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Sim D, Kuo KT, Rodriguez-Silva W, Seal S, Filippi L, Tuffaha S, Elhelali A. Evaluation of Rehabilitation Techniques for Traumatic Ulnar Nerve Injuries After Surgical Repair: A Systematic Review. Ann Plast Surg 2024; 93:478-487. [PMID: 39331746 DOI: 10.1097/sap.0000000000004123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2024]
Abstract
BACKGROUND Traumatic ulnar nerve injuries often result in significant loss of motor and sensory function, negatively impacting patients' quality of life. Physical rehabilitation is crucial for recovery, but standardized treatment protocols are lacking. This study aims to systematically review rehabilitation techniques to identify future research direction and improve existing protocols for ulnar nerve injury patients. METHODS PubMed, Embase, CINAHL, Cochrane CENTRAL, Web of Science, and Scopus were queried from inception until July 31, 2023. Articles containing axonotmesis or neurotmesis injuries of the ulnar nerve were included. Reviews, opinions, editorials, technical reports without clinical outcomes, conference abstracts, non-English text, nonhuman studies, and studies without adult patients were excluded. Three independent reviewers performed screening and data extraction using Covidence, and risk of bias assessments utilizing Cochrane and JBI tools. Because of article heterogeneity, a narrative review was conducted. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database, registration number CRD42023442016. RESULTS This systematic review included one randomized controlled trial and four observational studies (103 patients), which exhibited differences in study quality. Overall, motor and sensory outcomes improved after rehabilitation. Rehabilitation techniques varied widely, and early sensory reeducation appeared to improve sensory function. Only two studies included patient-reported outcomes. CONCLUSIONS Diverse rehabilitation techniques are used to address ulnar nerve injuries. The low number of included studies, differences in study quality, and small sample size underscore the need for larger and more inclusive studies to improve functional recovery after ulnar nerve injuries. Future research should consider the impact of patient and injury characteristics to develop comprehensive treatment guidelines for these patients.
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Affiliation(s)
- Danielle Sim
- From the Department of Plastic and Reconstructive Surgery
| | - Keith T Kuo
- From the Department of Plastic and Reconstructive Surgery
| | | | | | - Lourdes Filippi
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - Sami Tuffaha
- From the Department of Plastic and Reconstructive Surgery
| | - Ala Elhelali
- From the Department of Plastic and Reconstructive Surgery
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Giunta S, Xia S, Pelliccioni G, Olivieri F. Autonomic nervous system imbalance during aging contributes to impair endogenous anti-inflammaging strategies. GeroScience 2024; 46:113-127. [PMID: 37821752 PMCID: PMC10828245 DOI: 10.1007/s11357-023-00947-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023] Open
Abstract
Inflammaging refers to the age-related low grade, sterile, chronic, systemic, and long-lasting subclinical, proinflammatory status, currently recognized as the main risk factor for development and progression of the most common age-related diseases (ARDs). Extensive investigations were focused on a plethora of proinflammatory stimuli that can fuel inflammaging, underestimating and partly neglecting important endogenous anti-inflammaging mechanisms that could play a crucial role in such age-related proinflammatory state. Studies on autonomic nervous system (ANS) functions during aging highlighted an imbalance toward an overactive sympathetic nervous system (SNS) tone, promoting proinflammatory conditions, and a diminished parasympathetic nervous system (PNS) activity, playing anti-inflammatory effects mediated by the so called cholinergic anti-inflammatory pathway (CAP). At the molecular level, CAP is characterized by signals communicated via the vagus nerve (with the possible involvement of the splenic nerves) through acetylcholine release to downregulate the inflammatory actions of macrophages, key players of inflammaging. Notably, decreased vagal function and increased burden of activated/senescent macrophages (macrophaging) probably precede the development of several age-related risk factors and diseases, while increased vagal function and reduced macrophaging could be associated with relevant reduction of risk profiles. Hypothalamic-pituitary-adrenal axis (HPA axis) is another pathway related to ANS promoting some anti-inflammatory response mainly through increased cortisol levels. In this perspective review, we highlighted that CAP and HPA, representing broadly "anti-inflammaging" mechanisms, have a reduced efficacy and lose effectiveness in aged people, a phenomenon that could contribute to fuel inflammaging. In this framework, strategies aimed to re-balance PNS/SNS activities could be explored to modulate systemic inflammaging especially at an early subclinical stage, thus increasing the chances to reach the extreme limit of human lifespan in healthy status.
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Affiliation(s)
- Sergio Giunta
- Casa Di Cura Prof. Nobili (Gruppo Garofalo (GHC)), Castiglione Dei Pepoli, Bologna, Italy
| | - Shijin Xia
- Department of Geriatrics, Shanghai Institute of Geriatrics, Huadong Hospital, Fudan University, Shanghai, China
| | | | - Fabiola Olivieri
- Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, Italy.
- Clinical Laboratory and Molecular Diagnostic, IRCCS INRCA, Ancona, Italy.
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Hagen KM, Gordon P, Frederick A, Palmer AL, Edalat P, Zonta YR, Scott L, Flancia M, Reid JK, Joel M, Ousman SS. CRYAB plays a role in terminating the presence of pro-inflammatory macrophages in the older, injured mouse peripheral nervous system. Neurobiol Aging 2024; 133:1-15. [PMID: 38381471 DOI: 10.1016/j.neurobiolaging.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 02/22/2024]
Abstract
Evidence indicates that dysfunction of older Schwann cells and macrophages contributes to poor regeneration of more mature peripheral nervous system (PNS) neurons after damage. Since the underlying molecular factors are largely unknown, we investigated if CRYAB, a small heat shock protein that is expressed by Schwann cells and axons and whose expression declines with age, impacts prominent deficits in the injured, older PNS including down-regulation of cholesterol biosynthesis enzyme genes, Schwann cell dysfunction, and macrophage persistence. Following sciatic nerve transection injury in 3- and 12-month-old wildtype and CRYAB knockout mice, we found by bulk RNA sequencing and RT-PCR, that while gene expression of cholesterol biosynthesis enzymes is markedly dysregulated in the aging, injured PNS, CRYAB is not involved. However, immunohistochemical staining of crushed sciatic nerves revealed that more macrophages of the pro-inflammatory but not immunosuppressive phenotype persisted in damaged 12-month-old knockout nerves. These pro-inflammatory macrophages were more efficient at engulfing myelin debris. CRYAB thus appears to play a role in resolving pro-inflammatory macrophage responses after damage to the older PNS.
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Affiliation(s)
- Kathleen Margaret Hagen
- Department of Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Paul Gordon
- Cumming School of Medicine Centre for Health Genomics and Informatics, University of Calgary, Calgary, Alberta, Canada
| | - Ariana Frederick
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Alexandra Louise Palmer
- Department of Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Pariya Edalat
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Yohan Ricci Zonta
- Department of Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lucas Scott
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Melissa Flancia
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jacqueline Kelsey Reid
- Department of Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Joel
- Department of Neuroscience, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Shalina Sheryl Ousman
- Departments of Clinical Neurosciences and Cell Biology and Anatomy, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
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4
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Sun P, Guan Y, Yang C, Hou H, Liu S, Yang B, Li X, Chen S, Wang L, Wang H, Huang Y, Sheng X, Peng J, Xiong W, Wang Y, Yin L. A Bioresorbable and Conductive Scaffold Integrating Silicon Membranes for Peripheral Nerve Regeneration. Adv Healthc Mater 2023; 12:e2301859. [PMID: 37750601 DOI: 10.1002/adhm.202301859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/03/2023] [Indexed: 09/27/2023]
Abstract
Peripheral nerve injury represents one of the most common types of traumatic damage, severely impairing motor and sensory functions, and posttraumatic nerve regeneration remains a major challenge. Electrical cues are critical bioactive factors that promote nerve regrowth, and bioartificial scaffolds incorporating conductive materials to enhance the endogenous electrical field have been demonstrated to be effective. The utilization of fully biodegradable scaffolds can eliminate material residues, and circumvent the need for secondary retrieval procedures. Here, a fully bioresorbable and conductive nerve scaffold integrating N-type silicon (Si) membranes is proposed, which can deliver both structural guidance and electrical cues for the repair of nerve defects. The entire scaffold is fully biodegradable, and the introduction of N-type Si can significantly promote the proliferation and production of neurotrophic factors of Schwann cells and enhance the calcium activity of dorsal root ganglion (DRG) neurons. The conductive scaffolds enable accelerated nerve regeneration and motor functional recovery in rodents with sciatic nerve transection injuries. This work sheds light on the advancement of bioresorbable and electrically active materials to achieve desirable neural interfaces and improved therapeutic outcomes, offering essential strategies for regenerative medicine.
