1
|
An M, Jia R, Wu L, Ma L, Qi H, Long Y. Identifying key risk factors for acute compartment syndrome in tibial diaphysis fracture patients. Sci Rep 2024; 14:8913. [PMID: 38632464 PMCID: PMC11024173 DOI: 10.1038/s41598-024-59669-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
Acute compartment syndrome (ACS) is a severe orthopedic issue that, if left untreated, can result in lasting nerve and muscle damage or even necessitate amputation. The association between admission laboratory blood test indicators and the occurrence of ACS in patients with tibial diaphysis fractures is currently a subject of debate. The objective of this research was to identify the contributing factors for ACS in individuals suffering from tibial diaphysis fractures. In this retrospective study, we collected data on a total of 705 individuals from our hospital, comprising 86 ACS patients and 619 non-ACS patients with tibial diaphysis fractures. These participants were categorized into two distinct groups: the ACS group and the non-ACS group. Despite the inherent limitations associated with retrospective analyses, such as potential biases in data collection and interpretation, we conducted a comprehensive analysis of demographics, comorbidities, and admission lab results. Our analytical approach included univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis techniques, aiming to mitigate these limitations and provide robust findings. The statistical analysis revealed several predictors of ACS, including gender (p = 0.011, OR = 3.200), crush injuries (p = 0.004, OR = 4.622), lactic dehydrogenase (LDH) levels (p < 0.001, OR = 1.003), and white blood cell (WBC) count (p < 0.001, OR = 1.246). Interestingly, the study also found that certain factors, such as falls on the same level (p = 0.007, OR = 0.334) and cholinesterase (CHE) levels (p < 0.001, OR = 0.721), seem to provide a degree of protection against ACS. In order to better predict ACS, the ROC curve analysis was employed, which determined threshold values for LDH and WBC. The established cut-off points were set at 266.26 U/L for LDH and 11.7 × 109 cells per liter for WBC, respectively. Our research has successfully pinpointed gender, crush injuries, LDH levels, and white blood cell (WBC) count as crucial risk factors for the development of ACS in patients experiencing tibial diaphysis fractures. Furthermore, by establishing the cut-off values for LDH and WBC, we have facilitated a more personalized assessment of ACS risk, enabling clinical doctors to implement targeted early interventions and optimize patient outcomes.
Collapse
Affiliation(s)
- Ming An
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China
| | - Ruili Jia
- Department of Nephrology, The First Central Hospital of Baoding, Baoding, 071000, China
| | - Limei Wu
- Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, 050000, China
| | - Leilei Ma
- Department of Burns and Plastic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Hui Qi
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China.
| | - Yubin Long
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China.
| |
Collapse
|
2
|
Cao XX, Zhang YL, Zhao SQ, Zhang Q, Chi ZL. [Clinical efficacy of posterior femoral muscle flaps combined with posterior femoral cutaneous nerve nutrient vessel flap and closed lavage in the treatment of stage Ⅳ ischial tuberosity pressure ulcers]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2024; 40:159-164. [PMID: 38418177 DOI: 10.3760/cma.j.cn501225-20231017-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Objective: To explore the clinical efficacy of posterior femoral muscle flaps combined with posterior femoral cutaneous nerve nutrient vessel flap and closed lavage in the treatment of stage Ⅳ ischial tuberosity pressure ulcers. Methods: This study was a retrospective observational study. From March 2021 to March 2022, 15 patients with stage Ⅳ ischial tuberosity pressure ulcers who met the inclusion criteria were admitted to Dezhou Dongcheng Hospital, including 11 males and 4 females, aged 31 to 72 years. The pressure ulcer wound size ranged from 6.0 cm×4.5 cm to 10.0 cm×6.0 cm, with cavity diameters of 10-14 cm. Five cases were complicated with ischial tuberosity bone infection. After clearing the lesion, the biceps femoris long head muscle flap with an area of 10.0 cm×4.0 cm-18.0 cm×5.0 cm and the semitendinosus muscle flap with an area of 8.0 cm×4.0 cm-15.0 cm×5.0 cm combined with the posterior femoral cutaneous nerve nutrient vessel flap with an area of 6.5 cm×5.5 cm-10.5 cm×6.5 cm was transplanted to repair the pressure ulcer wound. The flap donor area was directly sutured, and the closed lavage with tubes inserted into the wound cavity was performed for 2-3 weeks. The postoperative survival of the muscle flaps and skin flaps, the wound healing of the donor and recipient areas were observed. The recurrence of pressure ulcers, the appearance and texture of flaps, and scar conditions of the donor and recipient areas were followed up. Results: All the muscle flaps and skin flaps in the 15 patients successfully survived after surgery. Two patients experienced incisional dehiscence at one week after surgery due to improper turning over, during which the incision in the recipient area was pressed on, and the wounds healed after dressing changes of 3 to 4 weeks; the wounds in the donor and recipient areas healed well in the other patients. All patients received follow-up after surgery. During the follow-up period of 6 to 12 months, none of the patients experienced pressure ulcer recurrence, and the texture, color, and thickness of the skin flaps closely resembled those of the surrounding skin at the recipient site, with only linear scar left in the donor and recipient areas. Conclusions: When using the posterior femoral muscle flaps combined with the posterior femoral cutaneous nerve nutrient vessel flap and closed lavage to treat stage Ⅳ ischial tuberosity pressure ulcers, the tissue flap can be used to fully fill in the dead space of the pressure ulcers. After treatment, the wound heals well, the appearance of the donor and recipient areas is better, and the pressure ulcers are less prone to reoccur.
