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Increases in M-wave latency of biceps brachii after elbow flexor eccentric contractions in women. Eur J Appl Physiol 2016; 116:939-46. [PMID: 26994769 DOI: 10.1007/s00421-016-3358-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 03/12/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Eccentric contractions (ECCs) induce muscle damage that is indicated by prolonged loss of muscle function and delayed onset muscle soreness. It is possible that ECCs affect motor nerves, and this may contribute to the prolonged decreases in force generating capability. The present study investigated the hypothesis that M-wave latency of biceps brachii would be increased after maximal elbow flexor ECCs resulting in prolonged loss of muscle strength. METHODS Fifteen women performed exercise consisting of 60 maximal ECCs of the elbow flexors using their non-dominant arm. M-wave latency was assessed by the time taken from electrical stimulation applied to the Erb's point to the onset of M-wave of the biceps brachii before, immediately after, and 1-4 days after exercise. Maximal voluntary isometric contraction (MVC) torque, range of motion (ROM) and muscle soreness using a numerical rating scale were also assessed before and after exercise. RESULTS Prolonged decreases in MVC torque (1-4 days post-exercise: -54 to -15 %) and ROM (1-2 days: -32 to -22 %), and increased muscle soreness (peak: 4.2 out of 10) were evident after exercise (p < 0.05). The M-wave latency increased (p < 0.01) from 5.8 ± 1.0 ms before exercise to 6.5 ± 1.7 ms at 1 day and 7.2 ± 1.5 ms at 2 days after exercise for the exercised arm only. No significant changes in M-wave amplitude were evident after exercise. CONCLUSION The increased M-wave latency did not fully explain the prolonged decreases in MVC torque after eccentric exercise, but may indicate reversible motor nerve impairment.
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102
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Rosa Junior GM, Magalhães RMG, Rosa VC, Bueno CRDS, Simionato LH, Bortoluci CHF. Efeito da associação da laserterapia com a natação no reparo morfológico do nervo isquiático e na recuperação funcional de ratos submetidos à axonotmese. FISIOTERAPIA E PESQUISA 2016. [DOI: 10.1590/1809-2950/13929623012016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO As lesões de nervos periféricos ocorrem frequentemente e, de modo geral, causam perda funcional impactando de forma negativa na vida do paciente. O objetivo do estudo foi verificar a eficiência da associação da laserterapia e natação em ratos acometidos por axonotmeses. A amostra foi composta por 50 ratos da linhagem Wistar. Foram divididos em 5 grupos, sendo: grupo controle (GC); grupo controle cirúrgico (GCC); grupo experimental laser (GEL); grupo experimental natação (GEN) e grupo experimental laser associado à natação (GELAN). O nervo foi esmagado em um segmento de 5 mm de comprimento próximo a trifurcação do nervo isquiático, feito com uma pinça durante 60 segundos. Foi utilizado o laser infravermelho AsGa (904 nm) com energia irradiada de 0,4 J na primeira semana, 0,8 J na segunda semana e 1,2 J na terceira e quarta semana. Para avaliação funcional (IFC), os animais foram imobilizados, e a região plantar das patas foram pintadas com tinta de carimbo. Esse procedimento foi repetido duas vezes com cada animal. Foi realizada a morfometria (áreas, diâmetros e espessuras das fibras, axônios e bainha de mielina) dos nervos com mensuração de 220 fibras por animal de cada grupo. Pudemos observar que os grupos GEL e GEN, em todas as variáveis morfométricas estudadas, obtiveram os melhores resultados, quando comparados com os outros grupos (GC, GCC e GELAN), mas não apresentou diferença estatisticamente significante entre eles. Na análise funcional observou-se que o grupo GELAN obteve o melhor resultado quando comparado com os outros grupos (GCC, GEL e GEN) e quando comparados os grupos GEL e GEN entre eles não houve diferença estatisticamente significante. A conclusão foi que os grupos GEL e GEN obtiveram os melhores resultados morfométricos, enquanto o GELAN apresentou o melhor resultado funcional. Portanto, pode-se concluir que a associação destes recursos favoreceu a recuperação funcional desses animais.
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103
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Shaikh S, Shortland P, Lauto A, Barton M, Morley JW, Mahns DA. Sensory perturbations using suture and sutureless repair of transected median nerve in rats. Somatosens Mot Res 2016; 33:20-8. [PMID: 26899181 DOI: 10.3109/08990220.2016.1142438] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The effects of changes to cold, mechanical, and heat thresholds following median nerve transection with repair by sutures (Su) or Rose Bengal adhesion (RA) were compared to sham-operated animals. Both nerve-injured groups showed a transient, ipsilateral hyposensitivity to mechanical and heat stimuli followed by a robust and long-lasting hypersensitivity (6-7 weeks) with gradual recovery towards pre-injury levels by 90 days post-repair. Both tactile and thermal hypersensitivity were seen in the contralateral limb that was similar in onset but differed in magnitude and resolved more rapidly compared to the injured limb. Prior to injury, no animals showed any signs of aversion to cold plate temperatures of 4-16 °C. After injury, animals showed cold allodynia, lasting for 7 weeks in RA-repaired rats before recovering towards pre-injury levels, but were still present at 12 weeks in Su-repaired rats. Additionally, sensory recovery in the RA group was faster compared to the Su group in all behavioural tests. Surprisingly, sham-operated rats showed similar bilateral behavioural changes to all sensory stimuli that were comparable in onset and magnitude to the nerve-injured groups but resolved more quickly compared to nerve-injured rats. These results suggest that nerve repair using a sutureless approach produces an accelerated recovery with reduced sensorimotor disturbances compared to direct suturing. They also describe, for the first time, that unilateral forelimb nerve injury produces mirror-image-like sensory perturbations in the contralateral limb, suggesting that the contralateral side is not a true control for sensory testing. The potential mechanisms involved in this altered behaviour are discussed.
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Affiliation(s)
- Sumaiya Shaikh
- a School of Medicine, Western Sydney University , NSW , Australia
| | - Peter Shortland
- b School of Science and Health, Western Sydney University , NSW , Australia
| | - Antonio Lauto
- b School of Science and Health, Western Sydney University , NSW , Australia
| | - Matthew Barton
- a School of Medicine, Western Sydney University , NSW , Australia
| | - John W Morley
- a School of Medicine, Western Sydney University , NSW , Australia
| | - David A Mahns
- a School of Medicine, Western Sydney University , NSW , Australia
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104
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Pulley BR, Luo TD, Barnwell JC, Smith BP, Smith TL, Li Z. A chronically-denervated versus a freshly-harvested autograft for nerve repair in rats. HAND AND MICROSURGERY 2016; 5:124-129. [PMID: 30828670 DOI: 10.5455/handmicrosurg.215015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives Autologous nerve grafting remains the gold standard for repair of peripheral nerve injuries. Its use, however, is limited by donor nerve availability and donor site morbidity. This is especially problematic after failure of an initial autograft that requires a repeat nerve graft, resulting in a second surgical site with associated morbidity. Based on the molecular differences in nerve degeneration in the proximal and distal segments after transection, we hypothesized that a chronically-denervated proximal stump may be viable for autologous nerve repair. Methods 20 Sprague-Dawley rats underwent right sciatic nerve excision and sural nerve transection. After 8 weeks, nerve repair was performed by harvesting the proximal segment of the sural nerve (n=10) or a fresh sural nerve (n=10) from the contralateral hind limb. Electrophysiological changes were analyzed to compare the fresh and denervated grafts. Results Electrophysiological testing demonstrated higher compound motor action potential in the denervated group compared to the fresh autograft group, however this difference was not statistically significant (p=0.117). Conclusion The proximal segment of a chronically-denervated sural nerve can be as effective as a fresh sural nerve for autologous repair of peripheral nerve injuries in a rodent model.
