Percutaneous Intradiscal Radiofrequency Thermocoagulation Combined with Sinuvertebral Nerve Ablation for the Treatment of Discogenic Low Back Pain.

BACKGROUND: Percutaneous intervertebral radiofrequency thermocoagulation (PIRFT) and sinuvertebral nerve ablation (SVNA) are commonly used clinical treatments for discogenic low back pain (DLBP). However, they have been reported to have low efficacy rates of approximately 16.5%-26.5%, especially in the medium to long term. OBJECTIVES: To investigate whether PIRFT combined with SVNA can reduce pain and improve clinical outcomes in patients with DLBP. STUDY DESIGN: This is a prospective study. SETTING: All data were from Honghui Hospital in Xi'an. METHODS: Following the inclusion and exclusion criteria, 195 patients were enrolled in this study and randomly divided into 3 groups of 65 patients each and treated with PIRFT+SVNA, PIRFT, or SVNA. Postoperative follow-ups were done at one week, one month, 3 months, 6 months, and 12 months. The demographic characteristics, relevant surgical information, and observed complications of all groups were recorded. The efficacy of the surgeries was evaluated using the visual analog scale (VAS), Oswestry disability index (ODI), and modified Macnab criteria. RESULTS: In total, 167 patients, comprising 81 men and 86 women (aged 28-75 years), were included in this study and completed postoperative follow-ups. There were 54 patients in the combined PIRFT and SVNA (PIRFT+SVNA) group, 58 patients in the PIRFT group, and 55 patients in the SVNA group. All groups were comparable because there were no significant differences in gender, age, disease duration, follow-up time, surgical segments and presence of high-intensity zones of the groups (P > 0.05). In addition, the efficacy of the PIRFT+SVNA group was significantly higher than that of the PIRFT and SVNA groups as assessed by the modified Macnab criteria (P = 0.032). Surgery was successfully completed in all 3 groups, and VAS and ODI improved at all postoperative time points in all 3 groups compared to the preoperative scores. The differences between the VAS and ODI scores preoperation and 12 months postoperation were not statistically significant between all 3 groups. However, at one week, one month, 3 months, and 6 months after surgery, the VAS and ODI scores were lower in the PIRFT+SVNA group compared to the PIRFT and SVNA groups. The difference in VAS scores among the 3 groups was most significant at one week postoperation, and the difference in ODI scores was most significant at one month postoperation. The VAS and ODI improvement rates of the 3 groups showed significant improvement at one week, one month, 3 months, and 6 months postoperation (P < 0.05). There was no significant difference among the 3 groups at 12 months postoperation (P > 0.05). LIMITATIONS: This study was limited by its small sample size in a single-center study. CONCLUSIONS: In DLBP, the sinuvertebral nerve (SVN) is the main nerve involved in the lumbar disc pain signaling pathway, and compared with PIRFT and SVNA alone, combined PIRFT and SVNA treatment may provide more satisfactory pain relief and functional improvement at an early stage.

Idiopathic unilateral complete oculomotor nerve palsy: a case report of diagnostic quandary.

Introduction and importance: When compared to other cranial nerve palsies idiopathic unilateral oculomotor nerve palsy with pupillary sparing is one of the least noted neurological conditions. Moreover, there lies a series of diagnostic dilemmas to come into a final diagnosis resulting in several array of clinical investigations. Hence, there is a delay in prompt management. Case summary: An elderly female without any known comorbidities presented with the complaint of headache, dizziness and dropping of left eyelid. Several arrays of diagnostic workups was done to come to a diagnosis, but even with rigorous laboratory investigations and radiological examinations, a common working diagnosis could not be made. Hence with a diagnosis of exclusion after proper neurological and neuro-ophthalmological examination, idiopathic unilateral common oculomotor nerve palsy was identified for which improvement with steroids was noted in the patient. Discussion: Idiopathic unilateral complete oculomotor nerve palsy is considered as a diagnosis of exclusion when all the diagnostic parameters fail to signify and positive results. The vague symptomatic presentation of the disease condition further compels the treating physician to carry out several panels of laboratory to radiological investigations. But if identified in time the treatment modality is straightforward. Conclusion: The diagnostic quandary in timely identification of such disease conditions needs a pertinent diagnostic guideline so as to avoid the unwanted panel of investigations.