Collapse
Affiliation(s)
- X X Cao
- Department of Hand and Foot Microsurgery, Dezhou Dongcheng Hospital, Dezhou 253000, China
| | - Y L Zhang
- Department of Hand and Foot Microsurgery, Dezhou Dongcheng Hospital, Dezhou 253000, China
| | - S Q Zhao
- Department of Hand and Foot Microsurgery, Dezhou Dongcheng Hospital, Dezhou 253000, China
| | - Q Zhang
- Department of Hand and Foot Microsurgery, Dezhou Dongcheng Hospital, Dezhou 253000, China
| | - Z L Chi
- Repair and Reconstruction Microsurgery, Xi'an Zhongde Orthopedic Hospital, Xi'an 710043, China
| |
Collapse
|
3
|
Poirier M, Walton RAL. The successful use of a subcutaneous catheter in the management of severe subcutaneous emphysema in a dog with laryngeal crush injury and tracheostomy tube placement. J Vet Emerg Crit Care (San Antonio) 2023; 33:710-714. [PMID: 37793056 DOI: 10.1111/vec.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To describe the placement of a subcutaneous catheter in a dog for the management of severe subcutaneous emphysema secondary to severe laryngeal crushing injury and temporary tracheostomy tube placement. CASE SUMMARY A 6-year-old male neutered Kelpie suffered a severe laryngeal crushing injury following a dog attack. Case management included the placement of a temporary tracheostomy tube due to severe respiratory compromise and inspiratory dyspnea associated with the crush injury. During hospitalization, the patient developed severe subcutaneous emphysema, pneumomediastinum, and a pneumothorax as a complication of the laryngeal crushing injury and temporary tracheostomy. A subcutaneous catheter was placed to manage the recurrent subcutaneous emphysema while the tracheostomy stoma healed. Five months posttrauma, the dog returned to normal with mild stridor during excitement and while panting. NEW OR UNIQUE INFORMATION PROVIDED This is the first report in veterinary medicine describing the use of a subcutaneous catheter for the management of subcutaneous emphysema secondary to laryngeal crush injury and temporary tracheostomy tube placement.
Collapse
Affiliation(s)
- Maude Poirier
- Department of Small Animal Emergency and Critical Care, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Rebecca A L Walton
- Department of Small Animal Emergency and Critical Care, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| |
Collapse
|
4
|
Karacabay K, Savci A, Dalkılıç M, Kabu Hergül F. Determining the incidence and risk factors of medical device-related pressure injury in intensive care patients. J Tissue Viability 2023; 32:596-600. [PMID: 37607845 DOI: 10.1016/j.jtv.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/07/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
AIM This study aims to determine the incidence and risk factors of Medical Device-Related Pressure Injury (MDRPI) in Intensive Care Unit (ICU) patients. MATERIAL AND METHODS This descriptive cross-sectional study involved 300 patients who did not have an MDRPI at the time of admission to the ICU of a university hospital in Turkey. The data was collected using the Patient Information Form, the Medical Device-Related Pressure Injury Follow-Up Chart, and the Jackson/Cubbin Risk Assessment Scale. RESULTS The mean age of the patients was 71.88 ± 14.82 years old. Precisely 31% of patients were found to be at risk for pressure injuries, and MDRPI occurred in 18% of them. It was found that patients most commonly experienced stage 1 MDRPI in the hand-finger region due to pulse oximetry. It was also determined that nasal cannulas caused MDRPI the fastest. Patients with MDRPI had low Jackson/Cubbin scores, low albumin and hematocrit levels, and longer hospitalization durations (p < .05). Dependence on -respiratory support device, bedridden, and experiencing non-device-related pressure injuries were associated with MDRPI (p < .05). CONCLUSION It was found that factors causing non-device-related pressure injuries may also pose an MDRPI risk for patients in intensive care. It was also observed that devices used in ICU could cause pressure injuries even in very short periods in cases where necessary precautions are not taken. Periodic evaluation of the area the medical devices are in contact with, removal of unused devices as quickly as possible, and the use of prophylactic dressings can play an important role in preventing MDRPI.
Collapse
Affiliation(s)
- Kevser Karacabay
- Kütahya Health Sciences University, Health Sciences Faculty, Nursing Department, Germiyan Campus, Kütahya, Turkey.
| | - Ayşegül Savci
- Kütahya Health Sciences University, Health Sciences Faculty, Nursing Department, Germiyan Campus, Kütahya, Turkey.
| | - Mehmet Dalkılıç
- Kütahya Health Sciences University, Evliya Çelebi Training and Research Hospital, Kütahya, Turkey.
| | - Filiz Kabu Hergül
- Pamukkale University, Health Sciences Faculty, Nursing Department, Denizli, Turkey.
