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Bittner GD, Tuffaha S, Shores JT. Polyethylene Glycol-Fusion Repair of Peripheral Nerve Injuries. Hand Clin 2024; 40:389-397. [PMID: 38972683 DOI: 10.1016/j.hcl.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Axons successfully repaired with polyethylene glycol (PEG) fusion tecnology restored axonal continuity thereby preventing their Wallerian degeneration and minimizing muscle atrophy. PEG fusion studies in animal models and preliminary clinical trials involving patients with digital nerve repair have shown promise for this therapeutic approach. PEG fusion is safe to perform, and given the enormous potential benefits, there is no reason not to explore its therapeutic potential.
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Affiliation(s)
- George D Bittner
- Neuroscience Department, Patterson Laboratories, The University of Texas at Austin, Room 321, 2415 Speedway, Austin, TX 78712, USA.
| | - Sami Tuffaha
- Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jaimie T Shores
- Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Suite A513, Baltimore, MD 21224, USA
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2
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Kim T, Lohse KR, Mackinnon SE, Philip BA. Patient Outcomes After Peripheral Nerve Injury Depend on Bimanual Dexterity and Preserved Use of the Affected Hand. Neurorehabil Neural Repair 2024; 38:134-147. [PMID: 38268466 PMCID: PMC10922924 DOI: 10.1177/15459683241227222] [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] [Indexed: 01/26/2024]
Abstract
BACKGROUND Little is known about how peripheral nerve injury affects human performance, behavior, and life. Hand use choices are important for rehabilitation after unilateral impairment, but rarely measured, and are not changed by the normal course of rehabilitation and daily life. OBJECTIVE To identify the relationship between hand use (L/R choices), motor performance, and patient-centered outcomes. METHODS Participants (n = 48) with unilateral peripheral nerve injury were assessed for hand use via Block Building Task, Motor Activity Log, and Edinburgh Handedness Inventory; dexterity (separately for each hand) via Nine-Hole Peg Test, Jebsen Taylor Hand Function Test, and a precision drawing task; patient-centered outcomes via surveys of disability, activity participation, and health-related quality of life; and injury-related factors including injury cause and affected nerve. Factor Analysis of Mixed Data was used to explore relationships between these variables. The data were analyzed under 2 approaches: comparing dominant hand (DH) versus non-dominant hand (NH), or affected versus unaffected hand. RESULTS The data were best explained by 5 dimensions. Good patient outcomes were associated with NH performance, DH performance (separately and secondarily to NH performance), and preserved function and use of the affected hand; whereas poor patient outcomes were associated with preserved but unused function of the affected hand. CONCLUSION After unilateral peripheral nerve injury, hand function, hand usage, and patient life arise from a complex interaction of many factors. To optimize rehabilitation after unilateral impairment, new rehabilitation methods are needed to promote performance and use with the NH, as well as the injured hand.
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Affiliation(s)
- Taewon Kim
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Benjamin A. Philip
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
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3
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Longo D, Ammannati L, Melchiorre D, Serafini I, Bagni MA, Ferrarello F. The Muscle Shortening Maneuver: a noninvasive approach to the treatment of peroneal nerve injury. A case report. Physiother Theory Pract 2024; 40:176-183. [PMID: 35912501 DOI: 10.1080/09593985.2022.2106915] [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: 07/22/2021] [Accepted: 07/15/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND The treatment of peripheral nerve injuries is a debated topic. The Muscle Shortening Maneuver (MSM), a physiotherapy approach, is noninvasive and free of side effects; it consists of a muscle shortening and a solicitation in traction applied simultaneously. OBJECTIVE The focus of this report is to describe the effects of the MSM combined with walking retraining in a patient with incomplete injury of the peroneal nerve. DESCRIPTION The patient was a 17-year-old man, who underwent osteotomy surgery of the proximal two-thirds of the fibula, due to an Ewing sarcoma that caused a partial injury of the left peroneal nerve. Our assessment plan of the left ankle movement ability comprised range of movement, muscle strength, and surface electromyography (EMG); and a gait analysis was conducted by using an iPhone application. MSM and walking retraining were administered twice and once a week, respectively, for 4 weeks. OUTCOMES The active range of movement substantially improved in dorsiflexion (≥15°), whereas slightly decreased in plantar flexion (-5°). Aside from the tibialis anterior, an increase in muscle strength was detected. Surface EMG showed an increased activation, particularly in the peroneus longus. A decrease in gait speed and step length was recorded from the gait analysis, with a better bilateral symmetry. CONCLUSIONS Positive outcomes were reported without evidence of risk or adverse events for the participant.