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Affiliation(s)
- Pengcheng Sun
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Yanjun Guan
- Institute of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 51 Fucheng Road, Beijing, 100048, P. R. China
- Co-innovation Center of Neuroregeneration, Nantong University Nantong, Nantong, Jiangsu Province, 226007, P. R. China
- Graduate School of Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Can Yang
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Hanqing Hou
- School of Life Sciences, IDG/McGovern Institute for Brain Research at Tsinghua University, Tsinghua University, Beijing, 100084, P. R. China
| | - Shuang Liu
- School of Life Sciences, IDG/McGovern Institute for Brain Research at Tsinghua University, Tsinghua University, Beijing, 100084, P. R. China
| | - Boyao Yang
- Institute of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 51 Fucheng Road, Beijing, 100048, P. R. China
- Graduate School of Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Xiangling Li
- Institute of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 51 Fucheng Road, Beijing, 100048, P. R. China
| | - Shengfeng Chen
- Institute of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 51 Fucheng Road, Beijing, 100048, P. R. China
| | - Liu Wang
- Key Laboratory of Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, and with the School of Engineering Medicine, Beihang University, Beijing, 100083, P. R. China
| | - Huachun Wang
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology, Institute for Precision Medicine, Center for Flexible Electronics Technology, and IDG/McGovern Institute for Brain Research, Tsinghua University, Beijing, 100084, China
| | - Yunxiang Huang
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology, Institute for Precision Medicine, Center for Flexible Electronics Technology, and IDG/McGovern Institute for Brain Research, Tsinghua University, Beijing, 100084, China
| | - Xing Sheng
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology, Institute for Precision Medicine, Center for Flexible Electronics Technology, and IDG/McGovern Institute for Brain Research, Tsinghua University, Beijing, 100084, China
| | - Jiang Peng
- Institute of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 51 Fucheng Road, Beijing, 100048, P. R. China
| | - Wei Xiong
- School of Life Sciences, IDG/McGovern Institute for Brain Research at Tsinghua University, Tsinghua University, Beijing, 100084, P. R. China
| | - Yu Wang
- Institute of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, No. 51 Fucheng Road, Beijing, 100048, P. R. China
| | - Lan Yin
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
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Lai K, Eldredge RS, Zobel M, Hargis-Villanueva A, Ostlie A, Padilla BE. Intercostal Nerve Cryoablation for Postoperative Pain Control in Pediatric Thoracic Surgery: A Scoping Review. J Laparoendosc Adv Surg Tech A 2023; 33:994-1004. [PMID: 37462727 DOI: 10.1089/lap.2023.0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Background: Cryoanalgesia uses the application of cold temperatures to temporarily disrupt peripheral sensory nerve function for pain control. This review outlines the principles of cryoablation, clinical applications, and clinical data for its use in pediatric thoracic surgery. Methods: A comprehensive PubMed search was performed using the principal terms and combinations of cryoablation, cryoanalgesia, Nuss, Nuss repair, pectus, pectus excavatum, thoracic surgery, thoracotomy, and chest wall. Pediatric articles were reviewed and included if relevant. Adult articles were reviewed for supporting information as needed. Reference lists of included articles were reviewed for possible additional sources. Discussion: The scientific and clinical principles of cryoablation are outlined, followed by a focused review of current clinical application and outcome data. Conclusion: Postoperative pain is a major challenge following thoracic surgery. Cryoanalgesia is emerging as an adjunct in pediatric thoracic surgery, particularly for the Nuss procedure or minimally invasive repair of pectus excavatum. It effectively controls pain, decreasing postoperative opioid use and hospital length of stay with few short-term complications. Although more long-term studies are needed, early evidence suggests there is reliable return of sensation to the chest wall and long-term neuropathic pain is rare.
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Affiliation(s)
- Krista Lai
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - R Scott Eldredge
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Michael Zobel
- Division of Pediatric Surgery, University of California San Francisco, San Francisco, USA
| | | | - Andrew Ostlie
- Department of Child Health, University of Arizona School of Medicine, Tucson, Arizona, USA
| | - Benjamin E Padilla
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA
- Department of Child Health, University of Arizona School of Medicine, Tucson, Arizona, USA
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6
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Solomevich SO, Oranges CM, Kalbermatten DF, Schwendeman A, Madduri S. Natural polysaccharides and their derivatives as potential medical materials and drug delivery systems for the treatment of peripheral nerve injuries. Carbohydr Polym 2023; 315:120934. [PMID: 37230605 DOI: 10.1016/j.carbpol.2023.120934] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023]
Abstract
Peripheral nerve repair following injury is one of the most serious problems in neurosurgery. Clinical outcomes are often unsatisfactory and associated with a huge socioeconomic burden. Several studies have revealed the great potential of biodegradable polysaccharides for improving nerve regeneration. We review here the promising therapeutic strategies involving different types of polysaccharides and their bio-active composites for promoting nerve regeneration. Within this context, polysaccharide materials widely used for nerve repair in different forms are highlighted, including nerve guidance conduits, hydrogels, nanofibers and films. While nerve guidance conduits and hydrogels were used as main structural scaffolds, the other forms including nanofibers and films were generally used as additional supporting materials. We also discuss the issues of ease of therapeutic implementation, drug release properties and therapeutic outcomes, together with potential future directions of research.
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Affiliation(s)
- Sergey O Solomevich
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA; Research Institute for Physical Chemical Problems of the Belarusian State University, Minsk, Belarus
| | - Carlo M Oranges
- Plastic, Reconstructive and Aesthetic Surgery Division, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Daniel F Kalbermatten
- Plastic, Reconstructive and Aesthetic Surgery Division, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Bioengineering and Neuroregeneration Laboratory, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Anna Schwendeman
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Srinivas Madduri
- Plastic, Reconstructive and Aesthetic Surgery Division, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Bioengineering and Neuroregeneration Laboratory, Department of Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
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7
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Gohritz A, Laengle G, Boesendorfer A, Gesslbauer B, Gstoettner C, Politikou O, Sturma A, Aszmann OC. Nerve Transfers for Brachial Plexus Reconstruction in Patients over 60 Years. J Pers Med 2023; 13:jpm13040659. [PMID: 37109045 PMCID: PMC10142607 DOI: 10.3390/jpm13040659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Negative expectations regarding nerve reconstruction in the elderly prevail in the literature, but little is known about the effectiveness of nerve transfers in patients with brachial plexus injuries aged over 60 years. We present a series of five patients (1 female, 4 male) aged between 60 and 81 years (median 62.0 years) who underwent nerve reconstruction using multiple nerve transfers in brachial plexopathies. The etiology of brachial plexus injury was trauma (n = 2), or iatrogenic, secondary to spinal surgical laminectomy, tumor excision and radiation for breast cancer (n = 3). All but one patient underwent a one-stage reconstruction including neurolysis and extra-anatomical nerve transfer alone (n = 2) or combined with anatomical reconstruction by sural nerve grafts (n = 2). One patient underwent a two-stage reconstruction, which involved a first stage anatomical brachial plexus reconstruction followed by a second stage nerve transfer. Neurotizations were performed as double (n = 3), triple (n = 1) or quadruple (n = 1) nerve or fascicular transfers. Overall, at least one year postoperatively, successful results, characterized by a muscle strength of M3 or more, were restored in all cases, two patients even achieving M4 grading in the elbow flexion. This patient series challenges the widely held dogma that brachial plexus reconstruction in older patients will produce poor outcomes. Distal nerve transfers are advantageous as they shorten the reinnervation distance. Healthy, more elderly patients should be judiciously offered the whole spectrum of reconstructive methods and postoperative rehabilitation concepts to regain useful arm and hand function and thus preserve independence after a traumatic or nontraumatic brachial plexus injury.
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Affiliation(s)
- Andreas Gohritz
- Clinical Laboratory of Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, University Hospital, Petersgraben 4/Spitalstrasse 21, 4031 Basel, Switzerland
| | - Gregor Laengle
- Clinical Laboratory of Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Anna Boesendorfer
- Clinical Laboratory of Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Bernhard Gesslbauer
- Clinical Laboratory of Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Clemens Gstoettner
- Clinical Laboratory of Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Olga Politikou
- Clinical Laboratory of Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Agnes Sturma
- Clinical Laboratory of Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Bachelor's Degree Program Physiotherapy, University of Applied Sciences FH Campus Wien, Favoritenstrasse 226, 1100 Vienna, Austria
| | - Oskar C Aszmann
- Clinical Laboratory of Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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McNamara SL, Seo BR, Freedman BR, Roloson EB, Alvarez JT, O'Neill CT, Vandenburgh HH, Walsh CJ, Mooney DJ. Anti-inflammatory therapy enables robot-actuated regeneration of aged muscle. Sci Robot 2023; 8:eadd9369. [PMID: 36947599 DOI: 10.1126/scirobotics.add9369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Robot-actuated mechanical loading (ML)-based therapies ("mechanotherapies") can promote regeneration after severe skeletal muscle injury, but the effectiveness of such approaches during aging is unknown and may be influenced by age-associated decline in the healing capacity of skeletal muscle. To address this knowledge gap, this work used a noninvasive, load-controlled robotic device to impose highly defined tissue stresses to evaluate the age dependence of ML on muscle repair after injury. The response of injured muscle to robot-actuated cyclic compressive loading was found to be age sensitive, revealing not only a lack of reparative benefit of ML on injured aged muscles but also exacerbation of tissue inflammation. ML alone also disrupted the normal regenerative processes of aged muscle stem cells. However, these negative effects could be reversed by introducing anti-inflammatory therapy alongside ML application, leading to enhanced skeletal muscle regeneration even in aged mice.