| |
Collapse
|
5
|
Ye K, Li Z, Yin Y, Zhou J, Li D, Gan Y, Peng D, Xiao M, Zhao L, Dai Y, Tang Y. LIPUS-SCs-Exo promotes peripheral nerve regeneration in cavernous nerve crush injury-induced ED rats via PI3K/Akt/FoxO signaling pathway. CNS Neurosci Ther 2023; 29:3239-3258. [PMID: 37157936 PMCID: PMC10580359 DOI: 10.1111/cns.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE Clinical treatment of erectile dysfunction (ED) caused by cavernous nerve (CN) injury during pelvic surgery is difficult. Low-intensity pulsed ultrasound (LIPUS) can be a potential strategy for neurogenic ED (NED). However, whether Schwann cells (SCs) can respond to LIPUS stimulation signals is unclear. This study aims to elucidate the signal transmission between SCs paracrine exosome (Exo) and neurons stimulated by LIPUS, as well as to analyze the role and potential mechanisms of exosomes in CN repair after injury. METHODS The major pelvic ganglion (MPG) neurons and MPG/CN explants were stimulated with LIPUS of different energy intensities to explore the appropriate LIPUS energy intensity. The exosomes were isolated and purified from LIPUS-stimulated SCs (LIPUS-SCs-Exo) and non-stimulated SCs (SCs-Exo). The effects of LIPUS-SCs-Exo on neurite outgrowth, erectile function, and cavernous penis histology were identified in bilateral cavernous nerve crush injury (BCNI)-induced ED rats. RESULTS LIPUS-SCs-Exo group can enhance the axon elongation of MPG/CN and MPG neurons compared to SCs-Exo group in vitro. Then, the LIPUS-SCs-Exo group showed a stronger ability to promote the injured CN regeneration and SCs proliferation compared to the SCs-Exo group in vivo. Furthermore, the LIPUS-SCs-Exo group increased the Max intracavernous pressure (ICP)/mean arterial pressure (MAP), lumen to parenchyma and smooth muscle to collagen ratios compared to the SCs-Exo group in vivo. Additionally, high-throughput sequencing combined with bioinformatics analysis revealed the differential expression of 1689 miRNAs between the SCs-Exo group and the LIPUS-SCs-Exo group. After LIPUS-SCs-Exo treatment, the phosphorylated levels of Phosphatidylinositol 3-kinase (PI3K), protein kinase B (Akt) and forkhead box O (FoxO) in MPG neurons increased significantly compared to negative control (NC) and SCs-Exo groups. CONCLUSION Our study revealed that LIPUS stimulation could regulate the gene of MPG neurons by changing miRNAs derived from SCs-Exo, then activating the PI3K-Akt-FoxO signal pathway to enhance nerve regeneration and restore erectile function. This study had important theoretical and practical significance for improving the NED treatment.
Collapse
Affiliation(s)
- Kun Ye
- Department of UrologyThe Fifth Affiliated Hospital of Sun Yat‐Sen UniversityZhuhaiGuangdongChina
- Guangdong Provincial Key Laboratory of Biomedical ImagingThe Fifth Affiliated Hospital, Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Zitaiyu Li
- Department of UrologyThe Fifth Affiliated Hospital of Sun Yat‐Sen UniversityZhuhaiGuangdongChina
- Guangdong Provincial Key Laboratory of Biomedical ImagingThe Fifth Affiliated Hospital, Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Yinghao Yin
- Department of UrologyThe Fifth Affiliated Hospital of Sun Yat‐Sen UniversityZhuhaiGuangdongChina
- Guangdong Provincial Key Laboratory of Biomedical ImagingThe Fifth Affiliated Hospital, Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Jun Zhou
- Department of UrologyThe Fifth Affiliated Hospital of Sun Yat‐Sen UniversityZhuhaiGuangdongChina
- Guangdong Provincial Key Laboratory of Biomedical ImagingThe Fifth Affiliated Hospital, Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Dongjie Li
- Department of UrologyXiangya Hospital, Central South UniversityChangshaChina
| | - Yu Gan
- Department of UrologyXiangya Hospital, Central South UniversityChangshaChina
| | - Dongyi Peng
- Department of UrologyThe Third Xiangya Hospital of Central South UniversityChangshaChina
| | - Ming Xiao
- Department of UrologyThe Fifth Affiliated Hospital of Sun Yat‐Sen UniversityZhuhaiGuangdongChina
- Guangdong Provincial Key Laboratory of Biomedical ImagingThe Fifth Affiliated Hospital, Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Liangyu Zhao
- Department of UrologyThe Fifth Affiliated Hospital of Sun Yat‐Sen UniversityZhuhaiGuangdongChina
- Guangdong Provincial Key Laboratory of Biomedical ImagingThe Fifth Affiliated Hospital, Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Yingbo Dai
- Department of UrologyThe Fifth Affiliated Hospital of Sun Yat‐Sen UniversityZhuhaiGuangdongChina
- Guangdong Provincial Key Laboratory of Biomedical ImagingThe Fifth Affiliated Hospital, Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Yuxin Tang
- Department of UrologyThe Fifth Affiliated Hospital of Sun Yat‐Sen UniversityZhuhaiGuangdongChina
- Guangdong Provincial Key Laboratory of Biomedical ImagingThe Fifth Affiliated Hospital, Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| |
Collapse
|
6
|
Tura İ, Arslan S, Türkmen A, Erden S. Assessment of the risk factors for intraoperative pressure injuries in patients. J Tissue Viability 2023; 32:349-354. [PMID: 37147205 DOI: 10.1016/j.jtv.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Abstract
AIM This study was conducted to assess the risk factors for pressure injuries in patients during surgery. METHODS In this descriptive cross-sectional study, the risk of pressure injuries during surgery was evaluated in 250 patients in a university hospital. Data were collected through a Patient Descriptive Information Form (PDIF) and the 3S Intraoperative Pressure Injury Risk Assessment Scale (IPIRAS). RESULTS The mean age of the patients was 44.15 ± 17.00, and 52.4% were female. In addition, it was determined that the mean 3S IPIRAS score was higher in patients who were male, were aged ≥60 years, were obese, had a chronic disease, and had low serum albumin and hemoglobin levels (p < .05). During the surgery of the patients included in the study, support surfaces were used in 67.6%, positioning aids were used in 82.4%, and 55.6% had normal skin. Patients who underwent CVS procedures for more than 6 h, did not use support surfaces during surgery, had moist skin, or used vasopressors had higher and significantly different mean 3S IPIRAS scores (p < .05). CONCLUSIONS According to the results, all surgical patients were at risk for pressure injury in the intraoperative period. In addition, it was found that male gender was associated with risk factors and that being aged ≥60 years, obesity, chronic disease, low serum hemoglobin and albumin levels, CVS, operations lasting more than 6 h, moist skin, vasopressor drugs, and not using support surfaces during surgery increased the risk of pressure injuries significantly.