The Comparison of 940nm and 810nm Diode Laser Effects on the Repair of Inferior Alveolar Sensory Nerve Injury: A Clinical Trial.

Statement of the Problem: Healing of the inferior alveolar nerve injury during dental procedures is one of the biggest concerns of dentists. There are still debates on different treatment modalities. Purpose: This study aimed to compare the effect of 940nm and 810nm diode lasers on the repair of the inferior alveolar sensory nerve. Materials and Method: In this single-blinded randomized clinical trial, 39 patients with inferior alveolar nerve injury were divided into three groups: 1. 810nm laser irradiated, 2. 940nm laser irradiated, and 3. No laser irradiation (control group). All patients were treated in 12 sessions (3 days per week) and evaluated using a complete clinical neurosensory test (CNT), including brushstroke, 2-point discrimination, pinprick nociception, and thermal discrimination before and after treatment. Results: The mean dysesthesia of the patient treated with 810nm diode laser was significantly lower than the control group in all sessions (the 1st (p= 0.003), 3rd (p= 0.008), 7th (p= 0.006), and 12th sessions (p= 0.005)). The 810nm laser resulted in more satisfaction in patients than the control group in almost all sessions (1st (p< 0.001), 7th (p= 0.028), and 12th (p= 0.006)). More patient satisfaction was seen in the 1st and 3rd sessions in the 810nm laser than in the 980nm laser (p< 0.001 and p= 0.003, respectively). Conclusion: 810nm diode laser can be better than 940nm in repairing inferior alveolar sensory nerve damage.

Association of tear osmolarity and corneal nerves structure in dry eye disease: an in vivo study.

PURPOSE: To evaluate the structural changes in corneal sub-basal nerves of dry eye disease (DED) patients with tear hyperosmolarity versus normosmolar tears. METHODS: A prospective evaluation of the tear film (keratograph 5 M), tear osmolarity, and sub-basal corneal nerves (laser scanning in-vivo confocal microscopy) was performed in a cohort of 53 DED patients (106 eyes) diagnosed as per DEWS II criteria. Patients with tear hyperosmolarity (Group 1, n = 48 eyes) were compared with DED patients without tear hyperosmolarity (Group 2, n = 58 eyes). RESULTS: Of 53 patients (27 females), 28 had Sjogren's syndrome, and the rest had meibomian gland dysfunction. There were more SS patients (21 vs 7) and females in Group 1. The two groups were similar in age, TMH, NIBUT, meibomian gland loss, bulbar redness, and corneal staining, except for Schirmer I (p < 0.001), and tear osmolarity (p < 0.001; worse in group 1). The groups did not differ in dendritic cell density, whether immature (53.8 vs. 38) or mature (2.7 vs. 0). The significantly different corneal nerve parameters were nerve fiber length (p = 0.005), density (p = 0.01), and branching density (p = 0.04), with lower values observed in group 1. Only tear osmolarity had a weak negative correlation with corneal nerve fiber length (r, -0.38), density (r, -0.32), and branching (r, -0.28). SS patients with hyperosmolar tears had reduced nerve fiber length and branching compared to SS patients with normosmolar tears. CONCLUSION: Tear hyperosmolarity is associated with reduced nerve branching, fiber density, and fiber length despite similar levels of conjunctival congestion, tear film stability, and meibomian gland loss in DED patients. KEY MESSAGES: What is known • Corneal nerves are reduced in density and length in dry eye disease patients. • Laboratory studies have shown fragmentation of corneal nerves on exposure to hyperosmolar solutions. What is new • Tear hyperosmolarity is associated with reduced nerve branching, fiber density, and fiber length in dry eyes compared to normosmolar tears. • The effect is independent of dendritic cell density.

Dissection of the Sympathetic Nerves Around the Mesorectum at the Abdominopelvic Border.