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Affiliation(s)
- S L McNamara
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - B R Seo
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - B R Freedman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - E B Roloson
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - J T Alvarez
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - C T O'Neill
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - H H Vandenburgh
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, USA
| | - C J Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - D J Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
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9
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Roghani RS, Kara S, Taheri MJ, Gohari F, Sadrneshin S, Thant HL, Diaz JJ, Lokk J. Intra-flexor retinaculum steroid injection in elderly patients with carpal tunnel syndrome: A randomized clinical trial. INTERVENTIONAL PAIN MEDICINE 2022; 1:100106. [PMID: 39238523 PMCID: PMC11372893 DOI: 10.1016/j.inpm.2022.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 09/07/2024]
Abstract
Introduction The efficacy of ultrasonography-guided intra-flexor retinaculum corticosteroid injection is compared to within-carpal tunnel steroid injection, for the treatment of elderly patients with carpal tunnel syndrome (CTS). Material & methods In this prospective, double-blind, randomized trial, the elderly patients with CTS are allocated 1:1 into the two treatment groups. Subjects and assessors remained blinded to group allocation throughout the trial. All patients received 40 mg triamcinolone (1 mL) plus 1 mL of 2% lidocaine, either fenestrated in the flexor retinaculum (group 1) or injected within the carpal tunnel between the flexor retinaculum and median nerve (group 2). Patients were instructed to use a wrist splint for two weeks post-treatment. Symptom severity, grip, electrodiagnostic indices, and ultrasonographic features were measured at baseline and 6-weeks thereafter. The primary outcomes were median nerve distal motor and sensory latencies, and those secondary outcomes were Boston Carpal Tunnel Questionnaire (BCTQ) scores, visual analog scale (VAS) pain scores, and the median nerve inlet cross-sectional area (CSA). Results Of 92 individuals screened, 50 eligible participants were randomized, all of whom completed the study and were included in the analysis. Patients receiving the intra-flexor retinaculum injection demonstrated significantly greater improvements in their total BCTQ score (p = 0.023), VAS score (p = 0.026), and inlet CSA (p = 0.004), while the electrodiagnostic indices and the grip scale did not differ between groups. Conclusion The intra-flexor retinaculum corticosteroid injection can provide better functional recovery and symptom reduction for elderly patients with CTS, compared to the within-carpal tunnel corticosteroid injection.
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Affiliation(s)
- Reza S Roghani
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Physical Medicine and Rehabilitation, Larkin University & Health System, Miami, FL, USA
| | - Sam Kara
- Department of Neurology, Larkin University & Health System, Miami, FL, USA
| | - Mohammad J Taheri
- Department of PM&R, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faeze Gohari
- Department of PM&R, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Sadrneshin
- Department of PM&R, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hein Linn Thant
- Department of Physical Medicine and Rehabilitation, Larkin University & Health System, Miami, FL, USA
| | - Jose J Diaz
- Department of Physical Medicine and Rehabilitation, Larkin University & Health System, Miami, FL, USA
| | - Johan Lokk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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10
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Vasavada K, Shankar DS, Bi AS, Moran J, Petrera M, Kahan J, Alaia EF, Medvecky MJ, Alaia MJ. Predictors Using Machine Learning of Complete Peroneal Nerve Palsy Recovery After Multiligamentous Knee Injury: A Multicenter Retrospective Cohort Study. Orthop J Sports Med 2022; 10:23259671221121410. [PMID: 36172267 PMCID: PMC9511346 DOI: 10.1177/23259671221121410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Peroneal nerve (PN) palsy is one of the most debilitating sequelae of multiligamentous knee injuries (MLKIs). There is limited research on recovery from complete PN palsy. Purpose/Hypothesis The purpose of this study was to characterize PN injuries and develop a predictive model of complete PN recovery after MLKI using machine learning. It was hypothesized that elevated body mass index (BMI) would be predictive of lower likelihood of recovery. Study Design Case-control study; Level of evidence, 3. Methods The authors conducted a retrospective review of patients seen at 2 urban hospital systems for treatment of MLKI with associated complete PN palsy, defined as the presence of complete foot drop with or without sensory deficits on physical examination. Recovery was defined as the complete resolution of foot drop. A random forest (RF) classifier algorithm was used to identify demographic, injury, treatment, and postoperative variables that were significant predictors of recovery from complete PN palsy. Validity of the RF model was assessed using overall accuracy, F1 score, and area under the receiver operating characteristic curve (AUC). Results Overall, 16 patients with MLKI with associated complete PN palsy were included in the cohort. Among them, 75% (12/16) had documented knee dislocation requiring reduction. Complete recovery occurred in 4 patients (25%). Nerve contusions on magnetic resonance imaging were more common among patients without PN recovery, but there were no other significant differences between recovery and nonrecovery groups. The RF model found that older age, increasing BMI, and male sex were predictive of worse likelihood of PN recovery. The model was found to have good validity, with a classification accuracy of 75%, F1 score of 0.86, and AUC of 0.64. Conclusion The RF model in this study found that increasing age, BMI, and male sex were predictive of decreased likelihood of nerve recovery. While further study of machine learning models with larger patient data sets is required to identify the most superior model, these findings present an opportunity for orthopaedic surgeons to better identify, counsel, and treat patients with MLKIs and concomitant complete PN palsy.
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Affiliation(s)
- Kinjal Vasavada
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Dhruv S. Shankar
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Andrew S. Bi
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Jay Moran
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Massimo Petrera
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Joseph Kahan
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Erin F. Alaia
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Michael J. Medvecky
- Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael J. Alaia
- Division of Sports Medicine, Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
- Michael J. Alaia, MD, NYU Langone Orthopedic Center, 333 East 38th Street, 4th Floor, New York, NY 10016, USA () (Twitter: @MichaelAlaiaMD)
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11
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Lee JA, Smith BT, Egro FM, Stanger M, Koster W, Grunwaldt LJ. Timing of Nerve Recovery After Nerve Grafting in Obstetrical Brachial Plexus Palsy Patients With Isolated Upper Trunk Neuromas. Ann Plast Surg 2021; 87:446-450. [PMID: 34559713 DOI: 10.1097/sap.0000000000002939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The timing of nerve recovery after nerve grafting in obstetrical brachial plexus palsy patients has not been well reported. One prior study reported a return to baseline function at 3 to 6 months postoperatively. However, there is a paucity of studies to corroborate this timing, and there have been no studies delineating the timeline to obtain clinically meaningful function. METHODS OBPP patients with upper trunk neuromas-in-continuity who were treated with resection and sural nerve grafting at a single institution were studied. Time to return to baseline function was assessed by Active Movement Scale (AMS) scores preoperatively and postoperatively. Time to clinically meaningful function, defined as an AMS score of ≥6, was also assessed. RESULTS Eleven patients with isolated upper trunk neuromas-in-continuity underwent excision and reversed sural nerve grafting. Three of 11 patients also underwent spinal accessory to suprascapular nerve transfers. Average age at surgery was 9.8 ± 1.9 months. One patient did not have follow-up data and was excluded. Average follow-up was 37.1 ± 16.8 months. Average return to baseline AMS score was approximately 4 to 8 months for shoulder abduction, shoulder flexion, shoulder external rotation, elbow flexion, and forearm supination. Clinically meaningful function was obtained in most patients between 9 and 15 months. The remaining patients who did not achieve clinically meaningful function had all obtained scores of 5, which reflects less than one half normal range of motion against gravity. CONCLUSIONS Nerve recovery after surgical intervention in OBPP patients who undergo resection of an upper trunk neuroma-in-continuity and nerve grafting is more rapid than in adults but longer than previously reported in OBPP literature. This study provides an important data point in delineating the timeline of nerve recovery.
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Affiliation(s)
- Jessica A Lee
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center
| | - Brandon T Smith
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center
| | - Francesco M Egro
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center
| | - Meg Stanger
- Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Wendy Koster
- Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Lorelei J Grunwaldt
- Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
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12
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Combined Sequential Bilateral Hypoglossal-to-facial and Masseter-to-facial Transfers for Bilateral Facial Paralysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3689. [PMID: 34262843 PMCID: PMC8274737 DOI: 10.1097/gox.0000000000003689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
Bilateral facial paralysis is a challenging situation requiring complex management. Surgical treatment can include nerve transfers, mainly masseter-to-facial, or muscle transfers, gracilis free flap, or temporalis transposition. Deciding on the surgical option depends on the duration of the paralysis and the feasibility of facial muscles. We present the case of a 10-year-old child with permanent bilateral facial paralysis after brainstem tumor surgery. The patient was treated with bilateral simultaneous hypoglossal-to-facial transfer followed by bilateral simultaneous masseter-to-facial 12 months later. After 23 months of follow-up and specific physical therapy, she has good and symmetric resting tone, complete eye closure, moderate bilateral smile excursion, mild lip pucker movement, and good oral competence. The combination of these two nerve transfers, when possible, gives the opportunity of restoring movement taking the best of each technique, with acceptable results and no significant clinical deficits in the donor sites.