Collapse
Affiliation(s)
- İlknur Tura
- "Cukurova University", Faculty of Health Sciences, Department of Nursing, Balcalı Campus, Adana, Postcode: 01380, Turkey.
| | - Sevban Arslan
- "Cukurova University", Faculty of Health Sciences, Department of Nursing, Balcalı Campus, Adana, Postcode: 01380, Turkey.
| | - Açelya Türkmen
- "Cukurova University", Faculty of Health Sciences, Department of Nursing, Balcalı Campus, Adana, Postcode: 01380, Turkey.
| | - Sevilay Erden
- "Cukurova University", Faculty of Health Sciences, Department of Nursing, Balcalı Campus, Adana, Postcode: 01380, Turkey.
| |
Collapse
|
7
|
Wang T, Yang S, Guo J, Long Y, Hou Z. Predictors of muscle necrosis in patients with acute compartment syndrome. Int Orthop 2023; 47:905-913. [PMID: 36715712 PMCID: PMC9885051 DOI: 10.1007/s00264-023-05699-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE The predictors of muscle necrosis after acute compartment syndrome (ACS) remain debated. This study aimed to investigate the predictors for muscle necrosis in ACS patients. METHODS We collected data on ACS patients following fractures from January 2010 to November 2022. Patients were divided into the muscle necrosis group (MG) and the non-muscle necrosis group (NG). The demographics, comorbidities, and admission laboratory indicators were computed by univariate analysis, logistic regression analysis, and receiver-operating characteristic (ROC) curve analysis. RESULTS In our study, the rate of MN was 37.6% (83 of 221). Univariate analysis showed that numerous factors were associated with muscle necrosis following ACS. Logistic regression analysis indicated that crush injury (p = 0.007), neutrophil (NEU, p = 0.001), creatine kinase myocardial band (CKMB, p = 0.047), and prothrombin time (PT, p = 0.031) were risk factors. Additionally, ROC curve analysis identified 11.415 109/L, 116.825 U/L, and 12.51 s as the cut-off values for NEU, CKMB, and PT to predict muscle necrosis, respectively. Furthermore, the combination of NEU, CKMB, and PT had the highest diagnostic accuracy. CONCLUSIONS Our findings showed that crush injury and the level of NEU, CKMB, and PT were risk factors for muscle necrosis after ACS. Additionally, we also identified the cut-off values of NEU, CKMB, and PT and found the combination of crush injury, PT, and NEU with the highest diagnostic accuracy, helping us individualize the assessment risk of muscle necrosis to manage early targeted interventions.
Collapse
Affiliation(s)
- Tao Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Shuo Yang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Yubin Long
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China.
- The Third Department of Orthopedics, Baoding First Central Hospital, Baoding, Hebei, People's Republic of China.
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, China.
| |
Collapse
|
8
|
La Riva A, Sayegh AS, Perez LC, Poncel J, Medina LG, Adamic B, Powers R, Cacciamani GE, Aron M, Gill I, Sotelo R. Obturator Nerve Injury in Robotic Pelvic Surgery: Scenarios and Management Strategies. Eur Urol 2023; 83:361-368. [PMID: 36642661 DOI: 10.1016/j.eururo.2022.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/29/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Obturator nerve injury (ONI) is an uncommon complication of pelvic surgery, usually reported in 0.2-5.7% of cases undergoing surgical treatment of urological and gynecological malignancies involving pelvic lymph node dissection (PLND). OBJECTIVE To describe how an ONI may occur during robotic pelvic surgery and the corresponding management strategies. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed video content on intraoperative ONI provided by robotic surgeons from high-volume centers. SURGICAL PROCEDURE ONI was identified during PLND and managed according to the type of nerve injury. RESULTS AND LIMITATIONS The management approach varies with the type of injury. Crush injury frequently occurs at an advanced stage of PLND. For a crush injury to the obturator nerve caused by a clip, management only requires its safe removal. Three situations can occur if the nerve is transected: (1) transection with feasible approximation and tension-free nerve anastomosis; (2) transection with challenging approximation requiring certain strategies for proper nerve anastomosis; and (3) transection with a hidden proximal nerve ending that may initially appear intact, but is clearly injured when revealed by further dissection. Each case has different management strategies with a common aim of prompt repair of the anatomic disruption to restore proper nerve conduction. CONCLUSIONS ONI is a preventable complication that requires proper identification of the anatomy and high-risk areas when performing pelvic lymph node dissection. Prompt intraoperative recognition and repair using the management strategies described offer patients the best chance of recovery without sequelae. PATIENT SUMMARY We describe the different ways in which the obturator nerve in the pelvic area can be damaged during urological or gynecological surgeries. This is a preventable complication and we describe how it can be avoided and different management options, depending on the type of nerve injury.