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Affiliation(s)
- Diego Longo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Biological Systems Movement Research Laboratory, Pistoia Italy
| | - Lorenzo Ammannati
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniela Melchiorre
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Biological Systems Movement Research Laboratory, Pistoia Italy
| | - Isabella Serafini
- Department of Functional Rehabilitation Activities, Azienda USL Toscana Centro, Ex Filanda, V. Cesare Battisti 30, Pescia, Italy
| | - Maria Angela Bagni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Biological Systems Movement Research Laboratory, Pistoia Italy
| | - Francesco Ferrarello
- Department of Functional Rehabilitation Activities, Azienda USL Toscana Centro, c/o CSS Giovannini, Prato, Italy
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4
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Allgood JE, Bittner GD, Bushman JS. Repair and regeneration of peripheral nerve injuries that ablate branch points. Neural Regen Res 2023; 18:2564-2568. [PMID: 37449590 DOI: 10.4103/1673-5374.373679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
The peripheral nervous system has an extensive branching organization, and peripheral nerve injuries that ablate branch points present a complex challenge for clinical repair. Ablations of linear segments of the PNS have been extensively studied and routinely treated with autografts, acellular nerve allografts, conduits, wraps, and nerve transfers. In contrast, segmental-loss peripheral nerve injuries, in which one or more branch points are ablated so that there are three or more nerve endings, present additional complications that have not been rigorously studied or documented. This review discusses: (1) the branched anatomy of the peripheral nervous system, (2) case reports describing how peripheral nerve injuries with branched ablations have been surgically managed, (3) factors known to influence regeneration through branched nerve structures, (4) techniques and models of branched peripheral nerve injuries in animal models, and (5) conclusions regarding outcome measures and studies needed to improve understanding of regeneration through ablated branched structures of the peripheral nervous system.
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Affiliation(s)
- JuliAnne E Allgood
- Division of Pharmaceutical Sciences, University of Wyoming, Laramie, WY, USA
| | - George D Bittner
- Department of Neuroscience, The University of Texas at Austin, Austin, TX, USA
| | - Jared S Bushman
- Division of Pharmaceutical Sciences, University of Wyoming, Laramie, WY, USA
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5
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Aleemardani M, Zare P, Seifalian A, Bagher Z, Seifalian AM. Graphene-Based Materials Prove to Be a Promising Candidate for Nerve Regeneration Following Peripheral Nerve Injury. Biomedicines 2021; 10:73. [PMID: 35052753 PMCID: PMC8773001 DOI: 10.3390/biomedicines10010073] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/16/2022] Open
Abstract
Peripheral nerve injury is a common medical condition that has a great impact on patient quality of life. Currently, surgical management is considered to be a gold standard first-line treatment; however, is often not successful and requires further surgical procedures. Commercially available FDA- and CE-approved decellularized nerve conduits offer considerable benefits to patients suffering from a completely transected nerve but they fail to support neural regeneration in gaps > 30 mm. To address this unmet clinical need, current research is focused on biomaterial-based therapies to regenerate dysfunctional neural tissues, specifically damaged peripheral nerve, and spinal cord. Recently, attention has been paid to the capability of graphene-based materials (GBMs) to develop bifunctional scaffolds for promoting nerve regeneration, often via supporting enhanced neural differentiation. The unique features of GBMs have been applied to fabricate an electroactive conductive surface in order to direct stem cells and improve neural proliferation and differentiation. The use of GBMs for nerve tissue engineering (NTE) is considered an emerging technology bringing hope to peripheral nerve injury repair, with some products already in preclinical stages. This review assesses the last six years of research in the field of GBMs application in NTE, focusing on the fabrication and effects of GBMs for neurogenesis in various scaffold forms, including electrospun fibres, films, hydrogels, foams, 3D printing, and bioprinting.