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13
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Markus J, Sibbing IC, Ket JCF, de Jong JR, de Beer SA, Gorter RR. Treatment strategies for anterior cutaneous nerve entrapment syndrome in children: A systematic review. J Pediatr Surg 2021; 56:605-613. [PMID: 32553455 DOI: 10.1016/j.jpedsurg.2020.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anterior cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked cause of chronic abdominal pain in children. Currently, both nonsurgical and surgical treatment options are available to treat this disease. The objective was to give insight into the success rate of different treatment strategies for children with ACNES, and provide treatment recommendations for physicians based on the published evidence. METHOD A literature search of PubMed, Embase.com and the Wiley/Cochrane Library was conducted for studies published up to 25 February 2020. Randomized controlled trials, prospective or retrospective cohort studies, meta-analyses and literature reviews describing the outcome of different treatment strategies for children (<18 years old) with ACNES with a follow-up duration of at least four weeks were included. RESULTS Six studies, involving 224 patients, were included with an overall quality reported to be between fair and poor. Treatment success of local injections with an anesthetic agent into the trigger point ranged from 38% to 87% with a follow-up ranging from 4 weeks to 39 months. In addition, treatment success of anterior neurectomy ranged from 86% to 100%, with a follow-up duration ranging from 4 weeks to 36 months. CONCLUSION A step-up treatment strategy should be applied when treating pediatric patients with ACNES. This strategy starts with an injection with a local anesthetic agent, reserving surgery (anterior neurectomy) as a viable option in case of persistent pain. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Jasper Markus
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands.
| | - Iris C Sibbing
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands
| | | | - Justin R de Jong
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands
| | - Sjoerd A de Beer
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands
| | - Ramon R Gorter
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands
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14
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Alolayan AB, Leung YY. Longitudinal recovery pattern of neurosensory deficit after Le Fort I osteotomy. Int J Oral Maxillofac Surg 2021; 50:1069-1074. [PMID: 33454171 DOI: 10.1016/j.ijom.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/16/2020] [Accepted: 12/24/2020] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to investigate the incidence and recovery pattern of neurosensory deficit (NSD) following Le Fort I osteotomy, and to identify the possible risk factors that might contribute to the complication. A prospective longitudinal observational study on the incidence of NSD was conducted on patients who received Le Fort I osteotomy. Subjective and objective standardized neurosensory assessments were performed preoperatively as the baseline, and postoperatively at 2 weeks, 6 weeks, 3 months, 6 months, 12 months, and 24 months. Possible risk factors for NSD including patient age and sex, surgeon experience, and Le Fort I osteotomy with or without multi-segmentation were analysed. Sixty-six patients (43 female, 23 male) with 132 sides of Le Fort I osteotomy were recruited. The incidence of NSD at 2 weeks, 6 weeks, 3 months, 6 months, 12 months, and 24 months was 81.8%, 59.8%, 39.4%, 19.7%, 7.6%, and 3.2%, respectively. Subjective severity of NSD improved with time. Older age was found to be a risk factor for NSD in the early postoperative period, but there was no difference in the long-term. Patient sex, surgeon experience, and the need for multi-segmentation were not found to be related to the incidence of NSD after Le Fort I osteotomy.
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Affiliation(s)
- A B Alolayan
- Oral and Maxillofacial Surgery Department, Dental College and Hospital, Taibah University, Madinah, Saudi Arabia
| | - Y Y Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, the University of Hong Kong, Hong Kong.
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15
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Liu YP, Luo ZR, Wang C, Cai H, Zhao TT, Li H, Shao SJ, Guo HD. Electroacupuncture Promoted Nerve Repair After Peripheral Nerve Injury by Regulating miR-1b and Its Target Brain-Derived Neurotrophic Factor. Front Neurosci 2020; 14:525144. [PMID: 33132818 PMCID: PMC7550428 DOI: 10.3389/fnins.2020.525144] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 08/25/2020] [Indexed: 12/17/2022] Open
Abstract
Growing evidence indicates that electroacupuncture (EA) has a definite effect on the treatment of peripheral nerve injury (PNI), but its mechanism is not completely clear. MicroRNAs (miRNAs) are involved in the regulation of a variety of biological processes, and EA may enhance PNI repair by regulating miRNAs. In this study, the rat sciatic nerve injury model was treated with EA for 4 weeks. Acupoints Huantiao (GB30) and Zusanli (ST36) were stimulated by EA 20 min once a day, 6 days a week for 4 weeks. We found that EA treatment downregulated the expression of miR-1b in the local injured nerve. In vitro experiments showed that overexpression of miR-1b inhibited the expression of brain-derived neurotrophic factor (BDNF) in rat Schwann cell (SC) line, while BDNF knockdown inhibited the proliferation, migration, and promoted apoptosis of SCs. Subsequently, the rat model of sciatic nerve injury was treated by EA treatment and injection of agomir-1b or antagomir-1b. The nerve conduction velocity ratio (NCV), sciatic functional index (SFI), and S100 immunofluorescence staining were examined and showed that compared with the model group, NCV, SFI, proliferation of SC, and expression of BDNF in the injured nerves of rats treated with EA or EA + anti-miR-1b were elevated, while EA + miR-1b was reduced, indicating that EA promoted sciatic nerve function recovery and SC proliferation through downregulating miR-1b. To summarize, EA may promote the proliferation, migration of SC, and nerve repair after PNI by regulating miR-1b, which targets BDNF.
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Affiliation(s)
| | | | | | | | | | | | - Shui-jin Shao
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hai-dong Guo
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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16
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Ugrenović S, Jovanović I, Kundalić B, Stojanović V, Pavlović M, Antović A, Milić M, Kokoris JČ. Morphometric analysis of the epineurial and endoneurial blood vessels of the human sciatic nerve in relation to aging. Tissue Cell 2020; 66:101389. [PMID: 32933712 DOI: 10.1016/j.tice.2020.101389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/29/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
The aim of this research is to perform an analysis of the epineurial and endoneurial blood vessels in relation to aging. The research is conducted on samples of the human sciatic nerve of 12 case (age from 27 to 89). The histological sections are stained by streptavidin-biotin method of detecting the presence of Type IV collagen. After morphometric analysis the following stereological parameters have been calculated: the number of blood vessels per unit of area, the volume density of the blood vessels and the surface density of the blood vessels of the epineurium and endoneurium. An additional diameter measurement is performed for the endoneural blood vessels. In order to perform a more detailed analysis, the cases were classified into three age groups, the first (27-48 years), the second (49-70 years) and, the third (over 70 years). The bivariate correlation analysis showed that the number of blood vessels of the endoneurium, their volume and surface densities in relation to age produced a statistically significant positive correlation. One Way ANOVA test demonstrated a statistically significant increase in the number of endoneurial blood vessels in the age group III when compared the age group I and, in addition, it showed a significant decrease in the diameter of the age group II when compared to the age group I. Paired t - test shows a statistically significant higher number of endoneurial blood vessels in relation to the epineurial, namely, in the age group III. The volume and surface density of the epineurial blood vessels is significantly higher than the endoneurial in both the I and II age group. Age brings about significant changes of the endoneurial vascular network of the sciatic nerve due to the increase in density of the endoneurial blood vessels, their volume and surface densities. Consequently, in the cases older than 70 years, the number of endoneurial blood vessels significantly exceeds the number of epineurial blood vessels.
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Affiliation(s)
| | - Ivan Jovanović
- Department of Anatomy, Faculty of Medicine, University of Niš, Serbia
| | - Braca Kundalić
- Department of Anatomy, Faculty of Medicine, University of Niš, Serbia
| | - Vesna Stojanović
- Department of Anatomy, Faculty of Medicine, University of Niš, Serbia
| | - Miljana Pavlović
- Department of Anatomy, Faculty of Medicine, University of Niš, Serbia
| | - Aleksandra Antović
- Department of Forensic Medicine, Faculty of Medicine, University of Niš, Serbia
| | - Miroslav Milić
- Department of Forensic Medicine, Faculty of Medicine, University of Niš, Serbia
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17
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Zobel MJ, Ewbank C, Mora R, Idowu O, Kim S, Padilla BE. The incidence of neuropathic pain after intercostal cryoablation during the Nuss procedure. Pediatr Surg Int 2020; 36:317-324. [PMID: 31760443 DOI: 10.1007/s00383-019-04602-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE Intercostal nerve cryoblation during the Nuss procedure for pectus excavatum decreases pain, opiate requirement, and hospital length of stay (LOS) compared to thoracic epidural analgesia. However, long-term complications of cryoablation, including neuropathic pain development, are not well studied. METHODS We conducted a multi-institutional retrospective review of patients following intercostal nerve cryoablation during Nuss bar insertion (11/2015-7/2018). Patients completed the Leeds Assessment of Neuropathic Symptoms and Signs, a validated questionnaire for detecting neuropathic symptoms. Primary outcome was neuropathic pain development. Secondary outcomes included duration of chest numbness and LOS. T test was performed; p < 0.05 is significant. RESULTS 43 patients underwent intercostal cryoablation during the Nuss procedure. Ages at repair ranged 11-47 years (median 16). Patients were grouped by age: ≤ 21 years (30 patients) or older (13 patients). Mean LOS was shorter for the younger group, 2.0 versus 3.9 days (p = 0.03). No patients in the younger group, and three in the older, experienced neuropathic pain. Mean time to numbness resolution was shorter for the younger group, 3.4 versus 10.8 months (p = 0.003). CONCLUSION In pediatric patients, intercostal cryoablation provides effective analgesia following the Nuss procedure with minimal risk of post-operative neuropathic pain. Adult patients are at greater risk of experiencing neuropathic pain and prolonged numbness.