Collapse
Affiliation(s)
- Anibal La Riva
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aref S Sayegh
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Laura C Perez
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jaime Poncel
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Luis G Medina
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brittany Adamic
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ryan Powers
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Monish Aron
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Inderbir Gill
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rene Sotelo
- The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
9
|
Fernandes S, Oatman E, Weinberger J, Dixon A, Osei-Owusu P, Hou S. The susceptibility of cardiac arrhythmias after spinal cord crush injury in rats. Exp Neurol 2022; 357:114200. [PMID: 35952765 PMCID: PMC9801389 DOI: 10.1016/j.expneurol.2022.114200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 01/03/2023]
Abstract
High-level spinal cord injury (SCI) often interrupts supraspinal regulation of sympathetic input to the heart. Although it is known that dysregulated autonomic control increases the risk for cardiac disorders, the mechanisms mediating SCI-induced arrhythmias are poorly understood. Here, we employed a rat model of complete spinal cord crush injury at the 2nd/3rd thoracic (T2/3) level to investigate cardiac rhythm disorders resulting from SCI. Rats with T9 injury and naïve animals served as two controls. Four weeks after SCI, rats were implanted with a radio-telemetric device for electrocardiogram and blood pressure monitoring. During 24-h recordings, heart rate variability in rats with T2/3 but not T9 injury exhibited a significant reduction in the time domain, and a decrease in power at low frequency but increased power at high frequency in the frequency domain which indicates reduced sympathetic and increased parasympathetic outflow to the heart. Pharmacological blockade of the sympathetic or parasympathetic branches confirmed the imbalance of cardiac autonomic control. Activation of sympatho-vagal input during the induction of autonomic dysreflexia by colorectal distention triggered various severe arrhythmic events in T2/3 injured rats. Meanwhile, intravenous infusion of the β1-adrenergic receptor agonist, dobutamine, caused greater incidence of arrhythmias in rats with T2/3 injury than naïve and T9 injured controls. Together, the results indicate that high-level SCI increases the susceptibility to developing cardiac arrhythmias likely owing to compromised autonomic homeostasis. The T2/3 crush model is appropriate for studying abnormal cardiac electrophysiology resulting from SCI.
Collapse
Affiliation(s)
- Silvia Fernandes
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Emily Oatman
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Jeremy Weinberger
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Alethia Dixon
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Patrick Osei-Owusu
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
| | - Shaoping Hou
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA.
| |
Collapse
|
10
|
Dong C, Ubogu EE. Pro-inflammatory cytokines and leukocyte integrins associated with chronic neuropathic pain in traumatic and inflammatory neuropathies: Initial observations and hypotheses. Front Immunol 2022; 13:935306. [PMID: 35983047 PMCID: PMC9378781 DOI: 10.3389/fimmu.2022.935306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Leukocyte infiltration and persistence within peripheral nerves have been implicated in chronic nociception pathogenesis in murine peripheral neuropathy models. Endoneurial cytokine and chemokine expression contribute to leukocyte infiltration and maintenance of a pro-inflammatory state that delays peripheral nerve recovery and promotes chronic pain behaviors in these mice. However, there has been a failure to translate murine model data into safe and effective treatments for chronic neuropathic pain in peripheral neuropathy patients, or develop reliable biomarkers that may help diagnose or determine treatment responses in affected patients. Initial work showed that persistent sciatic nerve CD11b+ CD45+ leukocyte infiltration was associated with disease severity in three mouse models of inflammatory and traumatic peripheral neuropathies, implying a direct contributing role in disease pathogenesis. In support of this, CD11b+ leukocytes were also seen in the sural nerve biopsies of chronic neuropathic pain patients with three different peripheral neuropathies. Systemic CD11b antagonism using a validated function-neutralizing monoclonal antibody effectively treated chronic nociception following unilateral sciatic nerve crush injury (a representative traumatic neuropathy model associated with axonal degeneration and increased blood-nerve barrier permeability) and does not cause drug addiction behaviors in adult mice. These data suggest that CD11b could be an effective molecular target for chronic neuropathic pain treatment in inflammatory and traumatic peripheral neuropathies. Despite known murine peripheral neuropathy model limitations, our initial work suggests that early expression of pro-inflammatory cytokines, such as tissue inhibitor of metalloproteinases-1 may predict subsequent chronic nociception development following unilateral sciatic nerve crush injury. Studies aligning animal model investigation with observational data from well-characterized human peripheral neuropathies, including transcriptomics and proteomics, as well as animal model studies using a human clinical trial design should foster the identification of clinically relevant biomarkers and effective targeted treatments with limited addiction potential for chronic neuropathic pain in peripheral neuropathy patients.