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Affiliation(s)
- Mina Aleemardani
- Biomaterials and Tissue Engineering Group, Department of Materials Science and Engineering, Kroto Research Institute, The University of Sheffield, Sheffield S3 7HQ, UK;
| | - Pariya Zare
- Department of Chemical Engineering, University of Tehran, Tehran 1417935840, Iran;
| | - Amelia Seifalian
- Department of Surgery and Cancer, Imperial College London, London W12 0NN, UK;
| | - Zohreh Bagher
- ENT and Head and Neck Research Centre, Hazrat Rasoul Akram Hospital, The Five Senses Health Institute, Iran University of Medical Sciences, Tehran 16844, Iran
| | - Alexander M. Seifalian
- Nanotechnology and Regenerative Medicine Commercialization Centre (NanoRegMed Ltd.), London BioScience Innovation Centre, London NW1 0NH, UK
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6
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McGillivray MK, Haldane C, Doherty C, Berger MJ. Evaluation of muscle strength following peripheral nerve surgery: A scoping review. PM R 2021; 14:383-394. [PMID: 33751851 DOI: 10.1002/pmrj.12586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 12/14/2022]
Abstract
Peripheral nerve injury (PNI) can result in devastating loss of function, often with poor long-term prognosis. Increased use of peripheral nerve surgical techniques (eg, nerve transfer, nerve grafting, and nerve repair) has resulted in improved muscle strength and other functional outcomes in patients with PNI. Muscle strength has largely been evaluated with the British Medical Research Council (MRC) scale. MRC is convenient to use in clinical settings, but more robust measures of muscle function are necessary to fully elucidate patient recovery. This scoping review aims to examine alternative instruments used to assess muscle function in studies of peripheral nerve surgery for PNI of the upper and lower limbs. A scoping review was conducted using Ovid MEDLINE, CINAHL, EMBASE, and PubMed databases in May and December of 2020, yielding a total of 20 studies pertaining to the review question. Studies pertaining to handheld dynamometry, grip and pinch dynamometry, Rotterdam Intrinsic Hand Myometers, isokinetic dynamometry, ultrasonography, and electromyography were reviewed. We provide a synopsis of each method and current clinical applications and discuss potential benefits, disadvantages, and areas of future research.
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Affiliation(s)
- Meghan K McGillivray
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chloe Haldane
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Doherty
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael J Berger
- International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada.,Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
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7
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Amini S, Salehi H, Setayeshmehr M, Ghorbani M. Natural and synthetic polymeric scaffolds used in peripheral nerve tissue engineering: Advantages and disadvantages. POLYM ADVAN TECHNOL 2021. [DOI: 10.1002/pat.5263] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Shahram Amini
- Department of Anatomical Sciences and Molecular Biology, School of Medicine Isfahan University of Medical Sciences hezarjerib Isfahan Iran
- Student Research Committee Baqiyatallah University of Medical Sciences Tehran Iran
| | - Hossein Salehi
- Department of Anatomical Sciences and Molecular Biology, School of Medicine Isfahan University of Medical Sciences hezarjerib Isfahan Iran
| | - Mohsen Setayeshmehr
- Department of Biomaterials, Tissue Engineering and Nanotechnology, School of Advanced Technologies in Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Masoud Ghorbani
- Applied Biotechnology Research Center Baqiyatallah University of Medical Sciences Tehran Iran
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8
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Effective decellularization of human nerve matrix for regenerative medicine with a novel protocol. Cell Tissue Res 2021; 384:167-177. [PMID: 33471198 DOI: 10.1007/s00441-020-03317-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 09/30/2020] [Indexed: 01/10/2023]
Abstract