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Affiliation(s)
- Michael J Zobel
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, 550 16th Street, Fifth Floor, San Francisco, CA, 94158-0570, USA
| | - Clifton Ewbank
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, 550 16th Street, Fifth Floor, San Francisco, CA, 94158-0570, USA
| | - Roberta Mora
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, 550 16th Street, Fifth Floor, San Francisco, CA, 94158-0570, USA
| | - Olajire Idowu
- Division of Pediatric Surgery, Department of Surgery, UCSF Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA
| | - Sunghoon Kim
- Division of Pediatric Surgery, Department of Surgery, UCSF Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA, 94609, USA
| | - Benjamin E Padilla
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, 550 16th Street, Fifth Floor, San Francisco, CA, 94158-0570, USA.
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18
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Mok A, Allen J, Haney MM, Deninger I, Ballenger B, Caywood V, Osman KL, Zitsch B, Hopewell BL, Thiessen A, Szewczyk M, Ohlhausen D, Newberry CI, Leary E, Lever TE. A Surgical Mouse Model for Advancing Laryngeal Nerve Regeneration Strategies. Dysphagia 2019; 35:419-437. [PMID: 31388736 DOI: 10.1007/s00455-019-10045-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/06/2019] [Accepted: 07/31/2019] [Indexed: 01/16/2023]
Abstract
Iatrogenic recurrent laryngeal nerve (RLN) injury is a morbid complication of anterior neck surgical procedures. Existing treatments are predominantly symptomatic, ranging from behavioral therapy to a variety of surgical approaches. Though laryngeal reinnervation strategies often provide muscle tone to the paralyzed vocal fold (VF), which may improve outcomes, there is no clinical intervention that reliably restores true physiologic VF movement. Moreover, existing interventions neglect the full cascade of molecular events that affect the entire neuromuscular pathway after RLN injury, including the intrinsic laryngeal muscles, synaptic connections within the central nervous system, and laryngeal nerve anastomoses. Systematic investigations of this pathway are essential to develop better RLN regenerative strategies. Our aim was to develop a translational mouse model for this purpose, which will permit longitudinal investigations of the pathophysiology of iatrogenic RLN injury and potential therapeutic interventions. C57BL/6J mice were divided into four surgical transection groups (unilateral RLN, n = 10; bilateral RLN, n = 2; unilateral SLN, n = 10; bilateral SLN, n = 10) and a sham surgical group (n = 10). Miniaturized transoral laryngoscopy was used to assess VF mobility over time, and swallowing was assessed using serial videofluoroscopy. Histological assays were conducted 3 months post-surgery for anatomical investigation of the larynx and laryngeal nerves. Eight additional mice underwent unilateral RLN crush injury, half of which received intraoperative vagal nerve stimulation (iVNS). These 8 mice underwent weekly transoral laryngoscopy to investigate VF recovery patterns. Unilateral RLN injury resulted in chronic VF immobility but only acute dysphagia. Bilateral RLN injury caused intraoperative asphyxiation and death. VF mobility was unaffected by SLN transection (unilateral or bilateral), and dysphagia (transient) was evident only after bilateral SLN transection. The sham surgery group retained normal VF mobility and swallow function. Mice that underwent RLN crush injury and iVNS treatment demonstrated accelerated and improved VF recovery. We successfully developed a mouse model of iatrogenic RLN injury with impaired VF mobility and swallowing function that can serve as a clinically relevant platform to develop translational neuroregenerative strategies for RLN injury.
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Affiliation(s)
- Alexis Mok
- Department of Communication Science and Disorders, University of Missouri School of Health Professions, Columbia, MO, USA
| | - Jakob Allen
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Megan M Haney
- Department of Veterinary Pathobiology, University of Missouri College of Veterinary Medicine, Columbia, MO, USA
| | - Ian Deninger
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Brayton Ballenger
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Victoria Caywood
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Kate L Osman
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Bradford Zitsch
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Bridget L Hopewell
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Aaron Thiessen
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Marlena Szewczyk
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Daniel Ohlhausen
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Emily Leary
- Department of Orthopedic Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Teresa E Lever
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA. .,One Hospital Dr. MA314, Columbia, MO, 65212, USA.
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19
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Roh DS, Panayi AC, Bhasin S, Orgill DP, Sinha I. Implications of Aging in Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2085. [PMID: 30859042 PMCID: PMC6382222 DOI: 10.1097/gox.0000000000002085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/26/2018] [Indexed: 12/12/2022]
Abstract
Given the rapidly aging population, investigating the effect of age on plastic surgery outcomes is imperative. Despite this, the topic has received relatively little attention. Furthermore, there appears to be little integration between the basic scientists investigating the mechanisms of aging and the plastic surgeons providing the majority of "antiaging" therapies. This review first provides a description of the effects and mechanisms of aging in 5 types of tissue: skin, adipose tissue, muscles, bones and tendons, and nervous tissue followed by an overview of the basic mechanisms underlying aging, presenting the currently proposed cellular and molecular theories. Finally, the impact of aging, as well as frailty, on plastic surgery outcomes is explored by focusing on 5 different topics: general wound healing and repair of cutaneous tissue, reconstruction of soft tissue, healing of bones and tendons, healing of peripheral nerves, and microsurgical reconstruction. We find mixed reports on the effect of aging or frailty on outcomes in plastic surgery, which we hypothesize to be due to exclusion of aged and frail patients from surgery as well as due to outcomes that reported no postsurgical issues with aged patients. As plastic surgeons continue to interact more with the growing elderly population, a better appreciation of the underlying mechanisms and outcomes related to aging and a clear distinction between chronological age and frailty can promote better selection of patients, offering appropriate patients surgery to improve an aged appearance, and declining interventions in inappropriate patients.
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Affiliation(s)
- Danny S Roh
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Adriana C Panayi
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Shalender Bhasin
- Division of Endocrinology, Brigham and Women's Hospital, Boston, Mass
| | - Dennis P Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Indranil Sinha
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass
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20
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Büttner R, Schulz A, Reuter M, Akula AK, Mindos T, Carlstedt A, Riecken LB, Baader SL, Bauer R, Morrison H. Inflammaging impairs peripheral nerve maintenance and regeneration. Aging Cell 2018; 17:e12833. [PMID: 30168637 PMCID: PMC6260910 DOI: 10.1111/acel.12833] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 06/14/2018] [Accepted: 07/21/2018] [Indexed: 12/13/2022] Open
Abstract
The regenerative capacity of peripheral nerves declines during aging, contributing to the development of neuropathies, limiting organism function. Changes in Schwann cells prompt failures in instructing maintenance and regeneration of aging nerves; molecular mechanisms of which have yet to be delineated. Here, we identified an altered inflammatory environment leading to a defective Schwann cell response, as an underlying mechanism of impaired nerve regeneration during aging. Chronic inflammation was detected in intact uninjured old nerves, characterized by increased macrophage infiltration and raised levels of monocyte chemoattractant protein 1 (MCP1) and CC chemokine ligand 11 (CCL11). Schwann cells in the old nerves appeared partially dedifferentiated, accompanied by an activated repair program independent of injury. Upon sciatic nerve injury, an initial delayed immune response was followed by a persistent hyperinflammatory state accompanied by a diminished repair process. As a contributing factor to nerve aging, we showed that CCL11 interfered with Schwann cell differentiation in vitro and in vivo. Our results indicate that increased infiltration of macrophages and inflammatory signals diminish regenerative capacity of aging nerves by altering Schwann cell behavior. The study identifies CCL11 as a promising target for anti‐inflammatory therapies aiming to improve nerve regeneration in old age.
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Affiliation(s)
- Robert Büttner
- Leibniz Institute on Aging; Fritz Lipmann Institute; Jena Germany
| | - Alexander Schulz
- Leibniz Institute on Aging; Fritz Lipmann Institute; Jena Germany
- Department of Genetics and Program in Cellular Neuroscience, Neurodegeneration and Repair; Yale University School of Medicine; New Haven Connecticut
| | - Michael Reuter
- Leibniz Institute on Aging; Fritz Lipmann Institute; Jena Germany
| | - Asha K. Akula
- Leibniz Institute on Aging; Fritz Lipmann Institute; Jena Germany
| | - Thomas Mindos
- Leibniz Institute on Aging; Fritz Lipmann Institute; Jena Germany
| | | | - Lars B. Riecken
- Leibniz Institute on Aging; Fritz Lipmann Institute; Jena Germany
| | | | - Reinhard Bauer
- Institute of Molecular Cell Biology; Jena University Hospital; Jena Germany
| | - Helen Morrison
- Leibniz Institute on Aging; Fritz Lipmann Institute; Jena Germany
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Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children’s hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children.
Methods
This is a prospective, observational study of routine clinical practice. Data were collected on every regional block placed by an anesthesiologist at participating institutions and were uploaded to a secure database. The data were audited at multiple points for accuracy.
