Uso do laser de baixa potência para o tratamento de parestesia: uma revisão de literatura / Use of low-level laser to treat paresthesia: a literature review

Introdução: A parestesia é uma neuropatia que afeta a função sensorial. O Laser de Baixa Potência (LBP), por sua vez, apresenta propriedades analgésicas, bioestimuladoras e reparadoras. Objetivo: Realizar um levantamento na literatura científica sobre os aspectos gerais e benefícios do LBP no manejo terapêutico da parestesia, além de identificar a classificação e métodos de obtenção do diagnóstico desta condição. Materiais e Métodos: Tratou-se de uma revisão narrativa da literatura através da busca nas plataformas PubMed, SciELO, LILACS e Google Schoolar. Após o cruzamento dos descritores com os operadores booleanos e aplicação dos critérios de inclusão/exclusão, 26 estudos foram incluídos. Resultados: A parestesia pode ser classificada em neuropraxia, axonotmese e neurotmese, subdivididas em Grau I ao V. Seu diagnóstico pode ser executado através de testes subjetivos e objetivos. O LBP compreende em um dispositivo tecnológico com efeitos analgésico, anti-inflamatório e fotobiomodulador, que estimula o reparo neural. Os estudos mostram que a dosimetria nos comprimentos de onda vermelho e infravermelho, aplicação intra e extra oral, e com mais de uma sessão semanal exerce efeito modulatório positivo do reparo neural, com retorno progressivo da atividade sensitiva. Além disso, os estudos trazem uma ampla variação no número de pontos de aplicação, bem como no tempo de irradiação e quantidade de sessões, em virtude da extensão e tempo de diagnóstico da parestesia. Considerações finais: Apesar da alta complexidade da parestesia, o LBP exerce efeitos benéficos através do retorno da sensibilidade parcial ou total, além de ser um dispositivo bem tolerado pelo organismo e minimamente invasivo.

Introduction: Paresthesia is a neuropathy that affects sensory function. The Low-Level Laser (LLL), in turn, has analgesic, biostimulating and reparative properties. Purpose: Carry out a survey at the scientific literature on the general aspects and benefits of LLL in the therapeutic management of paresthesia in addition to identifying the classification and methods for obtaining a diagnosis of this condition. Materials and Methods: It was a narrative literature review through search in platforms PubMed, SciELO, LILACS and Google Schoolar. After crossing the descriptors with boolean operators and applying the inclusion/exclusion criteria, 26 articles were included in this study. Results: Paresthesia can be classified into neuropraxia, axonotmesis and neurotmesis, subdivided into Grades I to V. Its diagnostic can be carried out through subjective and objective tests. The LLL consists in a technological device with analgesic, anti-inflammatory and photobiomodulatory effects, which stimulates neural repair. Studies show that LLL in dosimetry at red and infrared wavelengths with intra and extra oral application and with more than one-week use exerts a positive modulatory effect on neural repair, with a progressive return of sensory activity. Furthermore, the studies show a wide variation in the number of application points, as well as the irradiation time and number of sessions, due to the extent and time of diagnosis of paresthesia. Final Considerations: Despite the high complexity of paresthesia, the LLL has beneficial effects through the return of partial or total sensitivity in addition being a device well tolerated by the body and minimally invasive.

Sources of Discrepancy between Retinal Nerve Fiber Layer and Bruch's Membrane Opening-Minimum Rim Width Thickness in Eyes with Glaucoma.

Purpose: To compare the discrepancies between circumpapillary retinal nerve fiber layer (RNFL) and Bruch's membrane opening-minimum rim width (BMO-MRW) thickness in glaucoma eyes. Design: A cross-sectional observational study. Subjects: One hundred eighty-six eyes (118 patients) with glaucoma. Methods: OCT optic nerve head volume scans of patients enrolled in the Advanced Glaucoma Progression Study at the final available visit were exported. The RNFL and BMO-MRW measurements were averaged into corresponding 7.5° sectors, and the nasal sector data were excluded from analyses. A 2-stage screening process was used to identify true mismatches between the RNFL and BMO-MRW measurements, in which either the RNFL or BMO-MRW value was in the less than first percentile range while its counterpart was in the greater than first percentile range on the temporal-superior-nasal-inferior-temporal curve. The prevalence of these mismatches was mapped, and corresponding images were reviewed to determine the underlying cause of these discrepancies. Main Outcome Measures: Proportion of mismatches between RNFL and BMO-MRW, location of mismatches between RNFL and BMO-MRW, anatomical causes of mismatches between RNFL and BMO-MRW. Results: Mismatch analysis revealed true mismatches between RNFL and BMO-MRW in 7.7% of sectors. High BMO-MRW with low corresponding RNFL mismatches were most frequently located at the 45° and 322.5° sectors, whereas high RNFL with corresponding low BMO-MRW mismatches peaked at the 75° sector. Large blood vessels accounted for 90.9% of high RNFL with low BMO-MRW mismatches. Small to large blood vessels accounted for 62.9% of high BMO-MRW with low RNFL mismatches; the remaining mismatches could be attributed to retinoschisis or inclusion of outer retinal layers in BMO-MRW measurements. Conclusions: Although overall agreement between RNFL and BMO-MRW measurements is good in areas with advanced damage, blood vessels and other anatomical factors can cause discrepancies between the 2 types of structural measurements and need to be considered when evaluating the utility of such measurements for detection of change. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Two-color fluorescence-guided surgery for head and neck cancer resections.