Introduction Along the border between the abdominal cavity and pelvis are nervous structures that belong to the autonomous nervous system, which is delicate. These can be easily injured during regional surgical procedures such as the total mesorectal excision, where the preservation of the nervous structures should be one of the main objectives. In our study, we aimed to dissect all the sympathetic nerve formations listed at the abdominopelvic border and to present their formation, anatomical routes, and relations, as well as the surgical importance of their preservation. Method We performed anatomical dissections on eight 60- to 75-year-old cadavers (three male and five female) in the Dissection Laboratory of Carol Davila University of Medicine and Pharmacy, Bucharest, ROM. We sectioned each pelvis along the right pararectal line and exposed the hypogastric plexuses and their branches, following their pathways toward the pelvic viscera. Results We highlight the main nervous structures in the pelvis, namely the paravertebral sympathetic ganglion chain, which continues into the pelvis with the sacral ganglion chain, and the prevertebral component of the abdominal sympathetic system, represented by the superior hypogastric plexus and its continuation via the hypogastric nerves toward the inferior hypogastric plexuses. We followed the pathway of the superior hypogastric plexus from its origin down to its bifurcation into the two hypogastric nerves. We then followed the nerves into the pelvis and observed the formation of the inferior hypogastric plexuses, from which branches emerged toward the pelvic organs. Along the way, we point out anatomical landmarks that are crucial in an attempt to spare these nervous structures during regional surgical procedures. Conclusions While performing surgeries such as rectal resection with the excision of the mesorectum, radical hysterectomy, and radical prostatectomy, a thorough knowledge of the sympathetic nerve structures that pass from the abdominal cavity into the pelvis is required to spare pelvic innervation. In such a context, the dissection and anatomical assessment of regional sympathetic nerves can prove to be crucial in establishing operative protocols.

The role of the nervous system in liver diseases.

The nervous system significantly participates in maintaining homeostasis, and modulating repair and regeneration processes in the liver. Moreover, the nervous system also plays an important role in the processes associated with the development and progression of liver disease, and can either potentiate or inhibit these processes. The aim of this review is to describe the mechanisms and pathways through which the nervous system influences the development and progression of liver diseases, such as alcohol-associated liver disease, nonalcoholic fatty liver disease, cholestatic liver disease, hepatitis, cirrhosis, and hepatocellular carcinoma. Possible therapeutic implications based on modulation of signals transduction between the nervous system and the liver are also discussed.

Effects of neural mobilization of sciatic nerve and its branches in plantar foot pressures and stabilometry.

Benefits of neural mobilization (NM) have been described in musculoskeletal patients. The effects of NM on balance appear to be unclear in research, and no studies have tested the possible effects of NM on plantar pressures. Eighteen subjects were evaluated pre and post bilateral gliding of the sciatic nerve and its branches posterior tibial nerve, lateral dorsocutaneous, medial and intermediate dorsocutaneous nerves. Static variables of the plantar footprint and stabilometric variables were measured in a pre-post study. We found no differences in plantar pressure variables, Rearfoot maximum pressure (p = 0.376), Rearfoot medium pressure (p = 0.106), Rearfoot surface (p = 0.896), Midfoot maximum pressure (p = 0.975), Midfoot medium pressure (p = 0.950), Midfoot surface (p = 0.470) Forefoot maximum pressure (p = 0.559), Forefoot medium pressure(p = 0.481), Forefoot surface (p = 0.234), and stabilometric variables either, X-Displacement eyes-open (p = 0.086), Y-Displacement eyes-open (p = 0.544), Surface eyes-open (p = 0.411), Medium speed latero-lateral displacement eyes-open (p = 0.613), Medium speed anteroposterior displacement eyes-open (p = 0.442), X Displacement eyes-closed (p = 0.126), Y-Displacement eyes-closed (p = 0.077), Surface eyes-closed (p = 0.502), Medium speed latero-lateral displacement eyes-closed (p = 0.956), Medium speed anteroposterior displacement eyes-closed (p = 0.349). All variables don´t have significant differences however the measurements had a high reliability with at least an ICC of 0.769. NM doesn´t change plantar pressures or improve balance in healthy non-athletes subjects. NCT05190900.

Neuro- and immuno-modulation mediated by the cardiac sympathetic nerve: a novel insight into the anti-ischemic efficacy of acupuncture.