Results
There were no permanent neurologic deficits reported (95% CI, 0 to 0.4:10,000). The risk of transient neurologic deficit was 2.4:10,000 (95% CI, 1.6 to 3.6:10,000) and was not different between peripheral and neuraxial blocks. The risk of severe local anesthetic systemic toxicity was 0.76:10,000 (95% CI, 0.3 to 1.6:10,000); the majority of cases occurred in infants. There was one epidural abscess reported (0.76:10,000, 95% CI, 0 to 4.8:10,000). The incidence of cutaneous infections was 0.5% (53:10,000, 95% CI, 43 to 64:10,000). There were no hematomas associated with neuraxial catheters (95% CI, 0 to 3.5:10,000), but one epidural hematoma occurred with a paravertebral catheter. No additional risk was observed with placing blocks under general anesthesia. The most common adverse events were benign catheter-related failures (4%).
Conclusions
The data from this study demonstrate a level of safety in pediatric regional anesthesia that is comparable to adult practice and confirms the safety of placing blocks under general anesthesia in children.
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Orssatto LBDR, Wiest MJ, Diefenthaeler F. Neural and musculotendinous mechanisms underpinning age-related force reductions. Mech Ageing Dev 2018; 175:17-23. [PMID: 29997056 DOI: 10.1016/j.mad.2018.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/21/2018] [Accepted: 06/28/2018] [Indexed: 01/02/2023]
Abstract
Ageing leads to substantial force production capacity reductions, which is an indicator of frailty and disability, and a mortality predictor in elders. Understanding the age-dependent neuromuscular mechanisms underlying force reductions can optimize healthcare professionals' exercise protocol choices for patients and allows researchers to investigate new interventions to mitigate these reductions. Our primary goal was to provide an updated review about the main neural and musculotendinous mechanisms underpinning age-related reductions in force capacity. Our secondary goal was to summarize how aerobic and strength training can lessen these age-related reductions. This review suggests that several steps in the force production pathway, from cortical to muscular mechanisms, are negatively affected by ageing. However, combining aerobic and strength training can attenuate these effects. Strength training (i.e. moderate to high- intensity, progressive volume, accentuated eccentric loading and fast concentric contraction velocity) can increase overall force production capacity by producing beneficial neural and musculotendinous adaptations. Additionally, aerobic training (i.e. moderate and high intensities) plays an essential role in preserving the structure and function of the neuromuscular system.
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Affiliation(s)
- Lucas Bet da Rosa Orssatto
- Laboratório de Biomecânica, Centro de Desportos, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Matheus Joner Wiest
- Toronto Rehabilitation Institute - UHN. Neural Engineering & Therapeutic Team, Toronto, Ontario, Canada
| | - Fernando Diefenthaeler
- Laboratório de Biomecânica, Centro de Desportos, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil.
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Salman Roghani R, Holisaz MT, Tarkashvand M, Delbari A, Gohari F, Boon AJ, Lokk J. Different doses of steroid injection in elderly patients with carpal tunnel syndrome: a triple-blind, randomized, controlled trial. Clin Interv Aging 2018; 13:117-124. [PMID: 29403268 PMCID: PMC5779277 DOI: 10.2147/cia.s151290] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Carpal tunnel syndrome (CTS) is commonly seen in elderly populations, in part due to increased presence of predisposing comorbidities as well as physiological changes. We aimed at comparing the effectiveness of different doses of steroid using the ultrasound-guided hydrodissection method in elderly patients with CTS. Methods We conducted a prospective, triple-blind, randomized, controlled trial in elderly patients with CTS. Patients were allocated to one of three groups by simplified randomization. Groups I–III received 80 mg triamcinolone (2 mL) and 1 mL of 2% lidocaine; 40 mg triamcinolone (1 mL), 1 mL of 2% lidocaine, and 1 mL normal saline; and 1 mL of 2% lidocaine and 2 mL normal saline, respectively to make up to 3 mL volume. A wrist splint was then applied for support. Outcome measures included the visual analog scale (VAS) and the Boston Carpal Tunnel Questionnaire, and median motor and sensory nerve conduction and its sonographic inlet cross-sectional area were used as objective measures. All data were recorded at baseline and 2, 12, and 24 weeks after injection. The investigators, patients, and statistician were blinded to the treatment assignment. Results In total, 161 patients were recruited without statistically significant demographic differences between the three groups. There were no statistically significant differences between groups in any outcome, with the exception of the median distal motor latency, which was greater in Group II at all three follow-up visits, and significant baseline VAS difference between Groups I and III. Conclusion Hydrodissection with lidocaine and normal saline is as effective as hydrodissection with low- and high-dose steroid medication in elderly patients with CTS in this study, but further studies with matched baseline measures and also a sham group are suggested for definitive recommendation.
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Affiliation(s)
- Reza Salman Roghani
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences
| | - Mohammad Taghi Holisaz
- Department of Physical Medicine and Rehabilitation, Baqiyatallah University of Medical Sciences
| | - Masoud Tarkashvand
- Department of Physical Medicine and Rehabilitation, Baqiyatallah University of Medical Sciences
| | - Ahmad Delbari
- Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Faeze Gohari
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Johan Lokk
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
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Di Giminiani P, Edwards SA, Malcolm EM, Leach MC, Herskin MS, Sandercock DA. Characterization of short- and long-term mechanical sensitisation following surgical tail amputation in pigs. Sci Rep 2017; 7:4827. [PMID: 28684801 PMCID: PMC5500571 DOI: 10.1038/s41598-017-05404-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/26/2017] [Indexed: 12/25/2022] Open
Abstract
Commercial pigs are frequently exposed to tail mutilations in the form of preventive husbandry procedures (tail docking) or as a result of abnormal behaviour (tail biting). Although tissue and nerve injuries are well-described causes of pain hypersensitivity in humans and in rodent animal models, there is no information on the changes in local pain sensitivity induced by tail injuries in pigs. To determine the temporal profile of sensitisation, pigs were exposed to surgical tail resections and mechanical nociceptive thresholds (MNT) were measured in the acute (one week post-operatively) and in the long-term (either eight or sixteen weeks post-surgery) phase of recovery. The influence of the degree of amputation on MNTs was also evaluated by comparing three different tail-resection treatments (intact, ‘short tail’, ‘long tail’). A significant reduction in MNTs one week following surgery suggests the occurrence of acute sensitisation. Long-term hypersensitivity was also observed in tail-resected pigs at either two or four months following surgery. Tail amputation in pigs appears to evoke acute and sustained changes in peripheral mechanical sensitivity, which resemble features of neuropathic pain reported in humans and other species and provides new information on implications for the welfare of animals subjected to this type of injury.
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Affiliation(s)
- Pierpaolo Di Giminiani
- School of Agriculture, Food and Rural Development, Newcastle University, Newcastle upon Tyne, NE1 7RU, United Kingdom.
| | - Sandra A Edwards
- School of Agriculture, Food and Rural Development, Newcastle University, Newcastle upon Tyne, NE1 7RU, United Kingdom
| | - Emma M Malcolm
- School of Agriculture, Food and Rural Development, Newcastle University, Newcastle upon Tyne, NE1 7RU, United Kingdom
| | - Matthew C Leach
- School of Agriculture, Food and Rural Development, Newcastle University, Newcastle upon Tyne, NE1 7RU, United Kingdom
| | - Mette S Herskin
- Aarhus University, Department of Animal Science, Au-Foulum, Tjele, Denmark
| | - Dale A Sandercock
- Animal and Veterinary Science Research Group, Scotland's Rural College (SRUC), West Mains Road, Edinburgh, EH16 4SA, United Kingdom
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Lim EMF, Musa A, Frederick A, Ousman SS. AlphaB-crystallin expression correlates with aging deficits in the peripheral nervous system. Neurobiol Aging 2017; 53:138-149. [PMID: 28185662 DOI: 10.1016/j.neurobiolaging.2017.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 11/17/2022]
Abstract
In an effort to identify factors that contribute to age-related deficits in the undamaged and injured peripheral nervous system (PNS), we noted that Brady and colleagues found that mice null for a small heat shock protein called alphaB-crystallin (αBC) developed abnormalities early in life that are reminiscent of aging pathologies. Because of our observation that αBC protein levels markedly reduce as wild-type mice age, we investigated whether the crystallin plays a role in modulating age-related deficits in the uninjured and damaged PNS. We show here that the presence of αBC correlates with maintenance of myelin sheath thickness, reducing macrophage presence, sustaining lipid metabolism, and promoting remyelination following peripheral nerve injury in an age-dependent manner. More specifically, animals null for αBC displayed a higher frequency of thinly myelinated axons, enhanced presence of Iba1+ macrophages, and fewer immunoreactive profiles of the cholesterol biosynthesis enzyme, squalene monooxygenase, before and after sciatic nerve crush injury. These findings thus suggest that αBC plays a protective and beneficial role in the aging PNS.
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Affiliation(s)
- Erin-Mai F Lim
- Department of Neuroscience, University of Calgary and the Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Alim Musa
- Department of Clinical Neurosciences, University of Calgary and the Hotchkiss Brain Institute, Calgary, Alberta, Canada; Department of Cell Biology and Anatomy, University of Calgary and the Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Ariana Frederick
- Department of Clinical Neurosciences, University of Calgary and the Hotchkiss Brain Institute, Calgary, Alberta, Canada; Department of Cell Biology and Anatomy, University of Calgary and the Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Shalina S Ousman
- Department of Clinical Neurosciences, University of Calgary and the Hotchkiss Brain Institute, Calgary, Alberta, Canada; Department of Cell Biology and Anatomy, University of Calgary and the Hotchkiss Brain Institute, Calgary, Alberta, Canada.