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Affiliation(s)
| | | | | | - Beth P Smith
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Thomas L Smith
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Zhongyu Li
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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105
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Mohanty CB. Central Plasticity in Brachial Plexus Injury: A Neural Domino Effect. World Neurosurg 2015; 86:22-4. [PMID: 26518513 DOI: 10.1016/j.wneu.2015.10.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 10/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Chandan B Mohanty
- Consultant Neurosurgeon, Bombay Hospital and Medical Research Centre, Mumbai, India.
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106
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Tajdaran K, Gordon T, Wood MD, Shoichet MS, Borschel GH. An engineered biocompatible drug delivery system enhances nerve regeneration after delayed repair. J Biomed Mater Res A 2015; 104:367-76. [DOI: 10.1002/jbm.a.35572] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/21/2015] [Accepted: 09/21/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Kasra Tajdaran
- Division of Plastic and Reconstructive Surgery; the Hospital for Sick Children; 555 University Ave Toronto Ontario M5G1X8 Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto; Toronto Ontario Canada
| | - Tessa Gordon
- Division of Plastic and Reconstructive Surgery; the Hospital for Sick Children; 555 University Ave Toronto Ontario M5G1X8 Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery; University of Toronto; Toronto Ontario Canada
- Program in Neuroscience, the Hospital for Sick Children Research Institute; Toronto Ontario Canada
| | - Mathew D. Wood
- Division of Plastic and Reconstructive Surgery; Washington University School of Medicine; St. Louis Missouri
| | - Molly S. Shoichet
- Institute of Biomaterials and Biomedical Engineering, University of Toronto; Toronto Ontario Canada
- Department of Chemical Engineering and Applied Chemistry; University of Toronto; Toronto Ontario Canada
| | - Gregory H. Borschel
- Division of Plastic and Reconstructive Surgery; the Hospital for Sick Children; 555 University Ave Toronto Ontario M5G1X8 Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto; Toronto Ontario Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery; University of Toronto; Toronto Ontario Canada
- Program in Neuroscience, the Hospital for Sick Children Research Institute; Toronto Ontario Canada
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107
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Li T, Hua XY, Zheng MX, Wang WW, Xu JG, Gu YD, Xu WD. Different cerebral plasticity of intrinsic and extrinsic hand muscles after peripheral neurotization in a patient with brachial plexus injury: A TMS and fMRI study. Neurosci Lett 2015. [PMID: 26200252 DOI: 10.1016/j.neulet.2015.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Contralateral C7 (CC7) neurotization has been an important approach for brachial plexus injury (BPI). Patients can achieve relatively good grasping function driven by the proximal extrinsic hand muscle (flexor digitorum, FD) after CC7 neurotization, whereas the thumb opposition function driven by the distal intrinsic muscle (abductor pollicis brevis, APB) is poor. The present study aimed to investigate the brain reorganization patterns of the recovery processes of intrinsic and extrinsic hand functions after repairing the median nerve by CC7 neurotization. Transcranial magnetic stimulation (TMS) and functional magnetic resonance imaging (fMRI) were used to evaluate the cerebral plasticity in one BPI patient after CC7 neurotization. After the CC7 neurotization, the patient showed improvements in the paralyzed hand. Combination of TMS and fMRI investigations demonstrated different cortical reshaping patterns of APB and FD. It was also found that the activated cortical areas of FD were located in bilateral motor cortices, but the area of APB was only located in ipsilateral motor cortex. The cerebral plasticity procedure appeared to be different in the gross and fine motor function recovery processes. It provided a new perspective into the cerebral plasticity induced by CC7 neurotization.
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Affiliation(s)
- Tie Li
- Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - Xu-Yun Hua
- Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - Mou-Xiong Zheng
- Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - Wei-Wei Wang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - Jian-Guang Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - Yu-Dong Gu
- Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China
| | - Wen-Dong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200040, China.
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Schenck TL, Stewart J, Lin S, Aichler M, Machens HG, Giunta RE. Anatomical and histomorphometric observations on the transfer of the anterior interosseous nerve to the deep branch of the ulnar nerve. J Hand Surg Eur Vol 2015; 40:591-6. [PMID: 25261412 DOI: 10.1177/1753193414551909] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study focuses on the anatomical and histomorphometric features of the transfer of the anterior interosseous nerve to the deep motor branch of the ulnar nerve. The transfer was carried out in 15 cadaver specimens and is described using relevant anatomical landmarks. Nerve samples of donor and target nerves were histomorphometrically analysed and compared. The superficial and the deep ulnar branches had to be separated from each other for a length of 67 mm (SD 12; range 50-85) to reach the site of coaptation. We identified a suitable site for coaptation lying proximal to the pronator quadratus muscle, 202 mm (SD 15; range 185-230) distal to the medial epicondyle of the humerus. The features of the anterior interosseous nerve included a smaller nerve diameter, smaller cross-sectional area of fascicles, fewer fascicles and axons, but a similar axon density. The histomorphometric inferiority of the anterior interosseous nerve raises a question about whether it should be transferred only to selected parts of the deep motor branch of the ulnar nerve.Level III.
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Affiliation(s)
- T L Schenck
- Department of Plastic Surgery and Hand Surgery, University Hospital rechts der Isar, Technical University Munich, Germany
| | - J Stewart
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, Ludwig Maximilians University Munich, Germany
| | - S Lin
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, Ludwig Maximilians University Munich, Germany
| | - M Aichler
- Research Unit Analytical Pathology, Helmholtzzentrum München, German Research Center for Environmental Health, Munich, Germany
| | - H-G Machens
- Department of Plastic Surgery and Hand Surgery, University Hospital rechts der Isar, Technical University Munich, Germany
| | - R E Giunta
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, Ludwig Maximilians University Munich, Germany
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109
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Bliley JM, Sivak WN, Minteer DM, Tompkins-Rhoades C, Day J, Williamson G, Liao HT, Marra KG. Ethylene Oxide Sterilization Preserves Bioactivity and Attenuates Burst Release of Encapsulated Glial Cell Line Derived Neurotrophic Factor from Tissue Engineered Nerve Guides For Long Gap Peripheral Nerve Repair. ACS Biomater Sci Eng 2015; 1:504-512. [DOI: 10.1021/ab5001518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | | | - H. T. Liao
- Division
of Trauma Plastic Surgery, Department of Plastic and Reconstructive
Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, R.O.C
| | - K. G. Marra
- McGowan Institute for Regenerative Medicine, Pittsburgh, Pennsylvania, United States
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110
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Bekelis K, Missios S, Spinner RJ. Falls and peripheral nerve injuries: an age-dependent relationship. J Neurosurg 2015; 123:1223-9. [PMID: 25978715 DOI: 10.3171/2014.11.jns142111] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECT Despite the growing epidemic of falls, the true incidence of peripheral nerve injuries (PNIs) in this patient population remains largely unknown. METHODS The authors performed a retrospective cohort study of 839,210 fall-injured patients who were registered in the National Trauma Data Bank (NTDB) between 2009 and 2011 and fulfilled the inclusion criteria. Regression techniques were used to investigate the association of demographic and socioeconomic factors with the rate of PNIs in this patient population. The association of age with the incidence of PNIs was also investigated. RESULTS Overall, 3151 fall-injured patients (mean age 39.1 years, 33.3% females) sustained a PNI (0.4% of all falls). The respective incidence of PNIs was 2.7 per 1000 patients for ground-level falls, 4.9 per 1000 patients for multilevel falls, and 4.5 per 1000 patients for falls involving force. This demonstrated a rapid increase in the first 2 decades of life, with a maximum rate of 1.1% of all falls in the 3rd decade, followed by a slower decline and eventual plateau in the 7th decade. In a multivariable analysis, the association of PNIs with age followed a similar pattern with patients 20-29 years of age, demonstrating the highest association (OR 2.34 [95% CI 2.0-2.74] in comparison with the first decade of life). Falls involving force (OR 1.25 [95% CI 1.14-1.37] in comparison with multilevel falls) were associated with a higher incidence of PNIs. On the contrary, female sex (OR 0.87 [95% CI 0.80-0.84]) and ground-level falls (OR 0.79 [95% CI 0.72-0.86]) were associated with a lower rate of PNIs. CONCLUSIONS Utilizing a comprehensive national database, the authors demonstrated that PNIs are more common than previously described in fall-injured patients and identified their age distribution. These injuries are associated with young adults and falls of high kinetic energy.