Communication between sympathetic nerves and the immune system is a crucial and active process during myocardial ischemia (MI), as myocardial damage and inflammatory stimuli concurrently occur. Sympathetic nerves undergo structural and functional changes after MI, leading to adverse left ventricular (LV) remodeling and heart failure (HF). The complex inflammatory response to MI, including local myocardial anti-inflammatory repair and systemic immune reactions, plays a key role in adverse LV remodeling. Here, we review the progressive structural and electrophysiological remodeling of the LV and the involvement of sympathetic tone in complex and dynamic processes that are susceptible to MI pathological conditions. Acupuncture has been reported to effectively improve cardiac function, eliminate arrhythmia, and mitigate adverse LV remodeling via somatosensory regulation after MI. Moreover, acupuncture has an anti-inflammatory effect on the pathological process of myocardial ischemia. In this Review, we aim to summarize the involvement of sympathetic nerve activation in the neuro-immune modulation of structural and functional cardiac changes after MI. As a noninvasive method for sympathetic regulation, acupuncture is an ideal option because of its anti-ischemic efficacy. A better understanding of the neural circuitry that regulates cardiac function and immune responses following MI could reveal novel targets for acupuncture treatment.

9. Chronic knee pain.

INTRODUCTION: Chronic knee pain is defined as pain that persists or recurs over 3 months. The most common is degenerative osteoarthritis (OA). This review represents a comprehensive description of the pathology, diagnosis, and treatment of OA of the knee. METHODS: The literature on the diagnosis and treatment of chronic knee pain was retrieved and summarized. A modified Delphi approach was used to formulate recommendations on interventional treatments. RESULTS: Patients with knee OA commonly present with insidious, chronic knee pain that gradually worsens. Pain caused by knee OA is predominantly nociceptive pain, with occasional nociplastic and infrequent neuropathic characteristics occurring in a diseased knee. A standard musculoskeletal and neurological examination is required for the diagnosis of knee OA. Although typical clinical OA findings are sufficient for diagnosis, medical imaging may be performed to improve specificity. The differential diagnosis should exclude other causes of knee pain including bone and joint disorders such as rheumatoid arthritis, spondylo- and other arthropathies, and infections. When conservative treatment fails, intra-articular injections of corticosteroids and radiofrequency (conventional and cooled) of the genicular nerves have been shown to be effective. Hyaluronic acid infiltrations are conditionally recommended. Platelet-rich plasma infiltrations, chemical ablation of genicular nerves, and neurostimulation have, at the moment, not enough evidence and can be considered in a study setting. The decision to perform joint-preserving and joint-replacement options should be made multidisciplinary. CONCLUSIONS: When conservative measures fail to provide satisfactory pain relief, a multidisciplinary approach is recommended including psychological therapy, integrative treatments, and procedural options such as intra-articular injections, radiofrequency ablation, and surgery.

[Peripheral nerves' function recovery by intratissual electric stimulation]. / Vosstanovlenie funktsii perifericheskikh nervov vnutritkanevoi elektrostimulyatsiei.

An intratissual electrical stimulation, accompanied by irritation of their central neurons, is used to recover the function of damaged peripheral nerves. Treatment results exceeded those with the use of cutaneous electrical stimulation, which is confirmed by comparative results of trial animal experiments. The time and quality of peripheral nerves' function recovery in comparison of intratissual and cutaneous electrical stimulation methods remain unknown. OBJECTIVE: To evaluate the time and quality of peripheral nerves' functions recovery after their suturing and conducting two different methods of electrical stimulation, namely intratissual and cutaneous, in projection of central neurons of damaged spinal nerves in the postoperative period. MATERIAL AND METHODS: The basic technical parameters of the method of peripheral nerves' functions recovery in the postoperative period were ptacticed. Postoperative rehabilitation treatment was performed in 77 patients with traumatic peripheral nerves' injuries at the level of the forearm: in 42 with intratissual electrical stimulation, in 35 - using cutaneous one with similar characteristics of electrical current and concomitant pharmacological therapy. The follow-up duration was 2 years. RESULTS: A significant (in 4-6 times) reduction in time of treatment and a greater improvement in qualitative indicators when using intratissual electrical stimulation compared to the use of cutaneous stimulation were obtained. The effectiveness of the restorative therapy was dependent on the number of procedures, and a complete recovery of the damaged peripheral nerves' functions was observed after three courses of intratissual electrical stimulation. CONCLUSION: The time and degree of recovery of peripheral nerves' functions depends on the functional activity of their central neurons at the level of the spinal cord. The activation of these neurons by low-frequency electrical current allows to activate their trophic function. Thus, the cutaneous electrical stimulation does not cause the necessary level of irritation of the neurons due to the fact that the skin is a barrier to electrical current, which reduces its impact in 200-500 times. The intratissual electrical stimulation allows to solve the problem by supplying the needle-electrode much closer to the «target¼. The proposed method of intratissual electrical stimulation has shown its advantage over cutaneous electrical stimulation, significantly reducing the duration of the restorative treatment and increasing its qualitative indicators.

