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4万起神经损伤事件。然而，这些损伤的治疗还没有从最近医学科学的巨大进步中受益。用针和线将切断的神经末梢缝合在一起仍然是主要的治疗方案。这种治疗只会使一半的神经损伤成年人恢复有用的功能，只有10%的人会接近正常功能。大多数人会有永久性的感觉和运动障碍，干扰或阻碍工作或职业活动。现有的关于神经修复的书籍侧重于这一问题的临床或科学方面，而很少有将两者结合起来的工作。几乎所有的书都是由多位作者准备的。在过去的20年里，我一直专注于神经损伤的治疗，同时在实验室里研究这些问题。我撰写《神经修复科学》的目的是将外科和基础科学的方法结合起来，从而使外科和基础科学界能够设计出更好的解决神经损伤问题的方案。这本书将从回顾目前的临床结果开始，以了解它们可以教给我们关于人类神经再生的生物学知识。这种材料的相对无序性要求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。个别神经的治疗结果将围绕生物学主题进行分组和分析，而不是以外科医生熟悉的解剖学形式。这项审查还将确定临床需求最紧迫的领域，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，强调最近在轴突生长和引导的分子事件方面的工作。第三部分也是最后一部分将整合前两部分，临床和科学过去，试图为未来绘制蓝图。例如，第一章将患者年龄确定为神经损伤后预后的主要决定因素。因此，确定随年龄恶化的再生成分并将其恢复到青少年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将确保这项工作接触到广泛的受众，最大限度地激发年轻的外科和科学研究人员结成伙伴关系，解决神经再生问题。

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.