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Affiliation(s)
- Kimon Bekelis
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Symeon Missios
- Department of Neurosurgery, Louisiana State University-Health Sciences Center, Shreveport, Louisiana; and
| | - Robert J Spinner
- Departments of Neurosurgery and Orthopedics, Mayo Clinic, and Department of Anatomy, Mayo Medical School, Rochester, Minnesota
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111
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Tajdaran K, Shoichet MS, Gordon T, Borschel GH. A novel polymeric drug delivery system for localized and sustained release of tacrolimus (FK506). Biotechnol Bioeng 2015; 112:1948-53. [DOI: 10.1002/bit.25598] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/17/2015] [Accepted: 03/04/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Kasra Tajdaran
- Division of Plastic and Reconstructive Surgery; The Hospital for Sick Children; 555 University Ave Toronto Ontario Canada M5G1X8
- Institute of Biomaterials and Biomedical Engineering; University of Toronto; Toronto Ontario Canada
| | - Molly S. Shoichet
- Institute of Biomaterials and Biomedical Engineering; University of Toronto; Toronto Ontario Canada
- Department of Chemical Engineering and Applied Chemistry; University of Toronto; Toronto Ontario Canada
| | - Tessa Gordon
- Division of Plastic and Reconstructive Surgery; The Hospital for Sick Children; 555 University Ave Toronto Ontario Canada M5G1X8
- Division of Plastic and Reconstructive Surgery, Department of Surgery; University of Toronto; Toronto Ontario Canada
- Program in Neuroscience; The Hospital for Sick Children Research Institute; Toronto Ontario Canada
| | - Gregory H. Borschel
- Division of Plastic and Reconstructive Surgery; The Hospital for Sick Children; 555 University Ave Toronto Ontario Canada M5G1X8
- Institute of Biomaterials and Biomedical Engineering; University of Toronto; Toronto Ontario Canada
- Division of Plastic and Reconstructive Surgery, Department of Surgery; University of Toronto; Toronto Ontario Canada
- Program in Neuroscience; The Hospital for Sick Children Research Institute; Toronto Ontario Canada
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112
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Sobotka S, Mu L. Muscle reinnervation with nerve-muscle-endplate band grafting technique: correlation between force recovery and axonal regeneration. J Surg Res 2015; 195:144-51. [PMID: 25661741 PMCID: PMC4385406 DOI: 10.1016/j.jss.2015.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/08/2014] [Accepted: 01/08/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND This study was designed to determine the correlation between functional recovery and the extent of axonal regeneration after muscle reinnervation with our recently developed nerve-muscle-endplate band grafting (NMEG) technique in a rat model. MATERIALS AND METHODS The right experimentally paralyzed sternomastoid (SM) muscle by nerve transection was immediately reinnervated with an NMEG pedicle harvested from a neighboring sternohyoid muscle. The NMEG pedicle contained a muscle block (6 × 6 × 3 mm), a donor nerve branch with nerve terminals, and a motor endplate band. Three months after surgery, the tetanic force of the SM muscle was measured and the regenerated axons in the muscle were detected using neurofilament immunohistochemistry. RESULTS The results showed that the maximal tetanic force (a measure of muscle functional recovery) of the NMEG-reinnervated SM muscle reached up to 66.0% of the normal control. The wet weight of the reinnervated SM muscle (a measure of muscle mass recovery) was 87.2% of the control. The area fraction of the regenerating axons visualized with neurofilament staining within the NMEG-reinnervated SM muscle (a measure of muscle reinnervation) was 42.3%. A positive correlation was revealed between the extent of muscle reinnervation and maximal muscle force. CONCLUSIONS Our newly developed NMEG technique results in satisfactory functional outcomes and nerve regeneration. Further improvement in the functional recovery after NMEG reinnervation could be achieved by refining the surgical procedure and creating an ideal environment that favors axon-endplate connections and accelerates axonal growth and sprouting.
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Affiliation(s)
- Stanislaw Sobotka
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York.
| | - Liancai Mu
- Upper Airway Research Laboratory, Department of Research, Hackensack University Medical Center, Hackensack, New Jersey
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Abstract
This article provides an overview of the management of traumatic peripheral nerve injuries. It examines the basic pathophysiology of peripheral nerve injuries, along with the clinical presentation, diagnostic work-up, and treatment options and outcomes for the various classifications of traumatic peripheral nerve injuries.
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Affiliation(s)
- Matthew T Houdek
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Alexander Y Shin
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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114
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Zadegan SA, Firouzi M, Nabian MH, Zanjani LO, Kamrani RS. Two-stage nerve graft using a silicone tube. Front Surg 2015; 2:12. [PMID: 25954745 PMCID: PMC4407478 DOI: 10.3389/fsurg.2015.00012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/31/2015] [Indexed: 01/04/2023] Open
Affiliation(s)
- Shayan Abdollah Zadegan
- Tissue Repair Laboratory, Institute of Biochemistry and Biophysics (IBB), University of Tehran , Tehran , Iran ; Research Center for Neural Repair (RCNR), University of Tehran , Tehran , Iran
| | - Masoumeh Firouzi
- Tissue Repair Laboratory, Institute of Biochemistry and Biophysics (IBB), University of Tehran , Tehran , Iran ; Research Center for Neural Repair (RCNR), University of Tehran , Tehran , Iran
| | - Mohammad Hossein Nabian
- Research Center for Neural Repair (RCNR), University of Tehran , Tehran , Iran ; Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | - Leila Oryadi Zanjani
- Research Center for Neural Repair (RCNR), University of Tehran , Tehran , Iran ; Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences , Tehran , Iran
| | - Reza Shahryar Kamrani
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences , Tehran , Iran ; Joint Reconstruction Research Center, Tehran University of Medical Sciences , Tehran , Iran
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115
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In vivo evaluation of rabbit sciatic nerve regeneration with diffusion tensor imaging (DTI): correlations with histology and behavior. Magn Reson Imaging 2015; 33:95-101. [DOI: 10.1016/j.mri.2014.09.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/23/2014] [Accepted: 09/22/2014] [Indexed: 11/21/2022]
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116
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Missios S, Bekelis K, Spinner RJ. Traumatic peripheral nerve injuries in children: epidemiology and socioeconomics. J Neurosurg Pediatr 2014; 14:688-94. [PMID: 25303155 DOI: 10.3171/2014.8.peds14112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECT Despite the negative effects of peripheral nerve injuries (PNIs) on long-term population health, their true prevalence among pediatric trauma patients is under debate. The authors investigated the prevalence of PNIs among children involved in trauma and investigated associations between PNIs and several patient characteristics. METHODS The authors performed a retrospective cohort study of pediatric trauma patients who were registered in the National Trauma Data Bank from 2009 through 2011 and who fulfilled the study inclusion criteria. They used regression techniques to investigate the association of demographic and socioeconomic factors with the rate of PNIs among these patients. RESULTS Of the 245,470 study patients, 50,211 were involved in motor vehicle crashes, 3380 in motorcycle crashes, 20,491 in bicycle crashes, 18,262 in pedestrian accidents, 26,294 in other crashes (mainly involving all-terrain vehicles and snowmobiles), and 126,832 in falls. The respective prevalence of PNIs was 0.66% for motor vehicle crashes, 1% for motorcycle crashes, 0.38% for bicycle crashes, 0.42% for pedestrian accidents, 0.79% for other crashes, and 0.52% for falls. Multivariate logistic regression analysis demonstrated that the following were associated with an increased incidence of PNIs: increased patient age (OR 1.10, 95% CI 1.01-1.20), higher Injury Severity Score (OR 1.10, 95% CI 1.01-1.20), elevated systolic blood pressure at arrival at the emergency room (OR 1.10, 95% CI 1.01-1.20), and increased number of trauma surgeons at the institution (OR 1.10, 95% CI 1.01-1.20). The following were associated with lower incidence of PNIs: female sex (OR 0.94, 95% CI 0.87-1.02), rural hospitals (OR 0.94, 95% CI 0.87-1.02), and urban nonteaching hospitals (OR 0.94, 95% CI 0.87-1.02). CONCLUSIONS PNIs are more common than previously identified for the pediatric trauma population. These injuries are associated with older age and increased severity of the overall injury.