Collapse
|
11
|
Kuo PJ, Rau CS, Wu SC, Lin CW, Huang LH, Lu TH, Wu YC, Wu CJ, Tsai CW, Hsieh CH. Exosomes Secreted by Adipose-Derived Stem Cells Following FK506 Stimulation Reduce Autophagy of Macrophages in Spine after Nerve Crush Injury. Int J Mol Sci 2021; 22:9628. [PMID: 34502537 PMCID: PMC8431814 DOI: 10.3390/ijms22179628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/16/2022] Open
Abstract
Macrophages emerge in the milieu around innervated neurons after nerve injuries. Following nerve injury, autophagy is induced in macrophages and affects the regulation of inflammatory responses. It is closely linked to neuroinflammation, while the immunosuppressive drug tacrolimus (FK506) enhances nerve regeneration following nerve crush injury and nerve allotransplantation with additional neuroprotective and neurotrophic functions. The combined use of FK506 and adipose-derived stem cells (ADSCs) was employed in cell therapy for organ transplantation and vascularized composite allotransplantation. This study aimed to investigate the topical application of exosomes secreted by ADSCs following FK506 treatment (ADSC-F-exo) to the injured nerve in a mouse model of sciatic nerve crush injury. Furthermore, isobaric tags for relative and absolute quantitation (iTRAQ) were used to profile the potential exosomal proteins involved in autophagy. Immunohistochemical analysis revealed that nerve crush injuries significantly induced autophagy in the dorsal root ganglia and dorsal horn of the spinal segments. Locally applied ADSC-F-exo significantly reduced autophagy of macrophages in the spinal segments after nerve crush injury. Proteomic analysis showed that of the 22 abundant exosomal proteins detected in ADSC-F-exo, heat shock protein family A member 8 (HSPA8) and eukaryotic translation elongation factor 1 alpha 1 (EEF1A1) are involved in exosome-mediated autophagy reduction.
Collapse
Affiliation(s)
- Pao-Jen Kuo
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.K.); (C.-W.L.); (T.-H.L.); (Y.-C.W.); (C.-J.W.); (C.-W.T.)
| | - Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-S.R.); (L.-H.H.)
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Chia-Wei Lin
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.K.); (C.-W.L.); (T.-H.L.); (Y.-C.W.); (C.-J.W.); (C.-W.T.)
| | - Lien-Hung Huang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (C.-S.R.); (L.-H.H.)
| | - Tsu-Hsiang Lu
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.K.); (C.-W.L.); (T.-H.L.); (Y.-C.W.); (C.-J.W.); (C.-W.T.)
| | - Yi-Chan Wu
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.K.); (C.-W.L.); (T.-H.L.); (Y.-C.W.); (C.-J.W.); (C.-W.T.)
| | - Chia-Jung Wu
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.K.); (C.-W.L.); (T.-H.L.); (Y.-C.W.); (C.-J.W.); (C.-W.T.)
| | - Chia-Wen Tsai
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.K.); (C.-W.L.); (T.-H.L.); (Y.-C.W.); (C.-J.W.); (C.-W.T.)
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (P.-J.K.); (C.-W.L.); (T.-H.L.); (Y.-C.W.); (C.-J.W.); (C.-W.T.)
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, LinKou 33333, Taiwan
| |
Collapse
|
12
|
Kluijfhout WP, de Vries EN, de Ridder VA, de Bruin IGJM. [Compartment syndrome of the forearm in a child]. Ned Tijdschr Geneeskd 2021; 165:D5446. [PMID: 33793125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Compartment syndrome is a rare but serious entity with various causes. Timely diagnosis and treatment are essential. CASE DESCRIPTION We present a case of a 14-year-old boy with a crush injury of the forearm including a fracture of the radius and ulna. In addition, a traction injury of the brachial plexus was present. Despite the absence of pain, a fasciotomy was performed because of excessive swelling of the forearm with obvious bulging of the muscles intra-operatively. CONCLUSION Compartment syndrome can develop at several places in the body, including the forearm. Disproportional pain is the most relevant symptom which can however be absent due to concurrent neurological injury. Surgical exploration is always warranted in case of a clinical suspicion of compartment syndrome to prevent severe complications.
Collapse
|
13
|
Akar E, Tural Emon S, Efendioğlu M, Erdoğan B, Engin T, Vardar Aker F. Effects of tamoxifen therapy on sciatic nerve crush injury: An experimental study in rats. Acta Orthop Traumatol Turc 2021; 55:87-93. [PMID: 33847568 DOI: 10.5152/j.aott.2021.19183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to determine the effects of tamoxifen on sciatic nerve crush injury in a rat model using histopathological, histomorphometric, and immunohistochemical approaches. METHODS In this study, 24 male Sprague-Dawley rats aged of 5 to 7 weeks and weighing between 300 g and 400 g were used. The rats were randomly divided into 3 groups: control (group C), sciatic nerve injury (group SNI), and sciatic nerve injury with tamoxifen (group SNT). The sciatic nerve crush injury model was performed using the De Koning's crush force method. In group C, only a skin incision was made and then the skin was sutured. In group SNI, the injury model was performed but no treatment was applied. In group SNT, the injury model was executed, and then 40 mg/kg/day tamoxifen was given for 4 weeks by intraperitoneal methods. At the end of 4 weeks, all animals were killed using high doses of an anesthetic. Approximately, 2-cm sciatic nerve samples were obtained for histopathological, histomorphometric, and immunohistochemical analyses using the old skin incision. RESULTS In the histopathological examination, vascular congestion and density of vacuolization were significantly lower in group SNT than in group SNI (p<0.05). In the histomorphometric examination, the mean sciatic nerve diameter was 306±62 µm in group C, 510±42 µm in group SNI, and 204±23 µm in group SNT. A significant difference was observed in the sciatic nerve diameter measurements among the 3 groups (p<0.05). In pairwise comparisons, the mean sciatic nerve diameter was significantly lower in group SNT than in group SNI (p=0.00002). Sciatic nerve diameter measurements of both groups were found to be significantly higher than group C (p<0.05). The mean epineurium thickness was 17±0.8 µm in group C, 32±2.5 µm in group SNI, and 17±0.8 µm in group SNT. A significant difference was observed in the epineurium thickness measurements among the 3 groups (p<0.05). In pairwise comparisons, the epineurium thickness was significantly higher in group SNI than in groups SNT and C (p<0.05). In the immunohistochemical analysis, S100 immunoreactivity was found significantly higher in group SNI than in the other 2 groups (p<0.05). CONCLUSION The histomorphometric, histopathological, and immunohistochemical data obtained from this study have shown that tamoxifen has a beneficial effect on sciatic nerve crush injury in the experimental rat model.
