Application of ultrasound-guided C5 nerve root block using polydeoxyribonucleotide in traumatic C5 nerve root injury caused by fracture of the articular process of the cervical spine: A case report

Effect of epidural polydeoxyribonucleotide in a rat model of lumbar foraminal stenosis

Background

We aimed to investigate the effect of epidural polydeoxyribonucleotide (PDRN) on mechanical allodynia and motor dysfunction in a rat model of lumbar foraminal stenosis (LFS).

Methods

This study was conducted in two stages, using male Sprague-Dawley rats. The rats were randomly divided into eight groups. In the first stage, the groups were as follows vehicle (V), sham (S), and epidural PDRN at 5 (P5), 8 (P8), and 10 (P10) mg/kg; and in the second stage, they were as follows intraperitoneal PDRN 8 mg/kg, epidural 3,7-dimethyl-1-propargilxanthine (DMPX) (0.1 mg/kg), and DMPX (0.1 mg/kg). The LFS model was established, except for the S group. After an epidural injection of the test solutions, von Frey and treadmill tests were conducted for 3 weeks. Subsequently, histopathologic examinations were conducted in the V, S, P5, and P10 groups.

Results

A total of 65 rats were included. The P8 and P10 groups showed significant recovery from mechanical allodynia and motor dysfunction at all time points after drug administration compared to the V group. These effects were abolished by concomitant administration of DMPX. On histopathological examination, no epineurial inflammation or fibrosis was observed in the epidural PDRN groups.

Conclusions

Epidural injection of PDRN significantly improves mechanical allodynia and motor dysfunction in a rat model of LFS, which is mediated by the spinal adenosine A_2A receptor. The present data support the need for further research to determine the role of epidural PDRN in spinal stenosis treatment.

Applications of Marine Organism-Derived Polydeoxyribonucleotide: Its Potential in Biomedical Engineering

Polydeoxyribonucleotides (PDRNs) are a family of DNA-derived drugs with a molecular weight ranging from 50 to 1500 kDa, which are mainly extracted from the sperm cells of salmon trout or chum salmon. Many pre-clinical and clinical studies have demonstrated the wound healing and anti-inflammatory properties of PDRN, which are mediated by the activation of adenosine A2A receptor and salvage pathways, in addition to promoting osteoblast activity, collagen synthesis, and angiogenesis. In fact, PDRN is already marketed due to its therapeutic properties against various wound healing- and inflammation-related diseases. Therefore, this review assessed the most recent trends in marine organism-derived PDRN using the Google Scholar search engine. Further, we summarized the current applications and pharmacological properties of PDRN to serve as a reference for the development of novel PDRN-based technologies.

Does polydeoxyribonucleotide has an effect on patients with tendon or ligament pain?: A PRISMA-compliant meta-analysis

BACKGROUND

Pain in the tendons or ligaments is extremely common, accounting for 30% of the causes of visiting general practitioners. Polydeoxyribonucleotide (PDRN) is emerging as a new treatment for musculoskeletal pain. However, the effects of PDRN in patients with tendon or ligament pain are unclear. Therefore, this study aimed to determine the impact of PDRN in patients with tendon or ligament pain through a meta-analysis.

METHODS

Electronic literature search of PubMed, Embase, SCOPUS, and Cochrane Library databases of all articles on PDRN treatment for patients with tendon or ligament pain published in the English language from inception until January 31, 2020. The search identified 262 citations.

RESULTS

One randomized controlled trial and 3 retrospective observational studies were included. Pain due to tendon or ligament disorders showed significant improvement after PDRN injection (standardized mean difference [SMD] = -1.43, 95% confidence interval [CI] = -1.80 to -1.06, P < .00001). In the subanalysis of patients with rotator cuff tendinopathy, rotator cuff tendinopathy-induced pain significantly improved (SMD = -2.34, 95% CI = -3.61 to -1.07, P = .0003) after PDRN injection. However, there was no difference in shoulder pain and disability index score and strength of shoulder abduction in patients with rotator cuff tendinopathy (shoulder pain and disability index score, SMD = 1.16, 95% CI = -1.20 to 3.52, P = .34; strength of shoulder abduction, SMD = 0.42, 95% CI = -0.03 to 0.88, P = .07).