Injuries to the peripheral nerves represent a frequent cause of permanent disability in adults. The repair of large nerve lesions involves the use of autografts, but they have several inherent limitations. Overcoming these limitations, the use of decellularized nerve matrix has emerged as a promising treatment in tissue regenerative medicine. Here, we generate longer human decellularized nerve segments with a novel decellularization method, using nonionic, zwitterionic, and enzymatic incubations. Efficiency of decellularization was measured by DNA quantification and cell remnant analysis (myelin, S100, neurofilament). The evaluation of the extracellular matrix (collagen, laminin, and glycosaminoglycans) preservation was carried out by enzyme-linked immunosorbent assay (ELISA) or biochemical methods, along with histological and immunofluorescence analysis. Moreover, biomechanical properties and cytocompatibility were tested. Results showed that the decellularized nerves generated with this protocol have a concentration of DNA below the threshold of 50 ng/mg of dry tissue. Furthermore, myelin, S100, and MHCII proteins were absent, although some neurofilament remnants could be observed. Moreover, extracellular matrix proteins were well maintained, as well as the biomechanical properties, and the decellularized nerve matrix did not generate cytotoxicity. These results show that our method is effective for the generation of decellularized human nerve grafts. The generation of longer decellularized nerve segments would allow the understanding of the regenerative neurobiology after nerve injuries in both clinical assays and bigger animal models. Effective decellularization of human nerve matrix for regenerative medicine with a novel protocol. Combination of zwitterionic, non-ionic detergents, hyperosmotic solution and nuclease enzyme treatment remove cell remnants, maintain collagen, laminin and biomechanics without generating cytotoxic leachables.
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9
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Elfayoumy NM, Elgendy HH, Saad MSA, Labib AA. Role of nerve ultrasound versus electrophysiological studies in the evaluation of nerve injuries. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00166-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
High-resolution ultrasonography (US) is a non-invasive, readily applicable imaging modality capable of depicting real-time static and dynamic information concerning the peripheral nerves and their surrounding tissues. Although electrophysiological studies are the gold standard in the evaluation of nerve injuries, US can be used also to evaluate the morphological changes of nerve injuries.
Objectives
To evaluate the role of the high-resolution US in the assessment of nerve injuries and to compare it to the role of electrodiagnostic studies.
Subjects and methods
A total of 30 nerves from 22 consecutive patients with clinically definite nerve injury were considered. Two independent and blinded clinicians perform electrodiagnosis and US. The clinical, neurophysiological, and US findings were collected, and the contribution of US was then classified as “ contributive” or “non-contributive”, according to whether US confirmed the clinical and neurophysiological diagnosis or not.
Results
US was “contributive” (confirming the electrophysiological diagnosis) in 66.67% of cases (n = 20), providing information about continuity of the nerve, morphological changes after injury as swelling, scar tissue formation, or neuroma formation with sensitivity of 75% compared to the electrodiagnostic studies and accuracy of 66.67%.
Conclusion
Ultrasound can be used, when available, as a complementary tool for electrodiagnostic studies to provide anatomical information about the injured nerves in case of complete axonal lesion.
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10
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Perspectives on 3D Bioprinting of Peripheral Nerve Conduits. Int J Mol Sci 2020; 21:ijms21165792. [PMID: 32806758 PMCID: PMC7461058 DOI: 10.3390/ijms21165792] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/28/2020] [Accepted: 08/10/2020] [Indexed: 12/25/2022] Open
Abstract
The peripheral nervous system controls the functions of sensation, movement and motor coordination of the body. Peripheral nerves can get damaged easily by trauma or neurodegenerative diseases. The injury can cause a devastating effect on the affected individual and his aides. Treatment modalities include anti-inflammatory medications, physiotherapy, surgery, nerve grafting and rehabilitation. 3D bioprinted peripheral nerve conduits serve as nerve grafts to fill the gaps of severed nerve bodies. The application of induced pluripotent stem cells, its derivatives and bioprinting are important techniques that come in handy while making living peripheral nerve conduits. The design of nerve conduits and bioprinting require comprehensive information on neural architecture, type of injury, neural supporting cells, scaffold materials to use, neural growth factors to add and to streamline the mechanical properties of the conduit. This paper gives a perspective on the factors to consider while bioprinting the peripheral nerve conduits.