Magnetic Resonance Neurography of the Foot and Ankle.

Peripheral neuropathies of the foot and ankle can be challenging to diagnose clinically due to concomitant traumatic and nontraumatic or degenerative orthopedic conditions. Although clinical history, physical examination, and electrodiagnostic testing comprised of nerve conduction velocities and electromyography are used primarily for the identification and classification of peripheral nerve disorders, MR neurography (MRN) can be used to visualize the peripheral nerves as well as the skeletal muscles of the foot and ankle for primary neurogenic pathology and skeletal muscle denervation effect. Proper knowledge of the anatomy and pathophysiology of peripheral nerves is important for an MRN interpretation.

Greater exposure to PM2.5 and PM10 was associated with lower corneal nerve measures: the Maastricht study - a cross-sectional study.

BACKGROUND: Epidemiological and toxicological studies indicate that increased exposure to air pollutants can lead to neurodegenerative diseases. To further confirm this relationship, we evaluated the association between exposure to ambient air pollutants and corneal nerve measures as a surrogate for neurodegeneration, using corneal confocal microscopy. METHODS: We used population-based observational cross-sectional data from The Maastricht Study including N = 3635 participants (mean age 59.3 years, 51.6% were women, and 19.9% had type 2 diabetes) living in the Maastricht area. Using the Geoscience and hEalth Cohort COnsortium (GECCO) data we linked the yearly average exposure levels of ambient air pollutants at home address-level [particulate matter with diameters of ≤ 2.5 µm (PM2.5), and ≤ 10.0 µm (PM10), nitrogen dioxide (NO2), and elemental carbon (EC)]. We used linear regression analysis to study the associations between Z-score for ambient air pollutants concentrations (PM2.5, PM10, NO2, and EC) and Z-score for individual corneal nerve measures (corneal nerve bifurcation density, corneal nerve density, corneal nerve length, and fractal dimension). RESULTS: After adjustment for potential confounders (age, sex, level of education, glucose metabolism status, corneal confocal microscopy lag time, inclusion year of participants, smoking status, and alcohol consumption), higher Z-scores for PM2.5 and PM10 were associated with lower Z-scores for corneal nerve bifurcation density, nerve density, nerve length, and nerve fractal dimension [stß (95% CI): PM2.5 -0.10 (-0.14; -0.05), -0.04 (-0.09; 0.01), -0.11 (-0.16; -0.06), -0.20 (-0.24; -0.15); and PM10 -0.08 (-0.13; -0.03), -0.04 (-0.09; 0.01), -0.08 (-0.13; -0.04), -0.17 (-0.21; -0.12)], respectively. No associations were found between NO2 and EC and corneal nerve measures. CONCLUSIONS: Our population-based study demonstrated that exposure to higher levels of PM2.5 and PM10 are associated with higher levels of corneal neurodegeneration, estimated from lower corneal nerve measures. Our results suggest that air pollution may be a determinant for neurodegeneration assessed in the cornea and may impact the ocular surface health as well.

ßAR-mTOR-lipin1 pathway mediates PKA-RIIß deficiency-induced adipose browning.