Collapse
Affiliation(s)
- Ezgi Akar
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Selin Tural Emon
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Efendioğlu
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Barış Erdoğan
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Taner Engin
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Fügen Vardar Aker
- Department of Pathology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
14
|
Frei B, Sommer-Joergensen V, Holland-Cunz S, Mayr J. Acute compartment syndrome in children; beware of "silent" compartment syndrome: A CARE-compliant case report. Medicine (Baltimore) 2020; 99:e20504. [PMID: 32501996 PMCID: PMC7306352 DOI: 10.1097/md.0000000000020504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Acute compartment syndrome (ACS) is a feared complication following traumatic injuries. We describe the occurrence of silent ACS of the hand in a 2-year old patient with atypical symptoms. PATIENT CONCERNS Our patient experienced massive swelling but minimal pain of the hand after a heavy bistro table with a stone tabletop had fallen on the right hand. DIAGNOSIS After monitoring the development of ACS for 1 night, we noted increased firmness of the swelling and impaired perfusion of the skin covering the palm and dorsum of the hand. Notably, the patient held the hand in an intrinsic minus position but did not complain of pain after administration of only a single (weight-matched) dose of ibuprofen. Our suspicion of ACS was confirmed intraoperatively because of the elevated intramuscular pressure (up to 60 mm Hg) in several hand compartments. INTERVENTIONS We performed surgical fasciotomy of all hand compartments, followed by temporary coverage of the wounds with Epigard synthetic skin substitute. The wounds were closed stepwise after 2 and 7 days, and occupational therapy was initiated after 3 weeks. OUTCOMES At the 1-year follow-up, we noted unrestricted wrist and finger functions of the patient. The parents reported that there was no difference in the use of the 2 hands during daily activities. LESSONS The possible development of ACS should be borne in mind even in the absence of marked pain. Although the 3 A's (i.e., anxiety, agitation, and increased analgesic requirements) in the diagnosis of ACS in children are well established, some patients may experience only minimal pain. This challenges the correct and timely diagnosis of ACS in children, particularly if they are very young.
Collapse
|
15
|
|
16
|
Dias FJ, Fazan VPS, Cury DP, de Almeida SRY, Borie E, Fuentes R, Coutinho-Netto J, Watanabe IS. Growth factors expression and ultrastructural morphology after application of low-level laser and natural latex protein on a sciatic nerve crush-type injury. PLoS One 2019; 14:e0210211. [PMID: 30625210 PMCID: PMC6326513 DOI: 10.1371/journal.pone.0210211] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/18/2018] [Indexed: 12/21/2022] Open
Abstract
The effects of low-level laser therapy (LLLT) and natural latex protein (F1, Hevea brasiliensis) were evaluated on crush-type injuries (15kg) to the sciatic nerve in the expressions of nerve growth factor (NGF) and vascular endothelium growth factor (VEGF) and ultrastructural morphology to associate with previous morphometric data using the same protocol of injury and treatment. Thirty-six male rats were allocated into six experimental groups (n = 6): 1-Control; 2-Exposed nerve; 3-Injured nerve; 4-LLLT (15J/cm2, 780nm, 30mW, Continuous Wave) treated injured nerve; 5-F1 (0,1mg) treated injured nerve; and 6-LLLT&F1 treated injured nerve. Four or eight weeks after, sciatic nerve samples were processed for analysis. NGF expression were higher (p<0.05) four weeks after in all injured groups in comparison to Control (Med:0.8; Q1:0; Q3:55.5%area). Among them, the Injured (Med:70.7; Q1:64.4; Q3:77.5%area) showed the highest expression, and F1 (Med:17.3; Q1:14.1; Q3:21.7%area) had the lowest. At week 8, NGF expressions decreased in the injured groups. VEGF was expressed in all groups; its higher expression was observed in the injured groups 4 weeks after (Injured. Med:29.5; F1. Med:17.7 and LLLT&F1. Med:19.4%area). At week 8, a general reduction of VEGF expression was noted, remaining higher in F1 (Med:35.1; Q1.30.6; Q3.39.6%area) and LLLT&F1 (Med:18.5; Q1:16; Q3:25%area). Ultrastructural morphology revealed improvements in the treated groups; 4 weeks after, the F1 group presented greater quantity and diameter of the nerve fibers uniformly distributed. Eight weeks after, the F1 and LLLT&F1 showed similar characteristics to the non-injured groups. In summary, these results and our previous studies indicated that F1 and LLLT may favorably influence the healing of nerve crush injury. Four weeks after nerve injury F1 group showed the best results suggesting recovery acceleration; at 8th week F1 and LLLT&F1 groups presented better features and higher vascularization that could be associated with VEGF maintenance.