CONCLUSION

Effective pain relief was achieved in patients with tendon or ligament disorders after PDRN injection. To more precisely determine this effect, a meta-analysis with a larger number of clinical trials is warranted.

Effect of Polydeoxyribonucleotide Injection in a Patient With Carpal Tunnel Syndrome

Ultrasound-guided corticosteroid injection into the carpal tunnel is widely performed for the management of carpal tunnel syndrome. However, this injection may worsen the condition in patients with type 2 diabetes mellitus. Polydeoxyribonucleotide was recently recognized as a substitute for corticosteroid because of its anti-inflammatory effects. A 41-yr-old woman with type 2 diabetes mellitus was admitted to our rehabilitation clinic with a 1-mo history of numbness and tingling in her right hand and first three fingers tips. She declined corticosteroid treatment because of a previous episode of uncontrolled blood glucose levels after corticosteroid injection. Therefore, ultrasound-guided polydeoxyribonucleotide injections into the carpal tunnel were carried out. At the 6-mo follow-up, the patient demonstrated an improvement in the carpal tunnel syndrome symptoms without any complications. Thus, polydeoxyribonucleotide injections into the carpal tunnel can be an alternative to corticosteroid injections for carpal tunnel syndrome if there are limitations because of adverse effects of the latter.

Ultrasound-guided peri-brachial plexus polydeoxyribonucleotide injection for a patient with postherpetic brachial plexopathy: A case report

RATIONALE

Although most complications of herpes zoster (HZ) are associated with the spread of varicella-zoster virus from the initially involved sensory ganglion, motor nerve impairment, such as limb weakness, is a rare but severe complication that is difficult to treat.

PATIENT CONCERN

A 73-year-old female presented with sudden left upper limb pain and weakness after HZ.

DIAGNOSIS

Brachial plexopathy following HZ (postherpetic brachial plexopathy).

INTERVENTION

Despite alleviation of the vesicles with antiviral treatments, the left upper limb weakness and neuropathic pain did not improve. After obtaining patient's consent, ultrasound-guided polydeoxyribonucleotide (PDRN) injection was performed around the left brachial plexus.

OUTCOMES

The patient showed marked improvement in left arm pain from numerical rating scale (NRS) 9 to 4, 1 day after PDRN injection. Subsequently, the pain improved to NRS 3, and motor weakness improved to Medical Research Council grade 2 to 4.

LESSONS

PDRN can be considered a viable substitute for corticosteroid injection in treatment of motor weakness and neuropathic pain after HZ.

Distribution Patterns of Vasculature Around Cervical Nerve Roots

BACKGROUND

To the authors' knowledge, there has not been an ultrasound study of the vulnerable vessels in a C3-7 cervical nerve root block (CNRB).

OBJECTIVES

To evaluate the prevalence of vulnerable vessels around the target of a CNRB at the cervical nerve root of C3-7 levels in a clinical setting.

DESIGN

Retrospective, cross-sectional study.

SETTING

General teaching hospital, rehabilitation unit.

PARTICIPANTS

A total of 104 patients complaining of neck or arm pain with no prior surgical history and who had undergone a CNRB at an outpatient clinic from May 2015 to December 2017 were included.

MAIN OUTCOME MEASUREMENTS

The prevalence of vulnerable vessels as seen on a preprocedure ultrasound scan around the target of a CNRB at the cervical nerve root of C3-7 levels.

RESULTS

Out of 104 cases, the C3 level had 7 blood vessels (8.33%), the C4 level had 14 blood vessels (13.86%), the C5 level had 17 blood vessels (16.35%), the C6 level had 27 blood vessels (25.96%), and the C7 level had 31 blood vessels (29.81%) either at the targeted cervical nerve root or at the site of the imaginary needle's projected pathway to the targeted cervical nerve root.

CONCLUSION

There was a substantial prevalence of vulnerable vessels either at the targeted nerve root or at the site of the needle's projected pathway to the nerve root.

Clinical characteristics of patients with posterosuperior labral tear: a comparison with patients with other shoulder disorders

Background

Among the various causes of shoulder pain, the glenoid labral tear is likely to be overlooked due to its ambiguous symptoms, especially if clinicians do not have a prior suspicion, making it difficult to diagnose, unlike adhesive capsulitis or a rotator cuff tear. Therefore, the aim of this study was to evaluate the clinical features of posterosuperior (PS) labral tear.

