Incidence, Risk Factors, and Trends of Motor Peripheral Nerve Injury After Colorectal Surgery: Analysis of the National Surgical Quality Improvement Program Database

The dual roles of chemokines in peripheral nerve injury and repair

Peripheral nerve injuries (PNI) occur in approximately 13-23 per 100,000 individuals, predominantly affecting young and middle-aged adults. These injuries often require a lengthy recovery period, placing substantial burdens on healthcare systems and national economies. Current treatment strategies have not significantly shortened this lengthy regenerative process, highlighting the urgent need for innovative therapeutic interventions. Chemokines were originally noted for their powerful ability to recruit immune cells; however, as research has advanced, it has become increasingly evident that their role in peripheral nerve repair has been underestimated. In this review, we provide the first comprehensive overview of chemokine expression and activity during peripheral nerve injury and regeneration. We summarize the existing literature on chemokine family members, detailing their expression patterns and localization in injured nerves to facilitate further mechanistic investigations. For chemokines that remain controversial, such as CXCL1 and CCL2, we critically examine experimental methodologies and discuss factors underlying conflicting results, ultimately affirming their contributions to promoting nerve repair. Importantly, we highlight the dual nature of chemokines: in the early stages of injury, they initiate reparative responses, activate Schwann cells, regulate Wallerian degeneration, and support nerve recovery; but when the axons are connected and the repair enters the later stages, their persistent proinflammatory effects during later stages may impede the healing process. Additionally, we emphasize that certain chemokines, including CXCL5, CXCL12, and CCL2, can act directly on neurons/axons, thereby accelerating axonal regeneration. Future research should focus on precisely mapping the localization and temporal expression profiles of these chemokines and exploring therapeutic approaches.

Advances in tissue engineering of peripheral nerve and tissue innervation - a systematic review

Although various options are available to treat injured organs and peripheral nerves, none is without limitations. Auto- and allografts are the first choice of treatment, but tissue survival or functionality is not guaranteed due to often limited vascular and neural networks. In response, tissue-engineered solutions have been developed, yet clinical translations is rare. In this study, a systematic review was performed on tissue-engineered advancements for peripheral nerves and tissues, to aid future developments in bridging the gap toward the clinic by identifying high-potential solutions and unexplored areas. A systematic search was performed in PubMed, Embase, Web of Science, and Scopus until November 9, 2023. Search terms involved "tissue engineering," "guided," "tissue scaffold," and "tissue graft," together with "innervation" and "reinnervation." Original in vivo or in vitro studies meeting the inclusion criteria (tissue-engineered peripheral nerve/innervation of tissue) and no exclusion criteria (no full text available; written in foreign language; nonoriginal article; tissue-engineering of central nervous system; publication before 2012; insufficient study quality or reproducibility) were assessed. A total of 68 out of 3626 original studies were included. Data extraction was based on disease model, cell origin and host species, biomaterial nature and composition, and external stimuli of biological, chemical or physical origin. Although tissue engineering is still in its infancy, explored innervation strategies of today were highlighted with respect to biomaterials, cell types, and external stimuli. The findings emphasize that natural biomaterials, pre-seeding with autologous cell sources, and solutions for reproductive organs are beneficial for future research. Natural biomaterials possess important cues required for cell-material interaction and closely resemble native tissue in terms of biomechanical, geometrical and chemical composition. Autologous cells induce biomaterial functionalization. As these solutions pose no risk of immunorejection and have demonstrated good outcomes, they are most likely to fulfill the clinical demands.

Factors Associated With Peripheral Nerve Injury After Pelvic Laparoscopy: The Importance of Surgical Positioning

BACKGROUND

Nerve damage after abdominal and pelvic surgery is rare but potentially serious. The incidence of peripheral nerve injury is difficult to assess, and rates of between 0.02% and 21% have been cited in the literature. Signs and symptoms of this type of injury may appear immediately after surgery or a few days later.

PURPOSE

This study was developed to assess the rate of peripheral nerve injury after pelvic laparoscopy and to identify associated risk factors.

METHODS

A pilot prospective cohort study was conducted between March 2018 and April 2019 on 101 patients with a 1-month follow-up using two semistructured clinical interviews. We carried out a descriptive analysis followed by univariable and multivariable logistic regression analyses.

RESULTS

Thirteen patients were found to have peripheral nerve injuries, representing a rate of 12.9%. Overall, 14 injuries (five severe and nine mild) were detected. One patient had two mild injuries. In this study, the risk of injury was found to increase 1.77-fold (OR = 1.77, 95% CI [1.13, 2.76], p = .007) for each hour the patient was in the Trendelenburg position.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The longer the patient is in the Trendelenburg position, the greater the risk of peripheral nerve damage. Patients aged 60 years or less also face a higher risk of nerve injury.

Research Hotspots and Trends of Peripheral Nerve Injuries Based on Web of Science From 2017 to 2021: A Bibliometric Analysis

Background

Peripheral nerve injury (PNI) is very common in clinical practice, which often reduces the quality of life of patients and imposes a serious medical burden on society. However, to date, there have been no bibliometric analyses of the PNI field from 2017 to 2021. This study aimed to provide a comprehensive overview of the current state of research and frontier trends in the field of PNI research from a bibliometric perspective.

