kwenyaya chena takashandisa nharaunda yekufarira nzira yekuongorora misiyano yeboka rezvinhu zvichena zvichibva pane fungidziro yekutanga. Matunhu ekufarira aingogumira kumaturakiti machena akatenderedza uye achidyisa mune contralesional S1 uye thalamus. Pamusoro pezvo, isu takakweverawo matunhu anofarira mune chena nyaya padyo nekuruboshwe nekurudyi, anterior uye posterior insula. Iyo insula yakasarudzwa sezvainosanganisirwa mukugadzirisa somatosensory uye nekuti isu takaona yakaderedzwa grey nyaya mune chaiyo anterior insular neCTA. Iyi nharaunda yekufarira nzira yakaratidza kuti varwere vakanga vaderedza zvakanyanya chena nyaya yefractional anisotropy values ​​(MANOVA kusanganisira nzvimbo dzose nhanhatu dzekufarira) dziri pedyo nechemberi yakarurama [F (1, 26) = 4.39, P = 0.046; Mufananidzo 4A] uye posterior insula [F (1, 26) = 5.55, P = 0.026; Fig. 4B], asi pakanga pasina misiyano yeboka munyaya chena iri pedyo neruboshwe insula (kuruboshwe anterior insula: P = 0.51; kuruboshwe posterior insula: P = 0.26), thalamus (P = 0.46) kana S1 (P = 0.46 )

hurukuro

Pano, takaratidza kekutanga kuti kune purasitiki inoshanda uye zvese zviri zviviri grey uye chena nyaya yemaitiro abnormalities munzvimbo dzinoverengeka dzecortical dzinotevera chepamusoro chepamusoro peripheral nerve transection uye kuvhiya kugadziriswa. Iyi plastiki inogona kusimuka kubva mukusakwana kweperipheral nerve regeneration (peripheral cell death uye/kana kusakwana zvakare-myelination), sezvo nhanho dzekuita tsinga muvarwere ava dzakaratidza kusaenzana kwakanyanya. Uye zvakare, data redu rinoratidza kuti yakadzikira vibrotactile-yakaburitswa fMRI mhinduro mumashure-yepakati gyrus inoenderana negrey nyaya kutetepa muboka revarwere. Mhinduro idzi dzinoratidza kuti kuderedzwa kweBOLD mhinduro dzinogona kufambiswa nekudzikiswa kwecortical grey nyaya uye/kana kuderera kweiyo afferent input kune post-central gyrus. Pamusoro pezvo, ukobvu hwecortical mukati mezvikamu zvakafanana zveiyo post-central gyrus yakabatana zvisina kunaka nematanho ekuzvibata e somatosensory function. Kureva, kuwedzera somatosensory deficits akanga correlated ne thinner cortex; ese ari maviri anogona kunge ane chekuita neafferent input. Kutorwa pamwe chete, data yedu inoratidza kuti kusakwana kweperipheral nerve regeneration kunobatsira kukanganiswa kwe somatosensory, cortical grey nyaya atrophy uye kuderedzwa kwefMRI activation (ona Fig. 5 nokuda kwechidimbu chezviwanikwa izvi).

Zvinonyatsozivikanwa kuti cortical plasticity inotevera peripheral nerve transection uye kugadziriswa kwekuvhiya kunogona kuitika muCNS yese mune zvisiri zvevanhu primates (Kaas, 1991). Iyi purasitiki inofungidzirwa kuve nekuda kwekuburitswa kwemasinapsi aimbonyarara kana axonal inomera munzvimbo isina matsi (Wall et al., 1986; Florence naKaas, 1995). Mumuenzaniso we primate, gore re 1 rinotevera nerve transection uye kugadziriswa kwekuvhiya, iyo denervated cortex inoratidzirwa nekusakwana uye kusina kurongeka kumiririrwa kwezvakagadziridzwa uye zviri pedyo (zvakasimba) nerve. Ichi chinomiririra chinomiririra chinonzi chinokonzerwa nekusakwana kweparipheral kuvandudzwa zvichikonzera kudzoreredzwa kwechikamu cheiyo denervated cortical space (Kaas, 1991). Kuti tiongorore huwandu hwekuzvarwa patsva muhuwandu hwevarwere takaita zvidzidzo zvekunzwa uye mota nerve conduction munzvimbo yese yakachinjika. Yedu nerve conduction mibairo inoratidza kuti varwere vePNIr vakanyanya kuderera amplitude uye yakawedzera latency mune zvese zvinonzwa uye mota tsinga zvichienzaniswa neyavo isina kuchinjika. Kuderera kweamplitude pamwe chete nekuwedzera latency kunoratidza peripheral fiber kurasikirwa (kureva sero kufa) uye / kana kusakwana kana kusakwana kudzoreredza myelination inotevera transection (Kimura, 1984). Mukuwedzera, zvakasimbiswa kuti pakati pe20% ne50% ye dorsal root ganglion neurons inofa ichitevera nerve transection (Liss et al., 1996). Nokudaro, afferent cell death uye kusakwana kwekuzvarwa patsva kunogona kukonzera kuderera kweafferent input kune cortex, iyo inogona kuverengera kuenderera mberi kwekunzwa kuderera uye kuderera kweBOLD mhinduro muBA2 uye S2. Uyezve, iyi yakadzikira yekupinda yekupinza inogona zvakare kuverengera iyo cortical kuonda kwatakaona munzvimbo dzakafanana dze cortex. Kushaikwa kwekunzwa kwakaratidzwa kukonzeresa kuderera kwetrans-neuronal munzvimbo dzinoverengeka dzeCNS, kusanganisira iyo dorsal horn inotevera sciatic nerve chikamu (Knyihar-Csillik et al., 1989), uye inogona kusanganisira yechipiri- uye yechitatu-yero neurons (Powell uye Erulkar, 1962). Transneuronal degeneration inoratidzwa nesero shrinkage uye inofungidzirwa kuti ine hukama nekuderera, kana kusipo, afferent input (Knyihar-Csillik et al., 1989). Saka, cortical grey nyaya kurasikirwa (kana atrophy) inogona zvakare kuve yakanangana nekudzikira kwekuisa afferent.