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11
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Zheng F, Li R, He Q, Koral K, Tao J, Fan L, Xiang R, Ma J, Wang N, Yin Y, Huang Z, Xu P, Xu H. The electrostimulation and scar inhibition effect of chitosan/oxidized hydroxyethyl cellulose/reduced graphene oxide/asiaticoside liposome based hydrogel on peripheral nerve regeneration in vitro. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 109:110560. [PMID: 32228996 DOI: 10.1016/j.msec.2019.110560] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/22/2019] [Accepted: 12/14/2019] [Indexed: 10/25/2022]
Abstract
The application of hollow nerve conduits in the repair of peripheral nerve defects is effected by inferior recovery, and nerve extension is hampered by the scar tissue generated during the repair process. In this study, the filler in hollow nerve conduit, chitosan/oxidized hydroxyethyl cellulose (CS/OHEC) hydrogel loaded asiaticoside liposome and the conductive reduced graphene oxide (rGO) were developed and used to reform the microenvironment for peripheral nerve regeneration. The physiochemical properties of CS/OHEC/rGO/asiaticoside liposome hydrogel were characterized by Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and compressive modulus, porosity, swelling ratio, degradation and conductivity. In addition, the asiaticoside release profiles in vitro were investigated. The hydrogel had a continuous porous network structure with pore size distribution in the range of 50-250 μm. The majority of the hydrogels had porosities above 70%, and a compressive modulus of 0.45 MPa. The weight loss rate of hydrogel reached 76.14 ± 4.45% within 8 weeks. The conductivity of the hydrogel was 5.27 ± 0.42 × 10-4 S/cm. The hydrogel was non-toxic and suitable for adhesion and proliferation of nerve cells in vitro. In addition, the application of electrical stimulation after the addition of rGO can promote the differentiation and proliferation of nerve cells, accelerating nerve regeneration. The asiaticoside released from the hydrogel had a significant inhibitory effect on the growth and collagen secretion of fibroblasts, eliminating scars for regenerative nerves, which can promote the function recovery of defected peripheral nerve. Together, these positive results indicate that the hydrogel would be a promising candidate for peripheral nerve regeneration.
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Affiliation(s)
- Furong Zheng
- Department of Pharmaceutical Engineering, School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan 430070, China
| | - Rui Li
- Department of Pharmaceutical Engineering, School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan 430070, China
| | - Qundi He
- Wuhan Mafangshan Middle School, Wuhan 430070, China
| | - Kelly Koral
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Junyan Tao
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lihong Fan
- Department of Pharmaceutical Engineering, School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan 430070, China
| | - Runzhi Xiang
- Department of Pharmaceutical Engineering, School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan 430070, China
| | - Jingyao Ma
- Department of Pharmaceutical Engineering, School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan 430070, China
| | - Na Wang
- Department of Pharmaceutical Engineering, School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan 430070, China
| | - Yixia Yin
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan 430070, China
| | - Zhijun Huang
- Department of Pharmaceutical Engineering, School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan 430070, China
| | - Peihu Xu
- Department of Pharmaceutical Engineering, School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan 430070, China.
| | - Haixing Xu
- Department of Pharmaceutical Engineering, School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, Wuhan 430070, China; Wuhan Kanghua Century Pharmaceutical Limited Company, Wuhan 430070, China.