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Affiliation(s)
- Symeon Missios
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
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Bonetti LV, Schneider APK, Barbosa S, Ilha J, Faccioni-Heuser MC. Balance and coordination training and endurance training after nerve injury. Muscle Nerve 2014; 51:83-91. [PMID: 24752648 DOI: 10.1002/mus.24268] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Different rehabilitation treatments have proven useful in accelerating regeneration. METHODS After sciatic nerve crush in rats, we tested balance and coordination training (BCT) and endurance training (ET) through sensorimotor tests and analyzed nerve and muscle morphology. RESULTS After BCT and ET, rats performed better in sensorimotor tests than did non-trained animals. However, only BCT maintained sensorimotor function during training. Furthermore, BCT and ET produced significantly larger muscle area than in non-trained animals. CONCLUSIONS These findings indicate that BCT and ET, when initiated in the early phase after sciatic nerve injury, improve morphological properties of the soleus muscle and sciatic nerve, but only the task-oriented BCT maintained sensorimotor function. The success of rehabilitative strategies appears to be highly task-specific, and strategies that stimulate sensory pathways are the most effective in improving balance and/or coordination parameters.
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Affiliation(s)
- Leandro Viçosa Bonetti
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; Laboratório de Histofisiologia Comparada, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, CEP: 90050-170, Porto Alegre, Rio Grande do Sul, Brazil
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118
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Cho HY, Suh HR, Han HC. A single trial of transcutaneous electrical nerve stimulation reduces chronic neuropathic pain following median nerve injury in rats. TOHOKU J EXP MED 2014; 232:207-14. [PMID: 24646955 DOI: 10.1620/tjem.232.207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Neuropathic pain is a devastating chronic condition and is often induced in the upper limb following nerve injury or damage. Various drugs or surgical methods have been used to manage neuropathic pain; however, these are frequently accompanied by undesirable side effects. Transcutaneous electrical nerve stimulation (TENS) is a safe and non-invasive intervention that has been used to alleviate different types of pain in the clinic, but it is unclear whether TENS can improve chronic neuropathic pain in the upper limb. Thus, the aim of this study was to investigate the effects of a single trial of TENS on chronic neuropathic pain following median nerve injury. Male rats weighing 200-250 g received median nerve-ligation of the right forearm, while the control group received only skin-incision without nerve-ligation. Neuropathic pain-behaviors, including mechanical, cold, and thermal allodynia, were measured for 4 weeks. After the development of chronic neuropathic pain, TENS (100 Hz, 200 µs, sub-motor threshold) or placebo-TENS (sham stimulation) was applied for 20 min to the ipsilateral or contralateral side. Neuropathic pain behavior was assessed before and after intervention. Median nerve-ligation significantly induced and maintained neuropathic pain in the ipsilateral side. TENS application to the ipsilateral side effectively attenuated the three forms of chronic neuropathic pain in the ipsilateral side compared to sham-treated rats (peripheral and central effects), while TENS application to contralateral side only reduced mechanical allodynia in the ipsilateral side (central effect). Our findings demonstrate that TENS can alleviate chronic neuropathic pain following median nerve injury.
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Affiliation(s)
- Hwi-Young Cho
- Department of Physical Therapy, Gachon University College of Health Science
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119
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Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. BIOMED RESEARCH INTERNATIONAL 2014. [PMID: 25276813 DOI: 10.1155/2014/698256.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain good to excellent motor or sensory function and current surgical techniques are similar to those described by Sunderland more than 60 years ago. Our increasing knowledge about nerve physiology and regeneration far outweighs our surgical abilities to reconstruct damaged nerves and successfully regenerate motor and sensory function. It is technically possible to reconstruct nerves at the fascicular level but not at the level of individual axons. Recent surgical options including nerve transfers demonstrate promise in improving outcomes for proximal nerve injuries and experimental molecular and bioengineering strategies are being developed to overcome biological roadblocks limiting patient recovery.
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120
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Grinsell D, Keating CP. Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. BIOMED RESEARCH INTERNATIONAL 2014; 2014:698256. [PMID: 25276813 PMCID: PMC4167952 DOI: 10.1155/2014/698256] [Citation(s) in RCA: 565] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/16/2014] [Indexed: 01/09/2023]
Abstract
Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain good to excellent motor or sensory function and current surgical techniques are similar to those described by Sunderland more than 60 years ago. Our increasing knowledge about nerve physiology and regeneration far outweighs our surgical abilities to reconstruct damaged nerves and successfully regenerate motor and sensory function. It is technically possible to reconstruct nerves at the fascicular level but not at the level of individual axons. Recent surgical options including nerve transfers demonstrate promise in improving outcomes for proximal nerve injuries and experimental molecular and bioengineering strategies are being developed to overcome biological roadblocks limiting patient recovery.
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Affiliation(s)
- D. Grinsell
- Plastic and Reconstructive Surgery Unit, St. Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, VIC 3065, Australia
| | - C. P. Keating
- Plastic and Reconstructive Surgery Unit, St. Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, VIC 3065, Australia
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121
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Smith JK, Myers KP, Holloway RG, Landau ME. Ethical considerations in elective amputation after traumatic peripheral nerve injuries. Neurol Clin Pract 2014; 4:280-286. [PMID: 25279253 DOI: 10.1212/cpj.0000000000000049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Traumatic peripheral nerve injuries often complicate extremity trauma, and may cause substantial functional deficits. We have encountered patients who request amputation of such injured extremities, with the goal of prosthetic replacement as a means to restore function. Data on long-term outcomes of limb salvage vs amputation are limited and somewhat contradictory, leaving how to respond to such requests in the hands of the treating physician. We present example cases, drawn from our experience with wounded soldiers in a peripheral nerve injury clinic, in order to facilitate discussion of the ways in which these patients stress the system of medical decision-making while identifying ethical questions central to responding to these requests.
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Affiliation(s)
- Jonathan K Smith
- Departments of Neurology (JKS, MEL) and Physical Medicine & Rehabilitation (KPM), Walter Reed National Military Medical Center, Bethesda, MD; and Department of Neurology (RGH), University of Rochester Medical Center, NY
| | - Keith P Myers
- Departments of Neurology (JKS, MEL) and Physical Medicine & Rehabilitation (KPM), Walter Reed National Military Medical Center, Bethesda, MD; and Department of Neurology (RGH), University of Rochester Medical Center, NY
| | - Robert G Holloway
- Departments of Neurology (JKS, MEL) and Physical Medicine & Rehabilitation (KPM), Walter Reed National Military Medical Center, Bethesda, MD; and Department of Neurology (RGH), University of Rochester Medical Center, NY
| | - Mark E Landau
- Departments of Neurology (JKS, MEL) and Physical Medicine & Rehabilitation (KPM), Walter Reed National Military Medical Center, Bethesda, MD; and Department of Neurology (RGH), University of Rochester Medical Center, NY
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122
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Bekelis K, Missios S, Spinner RJ. Restraints and Peripheral Nerve Injuries in Adult Victims of Motor Vehicle Crashes. J Neurotrauma 2014; 31:1077-82. [DOI: 10.1089/neu.2013.3281] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kimon Bekelis
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Symeon Missios
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert J. Spinner
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
- Department of Anatomy, Mayo Medical School, Rochester, Minnesota
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123
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Abstract
Peripheral nerve injuries are a common clinical problem and can represent a major challenge, especially after trauma. In order to achieve optimal therapy, an early and adequate diagnosis with subsequent therapy is critical for functional preservation and restoration. Especially after complete severance of a peripheral nerve, the surgical techniques for nerve coaptation are an important prerequisite for peripheral nerve regeneration. The importance and necessity of adequate nerve coaptation and nerve transplantation are presented in detail. In addition, the types of primary and secondary nerve reconstruction procedures are described as well as the optimal time point of nerve repair. This article provides a comprehensive overview of the possibilities for diagnosis and intervention after nerve injury, additionally including an algorithm for surgical intervention. Furthermore, possible pitfalls and factors for improving the functional outcome are presented to optimize results with trauma-related nerve injury.