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26
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Scheib J, Höke A. Impaired regeneration in aged nerves: Clearing out the old to make way for the new. Exp Neurol 2016; 284:79-83. [PMID: 27451012 DOI: 10.1016/j.expneurol.2016.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/10/2016] [Accepted: 07/19/2016] [Indexed: 01/12/2023]
Abstract
Although many observational studies have shown that peripheral nerve regeneration is impaired with aging, underlying cellular and molecular mechanisms have remained obscure until recently. A series of recent genetic, live imaging and heterochronic parabiosis experiments are providing new insights into the underlying mechanisms of reduced regenerative capacity with aging. These studies show that Schwann cells pose a primary impediment to axon regeneration in older animals as they fail to support regenerating axons, while the contribution from macrophages remains an unresolved issue. Neurons do not appear to have an intrinsic defect of axonal elongation with aging but are impaired when they encounter an inhibitory environment, suggesting that therapeutic approaches to improve intrinsic neuronal regeneration capacity across inhibitory environments, as it is being done in central nervous system regeneration, can improve peripheral nerve regeneration as well. As in many aspects of neuroscience therapeutics development, a combinatorial approach may yield the best outcomes for nerve regeneration in aged individuals.
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Affiliation(s)
- Jami Scheib
- Departments of Neurology and Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Ahmet Höke
- Departments of Neurology and Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
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27
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Scheib JL, Höke A. An attenuated immune response by Schwann cells and macrophages inhibits nerve regeneration in aged rats. Neurobiol Aging 2016; 45:1-9. [PMID: 27459920 DOI: 10.1016/j.neurobiolaging.2016.05.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 12/21/2022]
Abstract
Although peripheral nerves are capable of regeneration, advanced age decreases the potential for functional recovery after injury. The cellular mechanisms for this are not currently understood. Here, we performed sciatic nerve grafting with young (2 months old) and aged (18 months old) Brown-Norway male rats, in which 1 cm nerve grafts from young or aged rats were sutured into nerves of young or aged rats. Axons were allowed to regenerate until the nerve grafts and distal nerves were harvested at 1, 3, and 7 days and 2 and 6 weeks. At 6 weeks, our data suggested that young nerve grafts supported regeneration better than aged nerve grafts. In addition, myelin debris clearance was inhibited in young nerves when grafted into aged rats, but clearance was faster when aged nerves were grafted into young rats. Further analysis revealed that aged macrophages have delayed migration into injured nerve, and macrophages and Schwann cells from aged rats were less phagocytic for myelin debris in vitro. To understand these impairments, expression levels of pro- and anti-inflammatory cytokines were analyzed at 1 day after injury. Based on these levels, there was not a clear polarization to either an M1 or M2 phenotype; however, expression levels of IL-6, IL-10, CCL2 (MCP1), and Arg-1 were decreased in aged nerves. Taken together, both macrophages and Schwann cells had attenuated responses to nerve injury in aged rats, leading to inefficient clearance of debris and impaired axonal regeneration.
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Affiliation(s)
- Jami L Scheib
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ahmet Höke
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Morphometric analysis of the diameter and g-ratio of the myelinated nerve fibers of the human sciatic nerve during the aging process. Anat Sci Int 2015; 91:238-45. [DOI: 10.1007/s12565-015-0287-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 05/05/2015] [Indexed: 11/25/2022]
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Hourigan ML, McKinnon NB, Johnson M, Rice CL, Stashuk DW, Doherty TJ. Increased motor unit potential shape variability across consecutive motor unit discharges in the tibialis anterior and vastus medialis muscles of healthy older subjects. Clin Neurophysiol 2015; 126:2381-9. [PMID: 25727901 DOI: 10.1016/j.clinph.2015.02.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 01/31/2015] [Accepted: 02/02/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To study the potential utility of using near fiber (NF) jiggle as an assessment of neuromuscular transmission stability in healthy older subjects using decomposition-based quantitative electromyography (DQEMG). METHODS The tibialis anterior (TA) and vastus medialis (VM) muscles were tested in 9 older men (77 ± 5 years) and 9 young male control subjects (23 ± 0.3 years). Simultaneous surface and needle-detected electromyographic (EMG) signals were collected during voluntary contractions, and then analyzed using DQEMG. Motor unit potential (MUP) and NF MUP parameters were analyzed. RESULTS NF jiggle was significantly increased for both the TA and VM in the old age group relative to the younger controls (P<0.05). NF jiggle was significantly higher in the TA compared to VM (P<0.05). For TA, NF jiggle was negatively correlated with MUNE, and positively correlated with S-MUP amplitude, NF count, MUP duration, MUP peak-to-peak voltage, and MUP area (P<0.05). For VM, NF jiggle was positively correlated with NF count and MUP area (P<0.05), and no significant correlations were found between NF jiggle and S-MUP amplitude, MUP duration, or MUP peak-to-peak voltage (MUNE was not calculated for VM, so no correlation could be made). CONCLUSIONS Healthy aging is associated with neuromuscular transmission instability (increased NF jiggle) and MU remodeling, which can be measured using DQEMG. SIGNIFICANCE NF jiggle derived from DQEMG can be a useful method of identifying neuromuscular dysfunction at various stages of MU remodeling and aging.
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Affiliation(s)
- Maddison L Hourigan
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Neal B McKinnon
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Marjorie Johnson
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Charles L Rice
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Daniel W Stashuk
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Timothy J Doherty
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada; Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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Bennmann D, Horstkorte R, Hofmann B, Jacobs K, Navarrete-Santos A, Simm A, Bork K, Gnanapragassam VS. Advanced glycation endproducts interfere with adhesion and neurite outgrowth. PLoS One 2014; 9:e112115. [PMID: 25386903 PMCID: PMC4227844 DOI: 10.1371/journal.pone.0112115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 10/13/2014] [Indexed: 11/26/2022] Open
Abstract
Advanced glycation endproducts (AGEs) represent a non-enzymatic posttranslational protein modification. AGEs are generated by a series of chemical reactions of free reducing monosaccharides, such as glucose, fructose or metabolites of the monosaccharide metabolism with amino groups of proteins. After oxidation, dehydration and condensation, stable AGE-modifications are formed. AGE-modified proteins accumulate in all cells and tissues as a normal feature of ageing and correlate with the glucose concentration in the blood. AGEs are increased in diabetic patients and play a significant role in the pathogenesis of most age-related neural disorders, such as Alzheimer’s disease. We examined the role of AGEs on neurite outgrowth of PC12 cells. We induced the formation of AGEs using the reactive carbonyl compound methylglyoxal (MGO) as a physiological metabolite of glucose. We found that AGE-modification of laminin or collagen interfered with adhesion but not with neurite outgrowth of PC12 cells. Furthermore, the AGE-modification of PC12 cell proteins reduced NGF-induced neurite outgrowth. In conclusion, our data show that AGEs negatively influence neural plasticity.
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Affiliation(s)
- Dorit Bennmann
- Institute for Physiological Chemistry, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Rüdiger Horstkorte
- Institute for Physiological Chemistry, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Britt Hofmann
- Department of Cardiothoracic Surgery, University Hospital, Halle (Saale), Germany
| | - Kathleen Jacobs
- Department of Cardiothoracic Surgery, University Hospital, Halle (Saale), Germany
| | | | - Andreas Simm
- Department of Cardiothoracic Surgery, University Hospital, Halle (Saale), Germany
| | - Kaya Bork
- Institute for Physiological Chemistry, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Vinayaga S. Gnanapragassam
- Institute for Physiological Chemistry, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- * E-mail:
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Mancini P, De Seta D, Prosperini L, Nicastri M, Gabriele M, Ceccanti M, Sementilli G, Terella M, Bertoli GA, Filipo R, Inghilleri M. Prognostic factors of Bell's palsy: Multivariate analysis of electrophysiological findings. Laryngoscope 2014; 124:2598-605. [DOI: 10.1002/lary.24764] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Luca Prosperini
- Department of Neurology and Psychiatry; University Sapienza; Rome Italy
| | - Maria Nicastri
- Department of Sense Organs; University Sapienza; Rome Italy
| | - Maria Gabriele
- Department of Neurology and Psychiatry; University Sapienza; Rome Italy
| | - Marco Ceccanti
- Department of Neurology and Psychiatry; University Sapienza; Rome Italy
| | | | - Maria Terella
- Department of Sense Organs; University Sapienza; Rome Italy
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The effect of patient age on the success of laryngeal reinnervation. Eur Arch Otorhinolaryngol 2014; 271:3241-7. [DOI: 10.1007/s00405-014-3091-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
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Li M, Chen S, Wang W, Chen D, Zhu M, Liu F, Zhang C, Li Y, Zheng H. Effect of duration of denervation on outcomes of ansa-recurrent laryngeal nerve reinnervation. Laryngoscope 2014; 124:1900-5. [PMID: 24473920 DOI: 10.1002/lary.24623] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/03/2014] [Accepted: 01/27/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Meng Li
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Shicai Chen
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Wei Wang
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Donghui Chen
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Minhui Zhu
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Fei Liu
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Caiyun Zhang
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Yan Li
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
| | - Hongliang Zheng
- Department of Otolaryngology-Head and Neck Surgery; Changhai Hospital, Second Military Medical University; Shanghai 200433 People's Republic of China
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Abstract
PURPOSE OF REVIEW Age-related muscle weakness causes a staggering economic, public, and personal burden. Most research has focused on internal muscular mechanisms as the root cause to strength loss. Here, we briefly discuss age-related impairments in the brain and peripheral nerve structures that may theoretically lead to muscle weakness in old age. RECENT FINDINGS Neuronal atrophy in the brain is accompanied by electrical noise tied to declines in dopaminergic neurotransmission that degrades communication between neurons. Additionally, sensorimotor feedback loops that help regulate corticospinal excitability are impaired. In the periphery, there is evidence for motor unit loss, axonal atrophy, demyelination caused by oxidative damage to proteins and lipids, and modified transmission of the electrical signal through the neuromuscular junction. SUMMARY Recent evidence clearly indicates that muscle weakness associated with aging is not entirely explained by classically postulated atrophy of muscle. In this issue, which focuses on 'Ageing: Biology and Nutrition' we will highlight new findings on how nervous system changes contribute to the aging muscle phenotype. These findings indicate that the ability to communicate neural activity to skeletal muscle is impaired with advancing age, which raises the question of whether many of these age-related neurological changes are mechanistically linked to impaired performance of human skeletal muscle. Collectively, this work suggests that future research should explore the direct link of these 'upstream' neurological adaptions and onset of muscle weakness in elders. In the long term, this new focus might lead to novel strategies to attenuate the age-related loss of muscle strength.