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Electromyographic Biofeedback in Motor Function Recovery After Peripheral Nerve Injury: An Integrative Review of the Literature. Appl Psychophysiol Biofeedback 2019; 43:247-257. [PMID: 30168003 DOI: 10.1007/s10484-018-9403-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Electromyographic biofeedback (EMG-BF) has been applied to treat different types of peripheral nerve injuries (PNI). However, despite the clinical practice widespread use its evidence is controversial. With the objective of summarize the available evidence on the electromyographic biofeedback effectiveness and efficacy to help motor function recovery after PNI an integrative review was performed. A secondary objective was to identify the conceptual framework and strategies of EMG-BF intervention, and the quality of technical description of EMG-BF procedures. To conduct this integrative review a systematic search of the literature was performed between October 2013 and July 2018, in PUBMED, ISI and COCHRANE databases for EMG-BF original studies in PNI patients of any etiology, in English, Portuguese, Spanish or French, published after 1990. Exclusion criteria were poor description of EMG-BF treatment, associated treatment that could impair EMG-BF effect, inclusion of non-PNI individuals and case studies design. The PEDro scale was used to evaluate study quality of randomized clinical trials (RCTs) included. This resulted in 71 potential articles enrolled to full reading, although only nine matched the inclusion criteria. PNI included facial paralysis, acute sciatic inflammation and carpal tunnel syndrome. The average quality score of the included RCTs was five, corresponding to low methodological quality. Due to the small number of included articles, low quality studies and heterogeneity of interventions, outcomes and population we concluded that there is limited evidence of EMG-BF effectiveness and efficacy for motor function recovery in PNI patients.
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Boni R, Ali A, Shavandi A, Clarkson AN. Current and novel polymeric biomaterials for neural tissue engineering. J Biomed Sci 2018; 25:90. [PMID: 30572957 PMCID: PMC6300901 DOI: 10.1186/s12929-018-0491-8] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022] Open
Abstract
The nervous system is a crucial component of the body and damages to this system, either by of injury or disease, can result in serious or potentially lethal consequences. Restoring the damaged nervous system is a great challenge due to the complex physiology system and limited regenerative capacity.Polymers, either synthetic or natural in origin, have been extensively evaluated as a solution for restoring functions in damaged neural tissues. Polymers offer a wide range of versatility, in particular regarding shape and mechanical characteristics, and their biocompatibility is unmatched by other biomaterials, such as metals and ceramics. Several studies have shown that polymers can be shaped into suitable support structures, including nerve conduits, scaffolds, and electrospun matrices, capable of improving the regeneration of damaged neural tissues. In general, natural polymers offer the advantage of better biocompatibility and bioactivity, while synthetic or non-natural polymers have better mechanical properties and structural stability. Often, combinations of the two allow for the development of polymeric conduits able to mimic the native physiological environment of healthy neural tissues and, consequently, regulate cell behaviour and support the regeneration of injured nervous tissues.Currently, most of neural tissue engineering applications are in pre-clinical study, in particular for use in the central nervous system, however collagen polymer conduits aimed at regeneration of peripheral nerves have already been successfully tested in clinical trials.This review highlights different types of natural and synthetic polymers used in neural tissue engineering and their advantages and disadvantages for neural regeneration.
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Affiliation(s)
- Rossana Boni
- Bioengineering Research Team, Centre for Bioengineering and Nanomedicine, Department of Food Science, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Azam Ali
- Bioengineering Research Team, Centre for Bioengineering and Nanomedicine, Department of Food Science, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Amin Shavandi
- Bioengineering Research Team, Centre for Bioengineering and Nanomedicine, Department of Food Science, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
- BioMatter-Biomass Transformation Lab (BTL), École interfacultaire de Bioingénieurs (EIB), École polytechnique de Bruxelles, Université Libre de Bruxelles, Avenue F.D. Roosevelt, 50 - CP 165/61, 1050 Brussels, Belgium
| | - Andrew N. Clarkson
- Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
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14
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Kowalska J, Grabowski R, Pigonska J, Domzalski M. Management of an iatrogenic injury to the tibial nerve in a 24-year-old hurdle runner. J Int Med Res 2018; 46:3394-3403. [PMID: 29996692 PMCID: PMC6134643 DOI: 10.1177/0300060518776061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 04/16/2018] [Indexed: 01/12/2023] Open
Abstract
According to previously published papers, neurovascular injuries seem to be the most unfortunate complications after surgical procedures. In this report, we present our therapeutic approach to iatrogenic injury of the posterior tibial nerve that occurred during ankle arthroscopy in a 24-year-old patient. The outcome of the therapy was a full sensory return and partial motor return (S4 and M3 according to the Medical Research Council Grading System for Nerve Recovery). Our patient was able to resume her typical training. In comparison with available reports, our therapeutic approach enabled earlier functional recovery after nerve injury. While sensory return is beneficial, motor improvement is also important. However, we are conscious of the poor functional outcomes reported by other researchers.