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Affiliation(s)
- C Radtke
- Klinik und Poliklinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland,
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124
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Abstract
Median nerve injuries in the forearm are reasonably common and can lead to devastating functional sequelae for the hand if they are not managed in a timely and appropriate fashion. Most nerve lacerations should be repaired soon after injury, and current widespread application of microsurgical techniques should lead to reasonable results in most individuals. Despite these advances, many patients do not have ideal outcomes from injuries to the median nerve and are often left with permanent sequelae. This article will discuss current techniques in the management of median nerve injuries, with the goal of preventing or alleviating the potential negative sequelae of these injuries.
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Affiliation(s)
- William C Pederson
- Hand Center of San Antonio, University of Texas Health Science Center at San Antonio, San Antonio, TX.
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125
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Shim HY, Lim OK, Bae KH, Park SM, Lee JK, Park KD. Sciatic nerve injury caused by a stretching exercise in a trained dancer. Ann Rehabil Med 2014; 37:886-90. [PMID: 24466525 PMCID: PMC3895530 DOI: 10.5535/arm.2013.37.6.886] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 04/30/2013] [Indexed: 11/05/2022] Open
Abstract
Sciatic nerve injury after stretching exercise is uncommon. We report a case of an 18-year-old female trained dancer who developed sciatic neuropathy primarily involving the tibial division after routine stretching exercise. The patient presented with dysesthesia and weakness of the right foot during dorsiflexion and plantarflexion. The mechanism of sciatic nerve injury could be thought as hyperstretching alone, not caused by both hyperstretching and compression. Electrodiagnostic tests and magnetic resonance imaging revealed evidence of the right sciatic neuropathy from the gluteal fold to the distal tibial area, and partial tear of the left hamstring origin and fluid collection between the left hamstring and ischium without left sciatic nerve injury. Recovery of motor weakness was obtained by continuous rehabilitation therapy and some evidence of axonal regeneration was obtained by follow-up electrodiagnostic testing performed at 3, 5, and 12 months after injury.
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Affiliation(s)
- Ho Yong Shim
- Department of Rehabilitation Medicine, Michuhol Rehabilitation Center, Incheon, Korea
| | - Oh Kyung Lim
- Department of Rehabilitation Medicine, Michuhol Rehabilitation Center, Incheon, Korea
| | - Keun Hwan Bae
- Department of Rehabilitation Medicine, Gachon University of Medicine and Science, Incheon, Korea
| | - Seok Min Park
- Department of Radiology, Incheon Imaging Diagnostic Center, Incheon, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Michuhol Rehabilitation Center, Incheon, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Michuhol Rehabilitation Center, Incheon, Korea
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126
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In vivo DTI longitudinal measurements of acute sciatic nerve traction injury and the association with pathological and functional changes. Eur J Radiol 2013; 82:e707-14. [DOI: 10.1016/j.ejrad.2013.07.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 05/30/2013] [Accepted: 07/19/2013] [Indexed: 11/17/2022]
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Squintani G, Bonetti B, Paolin A, Vici D, Cogliati E, Murer B, Stevanato G. Nerve regeneration across cryopreserved allografts from cadaveric donors: a novel approach for peripheral nerve reconstruction. J Neurosurg 2013; 119:907-13. [DOI: 10.3171/2013.6.jns121801] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The use of allografts from cadaveric donors has attracted renewed interest in recent years, and pretreatment with cryopreservation and immunosuppression methods has been investigated to maximize axonal regrowth and minimize allograft rejection. The authors wanted to assess the outcome of treatments of brachial plexus stretch injuries with cryopreserved allografts from cadaveric donors in nonimmunosuppressed patients.
Methods
Ten patients with brachial plexus lesions were submitted to electromyography (EMG) testing 1 and 3 months after a traumatic event and 1 week before surgery to localize and identify the type of lesion. Intraoperative EMG recordings were performed for intraoperative monitoring to select the best surgical strategy, and postoperative EMG was used to follow up patients and determine surgical outcomes. If nerve action potentials (NAPs) were present intraoperatively, neurolysis was performed, whereas muscular/nerve neurotization was performed if NAPs were absent. Cryopreserved allografts obtained from selected cadaveric donors and provided by the tissue bank of Treviso were used for nerve reconstruction in patients who were not treated with immunosuppressive drugs.
Results
The surgical strategy was selected according to the type and site of the nerve lesion and on the basis of IOM results: 14 cryopreserved allografts were used for 7 muscular neurotizations and for 7 nerve neurotizations, and 5 neurolysis procedures were performed. All of the patients had regained motor function at the 1- and 2-year follow-ups.
Conclusions
Some variables may affect functional recovery after allograft surgery, and the outcome of peripheral nerve reconstruction is more favorable when patients are carefully evaluated and selected for the surgery. The authors demonstrated that using cryopreserved allografts from cadaveric donors is a valid surgical strategy to restore function of the damaged nerve without the need for any immunosuppressive treatments. This approach offers new perspectives on procedures for extensive reconstruction of brachial and lumbosacral plexuses.
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Affiliation(s)
- Giovanna Squintani
- 1Unità Operativa Neurologia, Azienda Ospedaliera Universitaria Integrata, Verona
| | - Bruno Bonetti
- 2Dipartimento di Neuroscienze, Università di Verona, Verona
| | | | - Daniela Vici
- 3Banca dei Tessuti, Ospedale di Treviso, Treviso
| | | | - Bruno Murer
- 4Servizio di Anatomia Patologica, Ospedale dell'Angelo, Mestre, Venice; and
| | - Giorgio Stevanato
- 5Unità Operativa Neurochirurgia, Ospedale dell'Angelo, Mestre, Venice, Italy
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128
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Wood MD, Gordon T, Kim H, Szynkaruk M, Phua P, Lafontaine C, Kemp SW, Shoichet MS, Borschel GH. Fibrin gels containing GDNF microspheres increase axonal regeneration after delayed peripheral nerve repair. Regen Med 2013; 8:27-37. [PMID: 23259803 DOI: 10.2217/rme.12.105] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Recovery following nerve transection declines when target reconnection is delayed for prolonged periods. GDNF has previously been shown to promote motor axon regeneration following delayed nerve repair. MATERIALS & METHODS We constructed delivery systems using fibrin gels containing free GDNF or poly(lactide-co-glycolide) microspheres with GDNF. The delivery systems were implanted with fluorescent fibrinogen surrounding the common fibular (CF; peroneal) nerve in transgenic Thy-1 GFP rats (whose axons express GFP) to track degradation of the system. A delayed nerve repair model was designed by transecting the rat CF nerve, where nerve regeneration was prevented by ligating the two stumps to surrounding muscle for 2 months prior to resuture. At resuture, either a delivery system with GDNF or an additional group consisting of fibrin gels with empty microspheres were implanted surrounding the repair site. In an additional positive control, the CF was transected and repaired immediately without delay. RESULTS ELISA assays demonstrated GDNF release in vitro for 2 weeks from fibrin gels with GDNF microspheres. Implanted delivery systems, including GDNF microspheres, remained surrounding the nerve for at least 10 days compared with 3 days for free GDNF. Four weeks after repair, histomorphometry of distal nerve cross-sections taken 20 mm from the repair site demonstrated increased fiber diameter and myelin thickness due to release of GDNF from microspheres compared with empty microspheres. Additionally, the number of motoneurons that regenerated their axons to the same site increased to comparable levels as immediate repair due to the extended delivery of GDNF from microspheres. CONCLUSION These findings demonstrate that early measures of nerve regeneration after delayed nerve repair is improved by GDNF microspheres implanted at the coaptation site.