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Affiliation(s)
- Todd M Manini
- Institute of Aging and the Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida 32611, USA.
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Peskun CJ, Chahal J, Steinfeld ZY, Whelan DB. Risk factors for peroneal nerve injury and recovery in knee dislocation. Clin Orthop Relat Res 2012; 470:774-8. [PMID: 21822573 PMCID: PMC3270170 DOI: 10.1007/s11999-011-1981-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute knee dislocation is rare but has a high rate of associated neurovascular injuries and potentially limb-threatening complications. These include the substantial morbidity associated with peroneal nerve injury: neuropathic pain, decreased mobility, and considerably reduced function, which not only impairs patient function but complicates treatment. QUESTIONS/PURPOSES We therefore identified and quantified the risks associated with specific factors for peroneal nerve injury and recovery in patients with knee dislocations. PATIENTS AND METHODS We retrospectively reviewed the charts of 26 patients, from among a cohort of all 91 knee dislocations, with a peroneal nerve palsy over a 5-year period. We then used univariable and multivariable statistics to identify risk factors predicting peroneal nerve injury and recovery. RESULTS Gender (odds ratio, 5.47), body mass index (odds ratio, 1.14), and fibular head fracture (odds ratio, 4.77) were associated with peroneal nerve injury. Only younger age was associated with peroneal nerve recovery. CONCLUSIONS Knowledge of the risk factors for peroneal nerve injury and the predictors of recovery in knee dislocation allows the treating surgeon to have a better understanding of the nature of the neurologic injury and modify management based on the anticipated return of nerve function. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christopher J. Peskun
- Department of Orthopaedic Surgery, University of Toronto, St Michael’s Hospital, 55 Queen Street E, Suite 800, Toronto, ON M5C 1R6 Canada
| | - Jas Chahal
- Department of Orthopaedic Surgery, University of Toronto, St Michael’s Hospital, 55 Queen Street E, Suite 800, Toronto, ON M5C 1R6 Canada
| | - Zvi Y. Steinfeld
- Department of Orthopaedic Surgery, University of Toronto, St Michael’s Hospital, 55 Queen Street E, Suite 800, Toronto, ON M5C 1R6 Canada
| | - Daniel B. Whelan
- Department of Orthopaedic Surgery, University of Toronto, St Michael’s Hospital, 55 Queen Street E, Suite 800, Toronto, ON M5C 1R6 Canada
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Aging profoundly delays functional recovery from gustatory nerve injury. Neuroscience 2012; 209:208-18. [PMID: 22387273 DOI: 10.1016/j.neuroscience.2012.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/26/2012] [Accepted: 02/07/2012] [Indexed: 11/21/2022]
Abstract
The peripheral taste system remains plastic during adulthood. Sectioning the chorda tympani (CT) nerve, which sends sensory information from the anterior tongue to the central nervous system, causes degeneration of distal fibers and target taste buds. However, taste function is restored after about 40 days in young adult rodents. We tested whether aging impacts the reappearance of neural responses after unilateral CT nerve injury. Taste bud regeneration was minimal at day 50-65 after denervation, and most aged animals died before functional recovery could be assessed. A subset (n=3/5) of old rats exhibited normal CT responses at day 85 postsectioning, suggesting the potential for efficient recovery. The aged taste system is fairly resilient to sensory receptor loss and major functional changes in normal aging. However, injury to the taste system reveals a surprising vulnerability in old rodents. The gustatory system provides an excellent model to study mechanisms underlying delayed recovery from peripheral nerve injury. Strategies to accelerate recovery and restore normal function will be of interest, as the elderly population continues to grow.
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Wesley CK, Unger RH, Rosenberg M, Unger MA, Unger WP. Factors influencing postoperative hyperesthesia in hair restoration surgery. J Cosmet Dermatol 2011; 10:301-6. [DOI: 10.1111/j.1473-2165.2011.00582.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Carlos K Wesley
- Mount Sinai Medical Center, Department of Dermatology, New York, NY, USA.
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Prospective Computerized Analyses of Sensibility in Breast Reconstruction with Non-Reinnervated DIEP Flap. Plast Reconstr Surg 2011; 127:1790-1795. [DOI: 10.1097/prs.0b013e31820cf1c6] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Age affects reciprocal cellular interactions in neuromuscular synapses following peripheral nerve injury. Ageing Res Rev 2011; 10:43-53. [PMID: 20943206 DOI: 10.1016/j.arr.2010.10.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 10/04/2010] [Accepted: 10/04/2010] [Indexed: 01/09/2023]
Abstract
Studies of the influence of age on regeneration and reinnervation in the peripheral nervous system (PNS) and neuromuscular junction (NMJ) are reviewed, with a particular focus on aged and denervated skeletal muscles. The morphological and functional features of incomplete regeneration and reinnervation are compared between adult and aged animals. In addition, some possible mechanisms of the age-related defects will be discussed. Increased fragmentation or damage in individual components of the NMJ (terminal Schwann cells (TSCs), axon terminals and acetylcholine receptor sites occurs during muscle reinnervation following PNS injury in the aged animals. The capacity to produce ultraterminal sprouting or multiple innervation secondary to PNS injury is maintained, but not the capacity to eliminate such anomalous axonal profiles. The frequency and accuracy of reoccupation of the synaptic sites by TSCs and axon terminals are impaired. Thus, despite the capability of extending neural processes, the rate at which regenerating nerve fibers grow, mature and precisely appose the postsynaptic muscle fiber is impaired, resulting in the failure of re-establishment of the normal single motor innervation in the NMJ. A complex set of cellular interactions in the NMJ are known to participate in the neurotrophism and neurotrophism to support growth of the regenerating and sprouting axons and their pathfinding to direct the target muscle fiber. Besides the capability of α-motoneurons, signaling originating from the TSCs and muscle may be impaired during aging.
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Creed MC, Milgram NW. Amyloid-modifying therapies for Alzheimer's disease: therapeutic progress and its implications. AGE (DORDRECHT, NETHERLANDS) 2010; 32:365-84. [PMID: 20640545 PMCID: PMC2926857 DOI: 10.1007/s11357-010-9142-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 03/25/2010] [Indexed: 05/03/2023]
Abstract
Alzheimer's disease (AD) is the most prevalent form of dementia, affecting an estimated 4.8 million people in North America. For the past decade, the amyloid cascade hypothesis has dominated the field of AD research. This theory posits that the deposition of amyloid-beta protein (Abeta) in the brain is the key pathologic event in AD, which induces a series of neuropathological changes that manifest as cognitive decline and eventual dementia. Based on this theory, interventions that reduce Abeta burden in the brain would be expected to alleviate both the neuropathological changes and dementia, which characterize AD. Several diverse pharmacological strategies have been developed to accomplish this. These include inhibiting the formation of Abeta, preventing the aggregation of Abeta into insoluble aggregates, preventing the entry of Abeta into the brain from the periphery and enhancing the clearance of Abeta from the central nervous system. To date, no amyloid-modifying therapy has yet been successful in phase 3 clinical trials; however, several trials are currently underway. This article provides a review of the status of amyloid-modifying therapies and the implications for the amyloid cascade hypothesis.
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Affiliation(s)
- Meaghan C Creed
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada.
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Tos P, Ronchi G, Papalia I, Sallen V, Legagneux J, Geuna S, Giacobini‐Robecchi M. Chapter 4 Methods and Protocols in Peripheral Nerve Regeneration Experimental Research: Part I—Experimental Models. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:47-79. [DOI: 10.1016/s0074-7742(09)87004-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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