Significance: Head and neck squamous cell carcinoma (HNSCC) has the sixth highest incidence worldwide, with > 650,000 cases annually. Surgery is the primary treatment option for HNSCC, during which surgeons balance two main goals: (1) complete cancer resection and (2) preservation of normal tissues to ensure post-surgical quality of life. Unfortunately, these goals are not synergistic, where complete cancer resection is often limited by efforts to preserve normal tissues, particularly nerves, and reduce life-altering comorbidities. Aim: Currently, no clinically validated technology exists to enhance intraoperative cancer and nerve recognition. Fluorescence-guided surgery (FGS) has successfully integrated into clinical medicine, providing surgeons with real-time visualization of important tissues and complex anatomy, where FGS imaging systems operate almost exclusively in the near-infrared (NIR, 650 to 900 nm). Notably, this spectral range permits the detection of two NIR imaging channels for spectrally distinct detection. Approach: Herein, we evaluated the utility of spectrally distinct NIR nerve- and tumor-specific fluorophores for two-color FGS to guide HNSCC surgery. Using a human HNSCC xenograft murine model, we demonstrated that facial nerves and tumors could be readily differentiated using these nerve- and tumor-specific NIR fluorophores. Results: The selected nerve-specific fluorophore showed no significant difference in nerve specificity and off-target tissue fluorescence in the presence of xenograft head and neck tumors. Co-administration of two NIR fluorophores demonstrated successful tissue-specific labeling of nerves and tumors in spectrally distinct NIR imaging channels. Conclusions: We demonstrate a comprehensive FGS tool for cancer resection and nerve sparing during HNSCC procedures for future clinical translation.

Controlled Elevation of Intraocular Pressure (CEI) Glaucoma Model in Rats.

Experimental elevation of intraocular pressure (IOP), a major glaucoma risk factor, has been a mainstay of research into mechanisms of glaucomatous optic nerve damage for decades. Methods that produce sustained IOP elevation can mimic the chronic nature of glaucoma and produce optic nerve damage. However, the pressure course for individual animals can be variable, unpredictably high at times, and difficult to monitor with current tonometry methods. All of this can complicate correlations of pressure history with axonal injury. An alternative is to control the extent and duration of IOP elevation over a period of several hour-long enough to produce axonal injury and gene expression changes within the optic nerve head that may indicate cellular mechanisms of glaucomatous optic nerve damage. The prolonged general anesthesia that this requires does have the potential to reduce systemic blood pressure, which may contribute to axonal injury in the face of elevated IOP. This chapter will describe our Controlled Elevation of IOP (CEI) model in laboratory rats. We will include methods for applying this to several animals at a time, as well as how to maintain blood pressure, oxygenation, and body temperature to ensure that the resulting injury and tissue events reflect the effects of elevated IOP on optic nerve tissues and not simply reduced ocular perfusion and ischemia.

In Vitro and In Vivo Methods for Studying Retinal Ganglion Cell Survival and Optic Nerve Regeneration.

Glaucoma is marked by a progressive degeneration of the optic nerve and delayed loss of retinal ganglion cells (RGCs), the projection neurons of the eye. Because RGCs are not replaced and because surviving RGCs cannot regenerate their axons, the visual loss in glaucoma is largely irreversible. Here we describe methods to evaluate treatments that may be beneficial for treating glaucoma using in vitro cell culture models (immunopanning to isolate neonatal RGCs, dissociated mature retinal neurons, retinal explants) and in vivo models that test potential treatments or investigate underlying molecular mechanisms in an intact system. Potentially, the use of these models can help investigators continue to improve treatments to preserve RGCs and restore visual function in patients with glaucoma.

TSPO deficiency promotes the progression of malignant peripheral sheath tumors by regulating the G2/M phase of the cell cycle via CDK1.

