THE SCIENCE OF NERVE REPAIR

描述（由申请人提供）： 周围神经损伤是一个重要的临床问题。美国每年发生4万例神经损伤。然而，这些损伤的治疗尚未受益于最近医学科学的巨大进步。用针和线将切断的神经末端缝合在一起仍然是主要的治疗选择。这种治疗只能使1/2的神经损伤成年人恢复有用功能，只有10%的人能恢复正常功能。大多数人会有永久性的感觉和运动缺陷，干扰或阻止工作或职业活动。关于神经修复的现有书籍集中在问题的临床或科学方面，很少将两者结合起来。几乎都是由多个作者编写的。在过去的20年里，我专门从事神经损伤的治疗，同时在实验室研究这些问题。我写《神经修复科学》的目的是将外科和基础科学方法结合起来，从而将外科和基础科学社区结合起来，为神经损伤的问题设计出更好的解决方案。这本书将开始审查目前的临床结果，以了解他们可以教我们什么关于人类神经再生的生物学。这些材料的相对混乱需要进行严格的统计学荟萃分析，以更清楚地定义当前的临床现实。单个神经治疗的结果将围绕生物学主题进行分组和分析，而不是外科医生熟悉的解剖格式。这项审查还将确定临床需求最迫切的领域，这是确定未来研究优先事项的必要步骤。正文将批判性地评价与周围神经系统的结构、功能和再生相关的基础科学，强调轴突生长和指导的分子事件的最近工作。第三部分和最后一部分将整合前两部分，临床和科学的过去，试图为未来的蓝图。例如，第1章将患者年龄确定为神经损伤后结果的主要决定因素。因此，鉴定再生成分，随着年龄的增长和恢复到少年的功能水平，应是未来研究的主要目标。牛津大学出版社的出版物将确保这项工作达到广泛的受众，最大限度地提高其刺激年轻研究人员的能力，无论是外科还是科学，形成合作伙伴关系，以解决神经再生的问题。

DESCRIPTION (provided by applicant): Peripheral nerve injury is a significant clinical problem. Forty thousand nerve injuries occur in the US each year. However, treatment of these injuries has yet to benefit from recent dramatic advances in medical science. Sewing cut nerve ends together with needle and thread remains as the principle therapeutic option. This treatment will restore useful function to only 1/2 of adults with nerve injuries, and only 10% will approach normal function. Most will have permanent sensory and motor deficits, interfering with or preventing work or vocational activities. Available books on nerve repair focus on either clinical or scientific aspects of the problem, and little is done to integrate the two. Almost all are prepared by multiple authors. For the past 20 years I have specialized in the treatment of nerve injuries while simultaneously investigating these problems n the laboratory. My goal in writing The Science of Nerve Repair is to unite surgical and basic science approaches, and thus surgical and basic science communities, to devise better solutions to the problems of nerve injury. The book will begin by reviewing current clinical results to learn what they can teach us about the biology of human nerve regeneration. The relative disorganization of this material necessitated a statistically rigorous meta-analysis to more clearly define current clinical reality. Outcomes from treatment of individual nerves will be grouped and analyzed around biological themes instead of in the anatomical format familiar to surgeons. This review will also identify the areas where clinical need is most pressing, a necessary step towards defining priorities for future research. The main body of the text will critically evaluate the basic science relevant to the structure, function, and regeneration of the peripheral nervous system, emphasizing recent work on the molecular events of axonal growth and guidance. The third and final section will integrate the first two sections, the clinical and scientific past, to attempt a blueprint for the future. For instance, Chapter 1 establishes patient age as the primary determinant of outcome after nerve injury. Identification of regeneration components that deterioriate with age and their restoration to juvenile functional levels should therefore be a primary goal of future research. Publication by Oxford University Press will assure that this work reaches a wide audience, maximizing its ability to stimulate young investigators, both surgical and scientific, to form partnerships to solve the problems of nerve regeneration.