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Affiliation(s)
- Joanna Kowalska
- Orthopedic and Trauma Department, Veteran's Memorial Teaching Hospital, Medical University of Lodz, Lodz, Poland
- Sporto Clinic, Lodz, Poland
| | - Radoslaw Grabowski
- Orthopedic and Trauma Department, Veteran's Memorial Teaching Hospital, Medical University of Lodz, Lodz, Poland
- Sporto Clinic, Lodz, Poland
| | - Justyna Pigonska
- Clinical Department of Neurology, Central Clinical Hospital of Ministry of the Interior and Administration in Warsaw, Warsaw, Poland
- Sporto Clinic, Lodz, Poland
| | - Marcin Domzalski
- Orthopedic and Trauma Department, Veteran's Memorial Teaching Hospital, Medical University of Lodz, Lodz, Poland
- Sporto Clinic, Lodz, Poland
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Downs ME, Lee SA, Yang G, Kim S, Wang Q, Konofagou EE. Non-invasive peripheral nerve stimulation via focused ultrasound in vivo. Phys Med Biol 2018; 63:035011. [PMID: 29214985 DOI: 10.1088/1361-6560/aa9fc2] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Focused ultrasound (FUS) has been employed on a wide range of clinical applications to safely and non-invasively achieve desired effects that have previously required invasive and lengthy procedures with conventional methods. Conventional electrical neuromodulation therapies that are applied to the peripheral nervous system (PNS) are invasive and/or non-specific. Recently, focused ultrasound has demonstrated the ability to modulate the central nervous system and ex vivo peripheral neurons. Here, for the first time, noninvasive stimulation of the sciatic nerve eliciting a physiological response in vivo is demonstrated with FUS. FUS was applied on the sciatic nerve in mice with simultaneous electromyography (EMG) on the tibialis anterior muscle. EMG signals were detected during or directly after ultrasound stimulation along with observable muscle contraction of the hind limb. Transecting the sciatic nerve downstream of FUS stimulation eliminated EMG activity during FUS stimulation. Peak-to-peak EMG response amplitudes and latency were found to be comparable to conventional electrical stimulation methods. Histology along with behavioral and thermal testing did not indicate damage to the nerve or surrounding regions. The findings presented herein demonstrate that FUS can serve as a targeted, safe and non-invasive alternative to conventional peripheral nervous system stimulation to treat peripheral neuropathic diseases in the clinic.
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Affiliation(s)
- Matthew E Downs
- Departments of Biomedical Engineering, Columbia University, New York, NY 10032, United States of America
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Diogo CC, Camassa JA, Pereira JE, Costa LMD, Filipe V, Couto PA, Geuna S, Maurício AC, Varejão AS. The use of sheep as a model for studying peripheral nerve regeneration following nerve injury: review of the literature. Neurol Res 2017; 39:926-939. [DOI: 10.1080/01616412.2017.1331873] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Camila Cardoso Diogo
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | - José Arthur Camassa
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | - José Eduardo Pereira
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- CECAV, Centre for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Luís Maltez da Costa
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- CECAV, Centre for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Vítor Filipe
- Department of Engineering, School of Science and Technology, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- INESC TEC, Porto, Portugal
| | - Pedro Alexandre Couto
- Department of Engineering, School of Science and Technology, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- CITAB, Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Ana Colette Maurício
- Department of Veterinary Clinics, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Porto, Portugal
- Animal Science and Study Centre (CECA), Food and Agrarian Sciences and Technologies Institute (ICETA), University of Porto, Porto, Portugal
| | - Artur Severo Varejão
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- CECAV, Centre for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
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