Background: Enhancing white adipose tissue (WAT) browning combats obesity. The RIIß subunit of cAMP-dependent protein kinase (PKA) is primarily expressed in the brain and adipose tissue. Deletion of the hypothalamic RIIß gene centrally induces WAT browning, yet the peripheral mechanisms mediating this process remain unexplored. Methods: This study investigates the mechanisms underlying WAT browning in RIIß-KO mice. Genetic approaches such as ß3-adrenergic receptors (ß3ARs) deletion and sympathetic denervation of WAT were utilized. Genome-wide transcriptomic sequencing and bioinformatic analysis were employed to identify potential mediators of WAT browning. siRNA assays were employed to knock down mTOR and lipin1 in vitro, while AAV-shRNAs were used for the same purpose in vivo. Results: We found that WAT browning substantially contributes to the lean and obesity-resistant phenotypes of RIIß-KO mice. The WAT browning can be dampened by ß3ARs deletion or WAT sympathetic denervation. We identified that adipocytic mTOR and lipin1 may act as mediators of the WAT browning. Inhibition of mTOR or lipin1 abrogates WAT browning and hinders the lean phenotype of RIIß-KO mice. In human subcutaneous white adipocytes and mouse white adipocytes, ß3AR stimulation can activate mTOR and causes lipin1 nuclear translocation; knockdown of mTOR and Lipin1 mitigates WAT browning-associated gene expression, impedes mitochondrial activity. Moreover, mTOR knockdown reduces lipin1 level and nuclear translocation, indicating that lipin1 may act downstream of mTOR. Additionally, in vivo knockdown of mTOR and Lipin1 diminished WAT browning and increased adiposity. Conclusions: The ß3AR-activated mTOR-lipin1 axis mediates WAT browning, offering new insights into the molecular basis of PKA-regulated WAT browning. These findings provide potential adipose target candidates for the development of drugs to treat obesity.

Evidence of an excitatory purinergic innervation in mouse corpus cavernosum smooth muscle.

BACKGROUND: Evidence suggests that the corpus cavernosum smooth muscle (CCSM) cells of several species, including humans, express purinergic P2X receptors, but it is not known if the corpus cavernosum has an excitatory purinergic innervation. AIM: In this study we aimed to determine if the mouse CCSM has a functional purinergic innervation. METHODS: Mouse CCSM myocytes were enzymatically isolated and studied using the perforated patch configuration of the patch clamp technique. Isometric tension was measured in whole cavernosum tissue subjected to electrical field stimulation (EFS) to evoke nerve-mediated responses. OUTCOMES: The mouse CCSM myocytes expressed P2X1 receptors, and adenosine triphosphate (ATP) evoked inward currents in these cells. In addition, P2X1-mediated contractions were recorded in whole tissue in response to EFS. RESULTS: In cells held under a voltage clamp at -60 mV, ATP (1 µm) evoked large inward currents (mean approximately 900 pA). This current rapidly declined but was repeatable at 8-minute intervals. α,ß-methylene ATP (10 µM), an agonist of P2X1 and P2X3 receptors, caused a similar current that also rapidly declined. Desensitization to α,ß-methylene ATP negated the effect of ATP, but the ATP effect was restored 8 minutes after washout of α,ß-methylene ATP. The effect of ATP was reversibly blocked by NF449 (1 µm), a selective antagonist of P2X1 receptors. In isometric tension experiments electrical field stimulation (EFS) at 0.5-8 Hz evoked frequency-dependent contractions in the presence of l-nitro arginine (l-NO-Arg) (100 µm). When phentolamine (3 µm) and atropine (1 µm) were applied, there remained a nonadrenergic, noncholinergic component of the response to EFS, consisting mainly of a transient contraction. This was significantly reduced by NF449 (1 µm). Finally, in immunocytochemistry experiments, isolated CCSM myocytes stained positively when exposed to an antibody raised against P2X1 receptors. CLINICAL IMPLICATIONS: Previous studies have shown that P2X1 receptors in CCSM are upregulated in diabetes. These findings, taken together with the functional evidence presented here, indicate that P2X1 receptors may provide an alternative therapeutic target for treatment of erectile dysfunction in patients with diabetes, which is known to be relatively resistant to treatment with phosphodiesterase 5 inhibitors. STRENGTHS AND LIMITATIONS: Strengths of this study are the use of a combination of functional experiments (patch clamp) and immunocytochemical analyses to show expression of P2X1 receptors on CCSM myocytes while also performing functional experiments to show that stimulation these receptors results in contraction of CCSM. A limitation of this study was the use of animal rather than human tissue. CONCLUSION: This investigation provides evidence that mouse corpus cavernosum smooth muscle cells express P2X1 receptors and that these receptors are involved in mediating part of the contractile response to nerve stimulation evoked by EFS.