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Affiliation(s)
- Matthew D Wood
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
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129
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Peviani SM, Russo TL, Durigan JLQ, Vieira BS, Pinheiro CM, Galassi MS, Salvini TF. Stretching and electrical stimulation regulate the metalloproteinase-2 in rat denervated skeletal muscle. Neurol Res 2013; 32:891-6. [DOI: 10.1179/174313209x459093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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130
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Şahin F, Akca H, Akkaya N, Zincir ÖD, Işik A. Cost analysis and related factors in patients with traumatic hand injury. J Hand Surg Eur Vol 2013. [PMID: 23204134 DOI: 10.1177/1753193412469012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to measure the direct and indirect costs and factors influencing these costs in patients presenting following traumatic hand injury. We assessed patients aged 18-65 years who were in work. Hand injury severity and functional status were assessed. Direct costs, including medical care expenses, and indirect costs, including lost productivity, were calculated. Seventy-nine patients of a mean age of 32 years were included. The mean direct cost for each patient was $1772 (47% of total cost), and the indirect cost was $1891 (53% of total cost). Injury severity, time to return to work, and hospitalization time were the main parameters of increased total cost in a linear regression analysis.
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Affiliation(s)
- F Şahin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
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131
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Johnson PJ, Wood MD, Moore AM, Mackinnon SE. Tissue engineered constructs for peripheral nerve surgery. Eur Surg 2013; 45. [PMID: 24385980 DOI: 10.1007/s10353-013-0205-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tissue engineering has been defined as "an interdisciplinary field that applies the principles of engineering and life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function or a whole organ". Traumatic peripheral nerve injury resulting in significant tissue loss at the zone of injury necessitates the need for a bridge or scaffold for regenerating axons from the proximal stump to reach the distal stump. METHODS A review of the literature was used to provide information on the components necessary for the development of a tissue engineered peripheral nerve substitute. Then, a comprehensive review of the literature is presented composed of the studies devoted to this goal. RESULTS Extensive research has been directed toward the development of a tissue engineered peripheral nerve substitute to act as a bridge for regenerating axons from the proximal nerve stump seeking the distal nerve. Ideally this nerve substitute would consist of a scaffold component that mimics the extracellular matrix of the peripheral nerve and a cellular component that serves to stimulate and support regenerating peripheral nerve axons. CONCLUSIONS The field of tissue engineering should consider its challenge to not only meet the autograft "gold standard" but also to understand what drives and inhibits nerve regeneration in order to surpass the results of an autograft.
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Affiliation(s)
- P J Johnson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid, 8238, Saint Louis, MO 63110, USA
| | - M D Wood
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid, 8238, Saint Louis, MO 63110, USA
| | - A M Moore
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid, 8238, Saint Louis, MO 63110, USA
| | - S E Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 South Euclid, 8238, Saint Louis, MO 63110, USA
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133
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Döring R, Ciritsis B, Giesen T, Simmen HP, Giovanoli P. Direct nerve suture and knee immobilization in 90° flexion as a technique for treatment of common peroneal, tibial and sural nerve injuries in complex knee trauma. J Surg Case Rep 2012; 2012:rjs019. [PMID: 24968417 PMCID: PMC3854785 DOI: 10.1093/jscr/rjs019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There are different ways to treat peripheral nerve injuries with concomitant defects in the lower extremity. One option is a direct nerve suture followed by immobilization of the knee in flexion as it is described for gunshot wounds that lead to lesions of the sciatic nerve and its terminal branches as well as isolated nerve lesions. We used this technique to treat a case of multiple nerve injuries of the lower extremity combined with a complex knee trauma including a lesion of both bones and the posterior capsule. To our knowledge, this technique has not yet been described for such a combined injury in literature.
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Affiliation(s)
- Robert Döring
- Department of Trauma Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Bernhard Ciritsis
- Department of Trauma Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Thomas Giesen
- Department of Plastic Surgery and Hand Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Hans-Peter Simmen
- Department of Trauma Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital of Zurich, Zurich, Switzerland
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134
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Changes in CLIP3 expression after sciatic nerve injury in adult rats. J Mol Histol 2012; 43:669-79. [PMID: 23014974 DOI: 10.1007/s10735-012-9450-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 09/14/2012] [Indexed: 02/04/2023]
Abstract
CLIP3 (cytoplasmic linker protein 3) is a 547 amino acid residue cytoplasmic protein that localises to Golgi stacks and tubulovesicular elements juxtaposed to Golgi cisternae. Composed of three Ank (ankyrin) repeats and two CAP-Gly (cytoskeleton-associated protein-glycine) domains, CLIP3 may function as a cytoplasmic linker protein that is involved in TGN-endosome dynamics. To define the expression and role of CLIP3 during peripheral nervous system degeneration and regeneration, we created an acute sciatic nerve injury (SNI) model in adult rats. Western blot analyses revealed prominent up-regulation of CLIP3 and PCNA (proliferating cell nuclear antigen) protein levels at 3 days after SNI. Immunohistochemistry displayed that the expression of CLIP3 was noticeably increased in the injured nerve. Immunofluorescence further revealed that the CLIP3 and PCNA proteins colocalised respectively with S100 in the cytoplasm of Schwann cells. The expression profile of the SC/neuron co-cultures demonstrated that CLIP3 and PCNA protein levels were markedly expressed during the early stage of myelination. These results suggest that CLIP3 is likely associated with the myelination of proliferating Schwann cells, and nerve tissue regeneration after peripheral nerve injury. CLIP3 and PCNA expression during early myelination may be related to the direct uptake and transport of lipids and cholesterol, which were derived from the degenerating myelin, by Schwann cells to prepare for the formation of myelin sheath-like structures around regenerated axons after SNI.
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135
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Possamai F, Pacheco DR, Santos TSD, André ES. Repercussões morfológicas e funcionais do exercício sobre a regeneração nervosa periférica. FISIOTERAPIA EM MOVIMENTO 2012. [DOI: 10.1590/s0103-51502012000300017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A indicação de exercícios físicos como abordagem terapêutica após lesões nervosas periféricas, apesar de resultados clínicos favoráveis, ainda não é consenso na literatura pertinente. Objetivos: Este estudo buscou avaliar a interferência do exercício em roda motorizada no processo de regeneração nervosa periférica. MATERIAIS E MÉTODOS: Foram utilizados 48 ratos Wistar divididos proporcionalmente em quatro grupos de 12 ratos cada (seis controles e seis experimentais). Após treinamento, os ratos foram submetidos à axonotmese do nervo ciático direito. Todos os grupos iniciaram o regime de exercícios diários 24 horas após a lesão, porém com durações diferenciadas (G1 por 28 dias; G2 por 21 dias, G3 por 14 dias e G4 por sete dias). O exercício teve tempo e velocidade ajustados de acordo com o tempo de tratamento para cada grupo. RESULTADOS: Por meio do cálculo do Índice Funcional do Ciático, os animais submetidos ao exercício apresentaram sinais de atraso na recuperação funcional da marcha, em comparação a animais controles. Na análise histológica dos nervos lesionados, observou-se que animais exercitados apresentaram sinais de preservação dos axônios no coto proximal e de degeneração no coto distal, e os animais exercitados por somente sete dias não apresentaram a mesma característica degenerativa no coto distal. A aplicação de exercícios ativos e sem carga em animais que sofreram axonotmese interfere negativamente no processo de recuperação funcional de alguns parâmetros da marcha. CONCLUSÃO: Apesar de o exercício ativo não ter interferido na manutenção da viabilidade neuronal nos sítios proximais à lesão, sua continuidade prejudicou a viabilidade dos cotos neurais distais, provável causa do atraso na recuperação funcional da marcha.