Isu takaratidzawo kuwedzera activation muiyo post-central gyrus munharaunda inoenderana neBA1/3 (Talairach uye Tournoux, 1988). Electrophysiological, anatomical tracing uye neuroimaging zvidzidzo zvakasimbisa kuti kune ruzhinji rwecutaneous mechanoreceptive afferents ekutanga cortical kuenda kune BA1 uye BA3b. Idzi nzvimbo dzehuropi dzecytoarchitectonic imwe neimwe ine mepu yemuviri somatotopic ine minda midiki inogamuchira. Pamusoro pezvo, nzvimbo idzi dzinopindura kune akawanda maficha eruzivo rwetactile, senge magadzirirwo uye roughness, velocity uye curvature yekukurudzira (Bodegard et al., 2001). Zvidzidzo zvefMRI zvakaratidza kuti basa riri mukati me somatosensory cortex rinopesvedzerwa nekutarisisa kwakadai zvekuti mhinduro dzefMRI kune tactile stimuli muS1 dzinowedzerwa kana zvidzidzo zvichienda kune tactile stimulus, asi zvinosimbiswa kana zvidzidzo zvichikanganiswa (Arthurs et al., 2004; Porro et al., 2004). Uyezve, varwere vedu vakagadzira network yenzvimbo dzehuropi dzinozivikanwa sebasa rakanaka network (DeLuca et al., 2006) kupfuura kutonga kune hutano. Idzi nzvimbo dzehuropi dzinoitwa panguva yekutarisisa kunoda maitiro (Fox et al., 2005; Seminowicz naDavis, 2007). Pamwe chete, izvi zvakawanikwa zvinoreva kuti varwere vanofanirwa kuenda kune kukurudzira kupfuura kutonga nekuda kwekusagadzikana kwavo kwekunzwa. Uku kutarisisa kwakawedzera kunogona kuverengera kuwedzera activation muBA1/3b. Ehe, iyo yakawedzera activation muBA1 / 3b inogonawo kuratidza plastiki iyo isingaenderane nekutarisa mutoro.

BA2 uye S2 ese ari maviri anogashira fungidziro kubva kuBA1/3b uye zvakare kubva munzvimbo dzakasiyana dzeiyo ventroposterior thalamic complex (Pons et al., 1985; Friedman naMurray, 1986). Zvose izvi ubongo nzvimbo dzine mahombe, kazhinji ane manhamba akawanda (BA2) kana bilateral (S2) minda yekugamuchira (Pons et al., 1985; Iwamura et al., 2002). Kubva pane ana-tomical fungidziro uye neuronal mhinduro zvivakwa, hierarchical process yetactile ruzivo yakaratidzwa kubva kuBA1/3b kuenda kuBA2 (Kaas et al., 2002). Pamusoro pezvo, zvidzidzo zve electrophysiological mumacaques (Pons et al., 1987) uye magnetoence-phalography data yakawanikwa muvanhu, inoratidza kuti serial process ye tactile inputs inoitika kubva kuS1 kuenda kuS2 mumaprimates epamusoro (Frot naMauguiere 1999; Disbrow et al. ., 2001). Tsvakurudzo dzinoverengeka dzakaratidza kuti BA2 inonyanya kushandiswa nechimiro uye curvature (Bodegard et al., 2001), nepo S2 inogona kuve nechekuita mukudzidza tactile (Ridley naEttlinger 1976; Murray naMishkin, 1984), vachitsigira pfungwa yekuti idzi nzvimbo dzehuropi. vanobatanidzwa mune yepamusoro-soro somatosensory processing. Yedu psychophysical assessment yakaratidza kuti varwere vakanga vasina kukanganisa zvakanyanya pakuona nyore nyore tactile stimuli, uye mu Shape Texture Identification test 1.5 makore mushure mekuvhiyiwa (Taylor et al., 2008a). Iyi bvunzo yekupedzisira inoongorora kugona kwemurwere kuziva hunhu hwechinhu achinyatsoongorora chimiro kana magadzirirwo, achida kubatanidzwa kweruzivo rwekunzwa munzvimbo dzese dzemuviri (Rosen naLundborg, 1998). Kutorwa pamwe chete, dudziro yedata redu ndeyekuti varwere vePNIr vanopinda zvakanyanya kune vibrotactile stimulus, zvichiita kuti kuwedzere kushandiswa kwebasa rakanaka network uye BA1/3. Zvisinei, muvarwere ava, data yedu inoreva kuti nzvimbo dzepamusoro-soro dzekugadzirisa, dzakadai seBA2 neS2, hadzina kugamuchira ruzivo rwetactile, iyo, iyo, inogona kukonzera cortical thinning uye kuderedza mhinduro dzeBOLD.

