Effect of aerobic exercise on innate immune responses and inflammatory mediators in the spinal cord of diabetic rats

Neuronal inflammation is one of the pathophysiological causes of diabetes neuropathic pain. The purpose of this research was to determine the effect of aerobic exercise on innate immune responses and inflammatory mediators in the spinal dorsal horn in rats with diabetic neuropathic pain. 40 eight-week-old male Wistar rats (weight range 220±10.2 g) were randomly divided into four groups of (1) sedentary diabetic neuropathy (SDN), (2) training diabetic neuropathy (TDN), (3) training control (TC), and (4) sedentary control (SC). Diabetes was induced by injection of streptozocin (50 mg/kg). Following confirmation of behavioural tests for diabetes neuropathy, the training groups performed 6 weeks of moderate-intensity aerobic exercise on the treadmill. The expression of Toll like receptor (TLR)4, TLR2, tumour necrosis factor (TNF)-α, interleukin (IL)-1β and IL-10 genes in L4-L6 spinal cord sensory neurons was measured by Real Time PCR. Two-way ANOVA and Bonferroni’s post hoc tests were used for statistical analysis. After performing aerobic exercise protocol, the TDN compared to the SDN showed a significant decrease in the mean score of pain in the formalin test and a significant increase in the latency in Tail-Flick test was observed. The expression of TLR4, TLR2, TNF-α and IL-1β genes was significantly higher in the SDN than in the SC group (P<0.05). The expression of the above genes in the TDN was significantly lower than the SDN group (P<0.05). Also, the expression level of IL-10 gene was significantly higher in the TDN than the SDN group (P<0.05). Aerobic exercise improved sensitivity of nociceptors to pain-inducing agents in diabetic neuropathy due to inhibition of inflammatory receptors and increased levels of anti-inflammatory agents in the nervous system. Thus, aerobic exercise should be used as a non-pharmacological intervention for diabetic patients to reduce neuropathic pain.

Optimizing the modified laparoscopic Vecchietti procedure

OBJECTIVE

To enhance the modified laparoscopic Vecchietti procedure.

MATERIALS AND METHODS

A case series of five women with Mayer-Rokitansky-Küster-Hauser syndrome at the Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia underwent the modified laparoscopic Vecchietti procedure with intraperitoneal placement of sutures. This involved perforation of the vaginal dimple by a straight thread guide with two threads attached to the olive followed by pulling the two threads intra-peritoneally and through the abdominal wall to the traction device by grasping instruments under laparoscopic control.

RESULTS

Intraperitoneal placement of the sutures was easily done without complications in all five women. The operative time was 50 ± 10 (mean ± SD) minutes. After five postoperative days, the average vaginal length was seven to 7.5 cm. Two women were able to have vaginal intercourse without problems. After six months to one year of follow up, the vaginal length was at least ten cm and no postoperative complications occurred.

CONCLUSIONS

Intraperitoneal placement of sutures makes the modified laparoscopic Vecchietti procedure easy and appealing. Furthermore, it avoids potential damage to the vital structures at the pelvic side walls.

Airway and respiratory management following non-lethal hanging

PURPOSE

To review the literature on airway and respiratory management following non-lethal (suicidal) hanging and to describe the anatomy, injury and pathophysiological sequelae and their impact on patient care.

SOURCE

A Medline literature search of English-language and English-abstracted papers for 1990-96. Keywords were hanging; strangulation; airway obstruction; pulmonary oedema. Filters were applied to limit the search to relevant citations. (i.e., keywords = pulmonary oedema; filters = postobstructive, neurogenic). Citations were then hand-culled to obtain current and relevant papers about an unusual cohort of patients. A hand search of the bibliographies of relevant papers supplemented the Medline search. A review of our experience at the University of Ottawa adult hospitals over the last decade was also undertaken to determine the relevance of the literature to our clinical experiences.

PRINCIPAL FINDINGS

Most victims are young men and survivors are uncommon. Laryngo-tracheal injuries, although reported in 20-50% of postmortem examinations, are infrequent in survivors and have little impact on airway management. Spinal injuries are rare in survivors but should be excluded. Pulmonary complications including pulmonary oedema and bronchopneumonia are implicated in most in-hospital deaths. Pulmonary oedema is likely due to neurogenic factors or negative intrathoracic pressure. Although neurological injury determines outcome following hanging, initial neurological presentation is of limited prognostic value: a poor initial condition does not exclude a good recovery.

CONCLUSION

Airway injuries severe enough to interfere with airway management are uncommon after attempted suicide by hanging. Irrespective of the initial neurological assessment, aggressive and early resuscitation to optimize cerebral oxygenation is recommended.