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Chimutengwende-Gordon M, Khan W. Recent advances and developments in neural repair and regeneration for hand surgery. Open Orthop J 2012; 6:103-7. [PMID: 22431954 PMCID: PMC3293168 DOI: 10.2174/1874325001206010103] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 09/30/2011] [Accepted: 10/02/2011] [Indexed: 11/22/2022] Open
Abstract
End-to-end suture of nerves and autologous nerve grafts are the 'gold standard' for repair and reconstruction of peripheral nerves. However, techniques such as sutureless nerve repair with tissue glues, end-to-side nerve repair and allografts exist as alternatives. Biological and synthetic nerve conduits have had some success in early clinical studies on reconstruction of nerve defects in the hand. The effectiveness of nerve regeneration could potentially be increased by using these nerve conduits as scaffolds for delivery of Schwann cells, stem cells, neurotrophic and neurotropic factors or extracellular matrix proteins. There has been extensive in vitro and in vivo research conducted on these techniques. The clinical applicability and efficacy of these techniques needs to be investigated fully.
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Affiliation(s)
- Mukai Chimutengwende-Gordon
- University College London Institute of Orthopaedic and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
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Adult-brain-derived neural stem cells grafting into a vein bridge increases postlesional recovery and regeneration in a peripheral nerve of adult pig. Stem Cells Int 2012; 2012:128732. [PMID: 22448170 PMCID: PMC3289924 DOI: 10.1155/2012/128732] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 10/06/2011] [Accepted: 10/07/2011] [Indexed: 11/18/2022] Open
Abstract
We attempted transplantation of adult neural stem cells (ANSCs) inside an autologous venous graft following surgical transsection of nervis cruralis with 30 mm long gap in adult pig. The transplanted cell suspension was a primary culture of neurospheres from adult pig subventricular zone (SVZ) which had been labeled in vitro with BrdU or lentivirally transferred fluorescent protein. Lesion-induced loss of leg extension on the thigh became definitive in controls but was reversed by 45–90 days after neurosphere-filled vein grafting. Electromyography showed stimulodetection recovery in neurosphere-transplanted pigs but not in controls. Postmortem immunohistochemistry revealed neurosphere-derived cells that survived inside the venous graft from 10 to 240 post-lesion days and all displayed a neuronal phenotype. Newly formed neurons were distributed inside the venous graft along the severed nerve longitudinal axis. Moreover, ANSC transplantation increased CNPase expression, indicating activation of intrinsic Schwann cells. Thus ANSC transplantation inside an autologous venous graft provides an efficient repair strategy.
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138
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Yil H, Kiml MA, Backl SK, Eun JS, Nal HS. A novel rat forelimb model of neuropathic pain produced by partial injury of the median and ulnar nerves. Eur J Pain 2012; 15:459-66. [DOI: 10.1016/j.ejpain.2010.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 09/16/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022]
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Hoyng SA, Tannemaat MR, De Winter F, Verhaagen J, Malessy MJA. Nerve surgery and gene therapy: a neurobiological and clinical perspective. J Hand Surg Eur Vol 2011; 36:735-46. [PMID: 21914696 DOI: 10.1177/1753193411420348] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite major microsurgical improvements the clinical outcome of peripheral nerve surgery is still regarded as suboptimal. Over the past decade several innovative techniques have been developed to extend the armamentarium of the nerve surgeon. This review evaluates the potential of gene therapy in the context of peripheral nerve repair. First the main challenges impeding peripheral nerve regeneration are presented. This is followed by a short introduction to gene therapy and an overview of its most important advantages over the classical delivery of therapeutic proteins. Next, this review focuses on the most promising viral vectors capable of targeting the peripheral nervous system and their first application in animal models. In addition, the challenges of translating these experimental results to the clinic, the limitations of current vectors and the further developments needed, are discussed. Finally, four strategies are presented on how gene therapy could help patients that have to undergo reconstructive nerve surgery in the future.
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Affiliation(s)
- S A Hoyng
- Laboratory for Neuroregeneration, Netherlands Institute for Neuroscience, Royal Academy of Arts and Sciences, Amsterdam, The Netherlands.
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141
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Outcome measures of peripheral nerve regeneration. Ann Anat 2011; 193:321-33. [DOI: 10.1016/j.aanat.2011.04.008] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 04/14/2011] [Accepted: 04/18/2011] [Indexed: 01/25/2023]
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142
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Gigo-Benato D, Russo TL, Tanaka EH, Assis L, Salvini TF, Parizotto NA. Effects of 660 and 780 nm low-level laser therapy on neuromuscular recovery after crush injury in rat sciatic nerve. Lasers Surg Med 2011; 42:673-82. [PMID: 20976807 DOI: 10.1002/lsm.20978] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Post-traumatic nerve repair is still a challenge for rehabilitation. It is particularly important to develop clinical protocols to enhance nerve regeneration. The present study investigated the effects of 660 and 780 nm low-level laser therapy (LLLT) using different energy densities (10, 60, and 120 J/cm²) on neuromuscular and functional recovery as well as on matrix metalloproteinase (MMP) activity after crush injury in rat sciatic nerve. MATERIALS AND METHODS Rats received transcutaneous LLLT irradiation at the lesion site for 10 consecutive days post-injury and were sacrificed 28 days after injury. Both the sciatic nerve and tibialis anterior muscles were analyzed. Nerve analyses consisted of histology (light microscopy) and measurements of myelin, axon, and nerve fiber cross-sectional area (CSA). S-100 labeling was used to identify myelin sheath and Schwann cells. Muscle fiber CSA and zymography were carried out to assess the degree of muscle atrophy and MMP activity, respectively. Statistical significance was set at 5% (P≤0.05). RESULTS Six hundred sixty nanometer LLLT either using 10 or 60 J/cm² restored muscle fiber, myelin and nerve fiber CSA compared to the normal group (N). Furthermore, it increased MMP-2 activity in nerve and decreased MMP-2 activity in muscle and MMP-9 activity in nerve. In contrast, 780 nm LLLT using 10 J/cm² decreased MMP-9 activity in nerve compared to the crush group (CR) and N; it also restored normal levels of myelin and nerve fiber CSA. Both 60 and 120 J/cm² decreased MMP-2 activity in muscle compared to CR and N. 780 nm did not prevent muscle fiber atrophy. Functional recovery in the irradiated groups did not differ from the non-irradiated CR. CONCLUSION Data suggest that 660 nm LLLT with low (10 J/cm²) or moderate (60 J/cm²) energy densities is able to accelerate neuromuscular recovery after nerve crush injury in rats.
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Affiliation(s)
- Davilene Gigo-Benato
- Thermophototherapy Unit, Physical Therapy Department, Federal University of São Carlos (UFSCar), São Carlos, SP13565-905, Brazil.
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Morisaki S, Kawai Y, Umeda M, Nishi M, Oda R, Fujiwara H, Yamada K, Higuchi T, Tanaka C, Kawata M, Kubo T. In vivo assessment of peripheral nerve regeneration by diffusion tensor imaging. J Magn Reson Imaging 2011; 33:535-42. [DOI: 10.1002/jmri.22442] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 10/20/2010] [Indexed: 11/11/2022] Open
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Kent JB, Barkdull TJ, Guidi EJ. Median nerve compression from a nondisplaced fracture of the coronoid process of the ulna: a case report. Sports Health 2010; 2:484-6. [PMID: 23015978 PMCID: PMC3438873 DOI: 10.1177/1941738109357301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Median nerve neuropathy following an elbow injury is uncommon. When it occurs, understanding the median nerve distribution and anatomy is crucial for identifying the cause and for distinguishing cases that can be managed with observation as opposed to intervention. The consequences of misdiagnosis can result in permanent disability. Understanding the mechanisms of nerve injury will help the clinician anticipate prognosis and guide treatment. Stretch, transection, and compression of nerves may present similarly, but isolating the mechanism and the extent of injury can guide the treatment modalities and help predict the overall recovery. The case is a report of median nerve compression in a woman after a nondisplaced fracture of the coronoid process of the ulna. Despite the unique nature of the patient's symptoms, the neuropathy resolved with "watchful waiting." The location of the injury was a key component in identifying the cause of the neuropathy. It highlights the importance of identifying a cause; some cases will resolve without intervention. Clinicians should consider median nerve compression when presented with a patient experiencing neurologic symptoms following such a fracture.