Methods

Articles and reviews on PNI from 2017 to 2021 were extracted from the Web of Science database. An online bibliometric platform, CiteSpace, and VOSviewer software were used to generate viewable views and perform co-occurrence analysis, co-citation analysis, and burst analysis. The quantitative indicators such as the number of publications, citation frequency, h-index, and impact factor of journals were analyzed by using the functions of “Create Citation Report” and “Journal Citation Reports” in Web of Science Database and Excel software.

Results

A total of 4,993 papers was identified. The number of annual publications in the field remained high, with an average of more than 998 publications per year. The number of citations increased year by year, with a high number of 22,272 citations in 2021. The United States and China had significant influence in the field. Johns Hopkins University, USA had a leading position in this field. JESSEN KR and JOURNAL OF NEUROSCIENCE were the most influential authors and journals in the field, respectively. Meanwhile, we found that hot topics in the field of PNI focused on dorsal root ganglion (DRG) and satellite glial cells (SGCs) for neuropathic pain relief and on combining tissue engineering techniques and controlling the repair Schwann cell phenotype to promote nerve regeneration, which are not only the focus of research now but is also forecast to be of continued focus in the future.

Conclusion

This is the first study to conduct a comprehensive bibliometric analysis of publications related to PNI from 2017 to 2021, whose bibliometric results can provide a reliable source for researchers to quickly understand key information in this field and identify potential research frontiers and hot directions.

Position-Related Postoperative Peripheral Neuropathy After Laparoscopic Colorectal Surgery: A Comparative Single-Center Prospective Cohort Study

Background: Laparoscopic colorectal surgery requires perioperative positioning in the dorsal lithotomy position and intermittent Trendelenburg position. This position is associated with postoperative peripheral neuropathy (PPN), which is a substantial cause of anesthesia-related claims. The objective of this study was to assess the incidence of PPN of patients positioned in lithotomy position with shoulder braces, and second to compare this group with patients positioned on the foam mattress Pink Pad^®. Materials and Methods: This consecutive single-center prospective cohort study of 155 patients undergoing colorectal surgery was performed between November 2014 and June 2015. After initial results the implementation of the Pink Pad took place and a total of 52 patients were included between May 2016 and February 2017 to compare the two groups. Results: Positioning with the shoulder brace regimen during laparoscopic colorectal surgery was related to the development of PPN in 33% of cases, as opposed to 15% with Pink Pad. Positioning with shoulder braces increased the risk of PPN with an odds ratio of 3.14 (95% confidence interval: 1.10-8.992) when compared with positioning on Pink Pad. Conclusion: Position-related PPN is an important complication after laparoscopic colorectal surgery. This study concludes that careful attention should be paid to positioning and favors Pink Pad over positioning with shoulder braces. Prolonged time in anesthesia is a predictor of PPN. Clinical Trial Number: H-2-2014-FSP75.

Anesthesia for the Morbidly Obese Patient

Obesity is considered a major comorbidity, and it is imperative for an anesthesiologist to put increased emphasis on preoperative evaluation and perioperative management. A multidisciplinary team approach is the key for a successful outcome. This article encompasses basic tenets like pathophysiology and pharmacology pertaining to obesity. The authors also talk about important aspects of anesthesia care starting from preoperative assessment and optimization, intraoperative challenges and care, to recovery and discharge of these patients.

Mechanisms and treatment of painful neuromas

A painful neuroma is a common complication of a peripheral nerve injury or amputation, and it can cause tremendous pain that is resistant to most analgesics. Furthermore, painful neuromas have a high postoperative recurrence rate. Painful neuromas are often accompanied by functional disorders, drastically reducing the patient’s quality of life. Several pathophysiological mechanisms have been proposed to explain this type of neuropathic pain, including peripheral and central sensitisation and the involvement of nerve growth factor, α-smooth muscle actin, the cannabinoid CB2 receptor and structural changes in neuroma fibres. Nevertheless, the mechanisms of neuroma-associated pain are not fully understood, contributing to the challenge of managing patients with painful neuromas. There are several effective treatment methods, although none are universally accepted. This review summarises the common mechanisms and treatments of painful neuromas, attempting to link the mechanisms and treatments. We hope to provide useful guidelines for choosing the appropriate treatment for the management of painful neuromas.

Perioperative management of the obese surgical patient

INTRODUCTION

The escalation in the prevalence of obesity throughout the world has led to an upsurge in the number of obese surgical patients to whom perioperative care needs to be delivered.

SOURCES OF DATA

After determining the scope of the review, the authors used PubMed with select phrases encompassing the words in the scope. Both preclinical and clinical reports were considered.

AREAS OF AGREEMENT

There were no controversies regarding preoperative management and the intraoperative care of the obese surgical patient.

AREAS OF CONTROVERSY

Is there a healthy obese state that gives rise to the obesity paradox regarding postoperative complications?

GROWING POINTS

This review considers how to prepare for and manage the obese surgical patient through the entire spectrum, from preoperative assessment to possible postoperative intensive care.

AREAS TIMELY FOR DEVELOPING RESEARCH

What results in an obese patient developing 'unhealthy' obesity?