Methods

Of the patients who visited the clinic, the medical records of patients with shoulder pain who underwent shoulder magnetic resonance imaging or ultrasound after intra-articular injection (arthrosonography) were investigated retrospectively. Based on these criteria, a total of 120 patients with adhesive capsulitis, rotator cuff problem, or PS labral tear were included for analysis in this study.

Results

In the physical examination, all patients with a PS labral tear were positive on the O’Brien test (13/13, 100%) and the external rotation (ER) test with the upper arm in the abduction position (abduction and ER [ABER] test) (13/13, 100%), but they were negative on other tests, such as the Hawkins–Kennedy (1/13, 7.69%) and Neer (0/13, 0.00%) tests. Except one patient, all patients with a PS labral tear were negative on the ER test with the upper arm in the neutral position (ER test) (1/13, 7.69%). In the clinical history, all patients with a PS labral tear had a characteristic episode of shoulder pain occurring in the excessive ABER posture.

Conclusion

In patients with characteristic physical findings (no definite loss of motion of the shoulder joint, negative in an ER test, but positive in an ABER test and O’Brien test), and with a clinical history of PS labral tear (a history of pain occurring with the excessive ABER posture), clinicians need to have a suspicion of PS labral tear and to identify the PS labral tear using MRI or arthrosonography

Usefulness of F-18 FP-CIT PET to predict dopamine-responsive hand tremor in patients other than Parkinson's disease: Two case reports

RATIONALE

Treating the patients with hand tremors is clinically difficult, because a wide range of disorders can result in hand tremors. Therefore, when treatment for hand tremors begins, various pharmacological options have to be considered. In clinical practice, a practical approach is to initially check hand tremor patients for signs of Parkinson's disease (PD), because patients with PD can benefit from dopamine treatment. However, only part of patients with PD tends to show a meaningful improvement in hand tremors for dopamine treatment. On the other hand, dopamine treatment may help with hand tremors of patients with other disorders, but dopamine responsiveness can't be predicted by clinical assessment alone.

PATIENTS CONCERNS

Hand tremors.

DIAGNOSES

Hemiplegic patients (A 78-year-old man with cerebral infarction and a 65-year-old woman with traumatic brain injury) with hemi-sided hand tremor.

INTERVENTIONS

Fluorinated N-3-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) nortropane (F-18 FP-CIT) positron emission tomography (PET) and dopamine agonist.

OUTCOMES

After the medication, hemi-side hand tremor dramatically improved.

LESSONS

Collectively, a dysfunction of the dopaminergic nigro-striatal pathway may lead to abnormal findings of F-18 FP-CIT PET, and these abnormal findings in brain-lesion patients with hand tremor may help predict dopamine responsiveness of hand tremor. We believe that our report may be helpful in the diagnosis and treatment of hand tremor in patients with brain-lesion.

Usefulness of polydeoxyribonucleotide as an alternative to corticosteroids in patients with lateral epicondyitis: A case series

RATIONALE

Local corticosteroid injections are commonly used as an easy, cost-effective treatment for patients with lateral epicondylitis (LE). Despite their strong anti-inflammatory effect, repeated injections of corticosteroids are not recommended in LE because they can aggravate tearing of the tendons.

PATIENT CONCERNS

A 65-year-old (Case1) man and a 59-year-old (Case2) man had a 2-month history of right lateral elbow pain exacerbation.

DIAGNOSES

Lateral epicondylitis with hypervascularity of the common extensor tendon.

INTERVENTION

After informed consent was provided, ultrasound (US)-guided polydeoxyribonucleotide (PDRN) injections were made into on the common extensor tendons of both patients.

OUTCOMES

After 2 weeks from PDRN injection, both patients reported significant pain relief. The US 2 weeks after the PDRN injection showed that the hypervascularity of the common extensor tendon in both patients had been completely cured, although there was no significant change in the findings of tendinosis.

LESSONS

PDRN may be useful for patients with LE because there were no negative effects on tendon cells and tissues in previous in vitro and in vivo studies, despite its anti-inflammatory effects.