Collapse
Affiliation(s)
- Fernando José Dias
- Department of Integral Dentistry, CICO—Research Centre in Dental Sciences, Dental School, Universidad de La Frontera, Temuco, Chile
- * E-mail:
| | - Valéria Paula Sassoli Fazan
- Department of Surgery and Anatomy, School of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Diego Pulzatto Cury
- Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Eduardo Borie
- Department of Integral Dentistry, CICO—Research Centre in Dental Sciences, Dental School, Universidad de La Frontera, Temuco, Chile
| | - Ramón Fuentes
- Department of Integral Dentistry, CICO—Research Centre in Dental Sciences, Dental School, Universidad de La Frontera, Temuco, Chile
| | - Joaquim Coutinho-Netto
- Department of Pharmacology, School of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Ii-sei Watanabe
- Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
17
|
Matsumoto H, Matsumoto N, Shimazaki J, Nakagawa J, Imamura Y, Yamakawa K, Yamada T, Ikeda M, Hiraike H, Ogura H, Shimazu T. Therapeutic Effectiveness of Anti-RAGE Antibody Administration in a Rat Model of Crush Injury. Sci Rep 2017; 7:12255. [PMID: 28947744 PMCID: PMC5613014 DOI: 10.1038/s41598-017-12065-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 09/04/2017] [Indexed: 11/09/2022] Open
Abstract
Crush injury patients often have systemic inflammatory response syndrome that leads to multiple organ failure. Receptor for advanced glycation endproducts (RAGE) functions as a pattern recognition receptor that regulates inflammation. We evaluated the effects of anti-RAGE antibody in a crush injury model. Pressure was applied to both hindlimbs of rats for 6 h by 3.0-kg blocks and then released. Animals were randomly divided into the sham (RAGE-Sh) group, crush (RAGE-Ctrl) group or anti-RAGE antibody-treated crush (RAGE-Tx) group. Samples were collected at 3, 6 and 24 h after releasing pressure. In the RAGE-Ctrl group, fluorescent immunostaining in the lung showed upregulated RAGE expression at 3 h. The serum soluble RAGE (sRAGE) level, which reflects the amount of RAGE expression in systemic tissue, increased at 6 h. Serum interleukin 6 (IL-6; systemic inflammation marker) increased immediately at 3 h. Histological analysis revealed lung injury at 6 and 24 h. Administration of anti-RAGE antibody before releasing compression inhibited upregulated RAGE expression in the lung alveoli, suppressed RAGE-associated mediators sRAGE and IL6, attenuated the lung damage and improved the 7-day survival rate. Collectively, our results indicated that the use of anti-RAGE antibody before releasing compression is associated with a favourable prognosis following crush injury.
Collapse
Affiliation(s)
- Hisatake Matsumoto
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka, 565-0871, Japan.
| | - Naoya Matsumoto
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka, 565-0871, Japan
| | - Junya Shimazaki
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka, 565-0871, Japan
| | - Junichiro Nakagawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka, 565-0871, Japan
| | - Yukio Imamura
- Laboratory of Nano-Bio Probes, RIKEN Quantitative Biology Center, 6-2-3 Furuedai, Suita, Osaka, 565-0874, Japan
| | - Kazuma Yamakawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka, 565-0871, Japan
| | - Tomoki Yamada
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka, 565-0871, Japan
| | - Mitsunori Ikeda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka, 565-0871, Japan
| | - Hiroko Hiraike
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka, 565-0871, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka, 565-0871, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka, 565-0871, Japan
| |
Collapse
|
18
|
Cohen BH, Gaspar MP, Daniels AH, Akelman E, Kane PM. Multifocal Neuropathy: Expanding the Scope of Double Crush Syndrome. J Hand Surg Am 2016; 41:1171-1175. [PMID: 27751780 DOI: 10.1016/j.jhsa.2016.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 09/16/2016] [Indexed: 02/02/2023]
Abstract
Double crush syndrome (DCS), as it is classically defined, is a clinical condition composed of neurological dysfunction due to compressive pathology at multiple sites along a single peripheral nerve. The traditional definition of DCS is narrow in scope because many systemic pathologic processes, such as diabetes mellitus, drug-induced neuropathy, vascular disease and autoimmune neuronal damage, can have deleterious effects on nerve function. Multifocal neuropathy is a more appropriate term describing the multiple etiologies (including compressive lesions) that may synergistically contribute to nerve dysfunction and clinical symptoms. This paper examines the history of DCS and multifocal neuropathy, including the epidemiology and pathophysiology in addition to principles of evaluation and management.
Collapse
Affiliation(s)
- Brian H Cohen
- Department of Orthopedics, The Warren Alpert Medical School of Brown University, Providence, RI.
| | - Michael P Gaspar
- The Philadelphia Hand Center, PC, Thomas Jefferson University, Philadelphia, PA
| | - Alan H Daniels
- Department of Orthopedics, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Edward Akelman
- Department of Orthopedics, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Patrick M Kane
- The Philadelphia Hand Center, PC, Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|