Adductor canal block combined with genicular nerve block versus local infiltration analgesia for total knee arthroplasty: a randomized noninferiority trial.

OBJECTIVE: This randomized controlled and double-blind study aimed to investigate whether the analgesic effect of the adductor canal block (ACB) combined with the genicular nerve block (GNB) after total knee arthroplasty is noninferior to that of the adductor canal block combined with local infiltration analgesia (LIA). METHODS: A total of 102 patients undergoing total knee arthroplasty under general anesthesia were included and randomly divided into: ACB + GNB and ACB + LIA groups; the ACB + LIA group received 80 mL of 0.2% ropivacaine with adrenaline 10 µg/mL for LIA, whereas the ACB + GNB group received 4 mL of 0.2% ropivacaine for the blockade of five peri-knee nerves. The primary outcome was the median difference in the visual analog scale scores at rest at 24 h between the two groups. Secondary outcomes involved the median differences in the pain scores at other time points. Other outcomes included the cumulative dosage of opioids calculated in morphine equivalents in the first 24 h and indicators related to knee joint functional recovery. RESULTS: In total, 36 and 38 patients were included in the ACB + GNB and ACB + LIA groups, respectively. We found that the median difference (95% confidence internal) in postoperative rest pain at 24 h (noninferiority criteria, △ = 1) was - 0.5 (- 1 to 0, p = 0.002). The median difference in cumulative opioid consumption was 1 mg (- 1 to 3, p = 0.019), meeting the noninferiority criteria, △ = 7.7 mg. CONCLUSIONS: ACB combined with GNB provides noninferior analgesia compared to ACB with LIA on the first day after total knee arthroplasty while significantly reducing local anesthetic use. TRIAL REGISTRATION: Name of the Registry: Chinese Clinical Trial Registry; Trial Registration Number: ChiCTR2300074274; Date of Registration. August 2, 2023.

[Discussion on the relationship between pathological changes of sciatic nerve and Sarm1 protein expression in rats with n-hexane poisoning].

Objective: To explore the potential evidence of active peripheral nerve necrosis when n-hexane produces toxic effects on peripheral nerves. Methods: In May 2023, 36 SPF grade SD male rats with a body weight of 200-220 g were divided into 4 groups with 9 rats in each group and given normal saline and different doses of n-hexane (168, 675, 2 700 mg/kg) by gavage for 6 consecutive weeks (5 days/week). Three rats in each group were killed at the 2nd, 4th and 6th week, respectively. The spinal cord to sciatic nerve tissue was broken and the supernatant was extracted for SDS-PAGE protein isolation. The expression level of Sarm1 protein was analyzed with the ß-Actin color strip of internal reference protein by Western blot. The expression of Sarm1 protein was analyzed by the gray ratio of the two. At the 6th week, the sciatic nerve sections of the each group were observed by light microscope and electron microscope. Results: The number of axons was obviously reduced by light microscopy. According to electron microscope, myelin lesions were mainly local disintegration, deformation, and different thickness. The deformation of axonal surface became smaller. The axons in the nerve bundle membrane showed degeneration and reduction. The gray ratio of Sarm1 protein and internal reference protein bands in each group had no significant change at the second week of exposure, and the ratio of SARM1 protein to internal reference protein bands was 1.47 in the high dose group at the fourth week, and 1.51 and 1.89 in the middle and high dose group at the sixth week, respectively. Conclusion: Waller's degeneration was observed in sciatic neuropathologic manifestations of n-hexane-poisoned rats, and the expression level of Sarm1 protein increased.

Development of an ultrasound-guided radiofrequency ablation technique in the equine cadaveric distal limb: histological findings and potential for treating chronic lameness.