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Mesenchymal stem cells in a polycaprolactone conduit enhance median-nerve regeneration, prevent decrease of creatine phosphokinase levels in muscle, and improve functional recovery in mice. Neuroscience 2010; 170:1295-303. [PMID: 20800664 DOI: 10.1016/j.neuroscience.2010.08.042] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 08/17/2010] [Accepted: 08/18/2010] [Indexed: 12/11/2022]
Abstract
Although the majority of peripheral-nerve regeneration studies are carried out on the sciatic nerve, lesions of the upper extremities are more common in humans and usually lead to significant physical disabilities. The present study was driven by the hypothesis that a combination of strategies, namely grafts of mesenchymal stem cells (MSC) and resorbable polycaprolactone (PCL) conduits would improve median-nerve regeneration after transection. Mouse median nerves were transected and sutured to PCL tubes that were filled with either green fluorescent protein (GFP(+)) MSC in DMEM or with DMEM alone. During the post-operative period, animals were tested weekly for flexor digitorum muscle function by means of the grasping test. After 8 weeks, the proximal and middle portions of the PCL tube and the regenerating nerves were harvested and processed for light and electron microscopy. The flexor digitorum muscle was weighed and subjected to biochemical analysis for creatine phosphokinase (CK) levels. Scanning electron microscopy of the PCL tube 8 weeks after implantation showed clear signs of wall disintegration. MSC-treated animals showed significantly larger numbers of myelinated and unmyelinated nerve fibers and blood vessels compared with DMEM-treated animals. The flexor digitorum muscle CK levels were significantly higher in the MSC-treated animals, but muscle weight values did not differ between the groups. Compared with the DMEM-treated group, MSC-treated animals showed, by the grasping test, improved functional performance throughout the period analyzed. Immunofluorescence for S-100 and GFP showed, in a few cases, double-labeled cells, suggesting that transplanted cells may occasionally transdifferentiate into Schwann cells. Our data demonstrate that the polycaprolactone conduit filled with MSC is capable of significantly improving the median-nerve regeneration after a traumatic lesion.
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Ciaramitaro P, Mondelli M, Logullo F, Grimaldi S, Battiston B, Sard A, Scarinzi C, Migliaretti G, Faccani G, Cocito D. Traumatic peripheral nerve injuries: epidemiological findings, neuropathic pain and quality of life in 158 patients. J Peripher Nerv Syst 2010; 15:120-7. [DOI: 10.1111/j.1529-8027.2010.00260.x] [Citation(s) in RCA: 218] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Functional outcome and health status of injured patients with peripheral nerve lesions. Injury 2010; 41:540-3. [PMID: 19524899 DOI: 10.1016/j.injury.2009.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 05/05/2009] [Indexed: 02/02/2023]
Abstract
BACKGROUND Peripheral nerve lesions (PNLs) can complicate the clinical course and outcome of multiply injured patients. Since this often impedes recovery, it can be a significant burden for both patients and clinicians. The objective of the present study was to investigate the long-term outcome and health status of patients with PNL. SUBJECTS AND METHODS Multiply injured patients admitted to an intensive rehabilitation setting were identified. The Barthel and modified Rankin scales (mRS) were administered to all patients at admission, discharge and follow-up. The short form (SF)-36 questionnaire was used at follow-up (mean: 25.3+/-6.5 months). RESULTS Seventy-seven multiply injured patients were identified, and 45 (22 male, 23 female; mean age: 59.7+/-21.7 years; range: 19-83 years) were enrolled. Of the injured patients, 22 subjects (10 male and 12 female) had no PNL, while 23 (12 male, 11 female) did. In the PLN group, the mean Barthel scores at admission, discharge and follow-up, respectively, were 33.4+/-17.9, 85.3+/-3.8 and 93.0+/-6.9 (p<0.001) and the median mRS scores were 4 (interquartile range (IQR): 3-5), 3 (IQR: 1-3) and 1 (IQR: 0-2), respectively. In the group without PLN, the mean Barthel scores at admission, discharge and follow-up, respectively, were 30.4+/-14.5, 86.6+/-9.8 and 96.6+/-4.9 (p<0.001) and the median mRS scores were 4 (IQR: 3-5), 2 (IQR: 1-3) and 0.5 (IQR: 0-2). The mean length of hospital stay was 86.7+/-10.8 and 65.6+/-14.6 days in patients with and without PNL, respectively. The SF-36 did not show significant differences between the groups, but the patients with and without PNL reported significant lower mean scores on all items compared to national population norms. CONCLUSION Multiply injured patients with and without PNL showed significant improvement and a good long-term outcome after rehabilitation. However, those with PNL had a longer hospital stay and needed more rehabilitation than patients without PNL. Both the groups of patients experienced significant difficulties in the health status.
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148
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Rigoard P, Lapierre F. Rappels sur le nerf périphérique. Neurochirurgie 2009; 55:360-74. [DOI: 10.1016/j.neuchi.2009.08.156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 08/13/2009] [Indexed: 12/20/2022]
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Delmotte A, Rigoard S, Buffenoir K, Wager M, Giot JP, Robert R, Lapierre F, Rigoard P. Physiologie du nerf traumatisé. Neurochirurgie 2009; 55 Suppl 1:S13-21. [DOI: 10.1016/j.neuchi.2008.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 03/24/2008] [Indexed: 10/21/2022]
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Siemionow M, Brzezicki G. Chapter 8: Current techniques and concepts in peripheral nerve repair. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:141-72. [PMID: 19682637 DOI: 10.1016/s0074-7742(09)87008-6] [Citation(s) in RCA: 275] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Despite the progress in understanding the pathophysiology of peripheral nervous system injury and regeneration, as well as advancements in microsurgical techniques, peripheral nerve injuries are still a major challenge for reconstructive surgeons. Thorough knowledge of anatomy, pathophysiology, and surgical reconstruction is a prerequisite of proper peripheral nerve injury management. This chapter reviews the currently available surgical treatment options for different types of nerve injuries in clinical conditions. In overview of direct nerve repair, various end-to-end coaptation techniques and the role of end-to-side repair for proximal nerve injuries is described. When primary repair cannot be performed without undue tension, nerve grafting or tubulization techniques are required. Current gold standard for bridging nerve gaps is nerve autografting. However, disadvantages of this approach, such as donor site morbidity and limited length of available graft material encouraged the search for alternative means of nerve gap reconstruction. Nerve allografting was introduced for repair of extensive nerve injuries. Tubulization techniques with natural or artificial conduits are applicable as an alternative for bridging short nerve defects without the morbidities associated with harvesting of autologous nerve grafts. Achieving better outcomes depends both on the advancements in microsurgical techniques and introduction of molecular biology discoveries into clinical practice. The field of peripheral nerve research is dynamically developing and concentrates on more sophisticated approaches tested at the basic science level. Future directions in peripheral nerve reconstruction including, tolerance induction and minimal immunosuppression for nerve allografting, cell based supportive therapies and bioengineering of nerve conduits are also reviewed in this chapter.
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Affiliation(s)
- Maria Siemionow
- Cleveland Clinic, Department of Plastic Surgery, Cleveland, Ohio 44195, USA
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