Iyo insula inofungidzirwa kuita basa mukubatanidza ruzivo rwemultimodal rwakakosha kune sensorimotor, manzwiro, allostatic / homeostatic uye cognitive mabasa (Devinsky et al., 1995; Critchley, 2004; Craig, 2008) uye yakave yakasarudzwa limbic sensory cortex (Craig. , 2008). Ongororo dzinoverengeka dzakashuma insular activation mukupindura tactile stimulation (Gelnar et al., 1998;

Downar et al., 2002) uye zvidzidzo zvekutsvagisa anatomical mumaprimates zvakaratidza kuti insula yacho yakabatana nemberi, parietal uye temporal lobes (Augustine, 1996). Mune varwere vedu, iyo yakananga anterior insula ndiyo chete cortical nzvimbo yairatidza yakakosha cortical kuonda pamwe chete neyakaderedzwa fractional anisotropy values ​​mune yakatarisana nyaya chena, zvichiratidza kuti cortical thinning mukati medunhu rino inosanganiswa nekurasikirwa kwefibers inoratidzira kuenda kana kubva. chimiro ichi. Iyo yekurudyi anterior insula yakave yakabatanidzwa mukufungidzira sezvo iripo yekubatanidza homeostatic kupinza kubva mumuviri nekukurudzira, manzwiro uye magariro mamiriro (Craig, 2008). Uyezve, Critchley et al. (2004) yakashuma kuwirirana pakati pekugona kwekufungidzira uye grey nyaya vhoriyamu yekurudyi anterior insula. Tichifunga nezvekutsvaga kwedu kuti varwere vadzikira grey mune chaiyo anterior insula, zvingave zvekufarira kuongorora kugona kwekugona kunotevera peripheral tsinga kukuvara mune ramangwana kudzidza.

Takatorwa pamwe chete, takaratidza kekutanga kuti shanduko yekushanda uye yemaitiro iripo muhuro hwemunhu 1.5 makore mushure mechikamu chakakwana chepamusoro chepamusoro cheperipheral nerve yakagadziriswa microsurgically. Mukuwedzera, matanho ekuitisa nerve anoratidza kusakwana kweperipheral regeneration muvarwere ava. Uyezve, isu tinoratidza kuti cortical thickening inoenderana ne psychophysical matanho ekupora, mune iyo yakaonda cortex mukati meBA2 uye S2 yaibatanidzwa nehurombo somatosensory basa. Idzi data dzinoratidza kuti kumisikidzwazve kweyakajairika inoshanda activation mepu inobatanidzwa zvakananga nekubudirira kugadzirwa patsva kwemaperipheral afferents.

Keri S. Taylor,1,2 Dimitri J. Anastakis2,3,4 naKaren D. Davis1,2,3

1 Division of Brain, Imaging and Behaviour � Systems Neuroscience, Toronto Western Research Institute, University Health Network, Toronto, Canada M5T258
2 Institute of Medical Science, University of Toronto, Canada
3 Dhipatimendi Rokuvhiya, University of Toronto, Canada
4 Clinical Studies Resource Center, Toronto Western Research Institute, University Health Network, Toronto, Canada M5T2S8

Kunyorerana na: Karen D. Davis, Ph.D.,
Chikamu cheBrain, Imaging uye Behaviour � Systems Neuroscience, Toronto Western Research Institute,
Toronto Western Hospital,
University Health Network,
Kamuri MP14-306, 399 Bathurst Street,
Toronto, Ontario,
Canada M5T 2S8
E-mail: kdavis@uhnres.utoronto.ca

KUTENDA

Vanyori vanotenda Mr. Geoff Pope, Dr. Adrian Crawley, Mr. Eugene Hlasny uye Mr. Keith Ta nokuda kwehunyanzvi rubatsiro rwehunyanzvi. Vanyori vanoda kutenda Dr. Peter Ashby naVaFreddy Paiz vanobva kuToronto Western Hospital EMG Clinic nekuita ongororo dzetsinga uye nekupa ongororo yehunyanzvi yezvakawanikwa. Vanyori vanotendawo Drs Dvali, Binhammer, Fialkov naAntonyshyn kuti vabatane nechirongwa ichi. Dr. Davis iCanada Research Chair muBrain and Behavior (CIHR MOP 53304).

Mari

The Physicians� Services Incorporated uye rubatsiro rwembeu yakabatana kubva kuYunivhesiti yeToronto Center yeChidzidzo chePain/ AstraZeneca.

Supplementary material

Supplementary material inowanikwa kuBrain online.