Introduction: Radiofrequency (RF) relieves chronic pain in humans, but it is unexplored in horses affected by chronic lameness. This study aims to describe the technique and the histological effects of ultrasound (US)-guided radiofrequency ablation (RFA) of palmar digital nerves (PDNs) in horse's fetlock and pastern, ex vivo. Methods: After assessing the US anatomy of lateral and medial PDNs in fetlock and pastern in vivo (n = 10 horses; 20 forelimbs), US-guided RFA was performed on these sites in cadaveric forelimbs (n = 10) applying four different settings with increasing invasiveness (n = 40 total treatments): 60°C, 6 min (GROUP LOW); 70°C, 4 min (GROUP MEDIUM); 90°C, 2 min (GROUP HIGH); 80°C, 8 min (GROUP VERY HIGH). Needle-tip-to-nerve proximity was assessed with US and methylene blue, injected through the port of the RF needle. Nerves were collected for microscopical assessment. Results: Transverse palmaro-lateral and palmaro-medial US images of fetlock and pastern detected PDNs consistently, close to the palmar digital artery. With in-plane US technique, RFA was performed at target in 31/40 cases, with significantly higher number of failures in fetlock (p = 0.008). PDNs histology identified thermal injury/coagulation with axonal degeneration and collagen homogenation. Nuclear smearing of arterial leyomyocytes was also observed. Nerve coagulation was significantly associated with treatment (p = 0.03) and needle-tip-to-nerve proximity (US distance: p = 0.009; blue distance: p = 0.04). Discussion: The PDNs were easily visualized and reached with the RF needle by US in-plane-guided technique. RFA produced axonal thermal damage and intensity-related coagulation effectiveness. To ensure effective nerve coagulation, it is crucial that the needle is accurately positioned in close proximity to the target nerve. Based on the histopathological findings, HIGH and VERY HIGH RFA treatments might be worth of being tested in vivo in clinical studies aimed at treating chronic lameness of the distal forelimb in horses.

The clinical impact of contact lens wear on neural structure and function of the cornea.

Contact lens (CL) use is growing rapidly, with a current estimate of over 100 million wearers worldwide. Vast improvements in materials and designs have occurred over the past decades with advancements in the understanding of ocular surface health with CL wear. However, the potential impact of CL on neural structures and function of the ocular surface, particularly in relation to the richly innervated cornea, remain poorly understood. Problems with sensation such as CL discomfort and conditions that may be associated with lens wear including dry eye disease also remain pervasive. This narrative review discusses the findings from studies involving soft or rigid CL wearers, assessed with c linical techniques designed for examining the neural integrity of the cornea, namely in vivo confocal microscopy and esthesiometry. While the collective findings remain equivocal in terms of the changes in corneal nerve morphology and function with conventional CL wear, more specialised CLs, namely orthokeratology lenses, which mechanically manipulates the structure of the cornea seem to produce more prominent changes in nerve distribution and sensitivity reduction. Given the intricate relationship between neural and immune mechanisms in maintaining balanced ocular surface health, the potential links between these structural and functional findings with parainflammation and neuroinflammation, as well as clinical issues including CL discomfort and dry eye disease, are also explored.

Vascular supply of the radial nerve and its terminal branches: an anatomical study.

PURPOSE: The aim of this cadaveric study was to further describe the vascular supply of the radial, posterior interosseous and superficial radial nerves. METHODS: 11 cadaveric upper limbs, injected with colored latex, were dissected. Vascular afferents to the radial nerve, superficial radial nerve (SRN) and posterior interosseous nerve (PIN) were described and located. Their origin was identified and its distance to interepicondylar line was measured. RESULTS: The radial nerve had an average of 3 vascular afferents (1-5), of septomuscular origin in 54% of cases. 46% came from adjacent arteries. The PIN had an average of 8 vascular afferents (6-14), arising from septomuscular branches in 82% of cases. The PIN was vascularized in 100% of cases by a large arterial plexus originating from the supinator muscle between its two heads. The SRN had an average of 4 vascular afferents (3-7). Before crossing the septum of the brachioradialis, vascularization was predominantly septomuscular; after crossing the septum, the nerve was exclusively vascularized by septocutaneous arteries. CONCLUSION: This is the first study to describe the vascularization of the radial nerve and its terminal branches along their entire length. Our results are in line with the data available in the literature. An arterial plexus between the two heads of the supinator was surrounding the PIN in all cases. This vascular plexus might be involved in dynamic compression of the posterior interosseous nerve.