Malignant peripheral nerve sheath tumors (MPNSTs) are highly aggressive Schwann cell-derived sarcomas that are sporadic or associated with Neurofibromatosis 1 (NF1) gene mutations. Traditional therapies are usually ineffective for treating MPNSTs, so new targets need to be identified for the treatment of MPNSTs. In the present study, the role of the mitochondrial translocator protein (TSPO) in the regulation of cell proliferation and the cell cycle in MPNSTs was investigated. TSPO expression was lower in MPNSTs than in NFs. Loss-of-function experiments revealed that TSPO deficiency promoted MPNST cell growth, migration, and invasion and influenced the cell cycle in vitro and in vivo. In addition, TSPO depletion suppressed cell apoptosis by downregulating the expression of caspase-3, caspase-8, HSP60, p27, p53, and BCL-2 and suppressed the cell cycle by upregulating CDK1, CDK2, CCNB1 and CCNA2. Furthermore, CDK1 was determined to be an upstream target of TSPO-mediated regulation via RNA-seq, qPCR, and Western blotting. Specifically, depletion of CDK1 weakened the effect of TSPO deficiency on cell proliferation and migration. More importantly, CDK1 knockdown induced significant cell cycle arrest in the G2/M phase. In summary, TSPO deficiency regulates the cell cycle in MPNSTs by targeting CDK1, which may be an effective molecular target for prognosis evaluation and treatment.

Comparing scissors and scalpels to a novel surgical instrument: a biomechanical sectioning study.

BACKGROUND: This study introduces a novel surgical instrument to reduce iatrogenic nerve injuries during procedures such as carpal tunnel and ulnar nerve decompression surgery. These injuries often result from direct damage to surrounding tissues by surgical instruments, whose designs have remained largely unchanged over the past decades. The novel device is a modified surgical forceps that has a deployable surgical scalpel that runs along a groove on the forceps. This design protects important anatomical structures while allowing fast dissection and cutting of fascial layers. METHODS: The process used to develop a novel instrument included computer-aided design (CAD) modeling, 3D printing for prototyping, and the fabrication of an aluminum prototype. Biomechanical testing was performed with the novel device, iris scissors, bandage scissors, and a scalpel on an MTS Static Materials Test System. The peak force to slide-cut, number of cut attempts, and percentage cut on first attempt were compared between the prototype and traditional surgical tools. The materials cut in testing were Ace™ bandage, stockinette, and gauze. Statistical analyses were performed using Welch's t-tests and Fisher's exact tests. RESULTS: Compared to conventional bandage and iris scissors, the novel surgical instrument required significantly less force to cut through an Ace™ bandage, stockinette, and gauze (p < 0.01). The number of cuts required to transect those same materials with the novel device was comparable to that of the scalpel and bandage scissors. Additionally, while there were no differences between the novel device and the other devices for an Ace™ bandage and stockinette, the novel device tended to cut a greater percentage of gauze in one pass than did the iris scissors. CONCLUSION: The novel surgical instrument designed in this study required less force compared to conventional scissors, demonstrated cutting efficiency similar to that of a scalpel blade, and had more safety features than either instrument. This study highlights the value of collaboration between biomedical engineering and orthopedic surgery departments on innovation in medical technology, through which new technologies with improved design and functionality demonstrate the potential to reduce iatrogenic injuries.

Cranial nerves bridging the middle ear and cerebellum causing cerebellar peduncle abscess: A case report.

Cerebellar abscess is a reported complication of chronic suppurative otitis media (CSOM) and is life threatening at times. It usually develops by direct spread of CSOM through the bony erosion in the petrous bone or by thrombophlebitis of the sigmoid sinus. However, an alternative pathway of infection transmission from the petrous bone to the cerebellum through the anatomical bridge of the cranial nerves has possibly not been described before. A 63-year-old female patient with CSOM and cholesteatoma developed ataxia and right facial palsy. Computed tomography (CT) showed bone erosion of the right petrous bone suggesting middle ear infection. Post-contrast MRI revealed an enhancement of swollen 7th/8th nerve complex, suggesting neuritis, and cholesteatoma in the right petrous bone. It also showed ring enhancing lesion in the cerebellar peduncle of the same side suggesting brain abscess. Surgical intervention was performed emergently and pus aspirated. She also underwent mastoidectomy and removal of cholesteatoma later by the otolaryngology team and finally got better. This case illustrates that CSOM can cause cerebellar abscess by spreading infection via anatomical bridge of the cranial nerves without direct invasion from the temporal bone or thrombophlebitis of sinus.

Effects of online and offline trigeminal nerve stimulation on visuomotor learning.

Introduction: A current thrust in neurology involves using exogenous neuromodulation of cranial nerves (e.g, vagus, trigeminal) to treat the signs and symptoms of various neurological disorders. These techniques also have the potential to augment cognitive and/or sensorimotor functions in healthy individuals. Although much is known about the clinical effects of trigeminal nerve stimulation (TNS), effects on sensorimotor and cognitive functions such as learning have received less attention, despite their potential impact on neurorehabilitation. Here we describe the results of experiments aimed at assessing the effects of TNS on motor learning, which was behaviorally characterized using an upper extremity visuomotor adaptation paradigm. Objective: Assessing the effects of TNS on motor learning. Methods: Motor learning was behaviorally characterized using an upper extremity visuomotor adaptation paradigm. In Experiment 1, effects of offline TNS using clinically tested frequencies (120 and 60 Hz) were characterized. Sixty-three healthy young adults received TNS before performing a task that involved reaching with perturbed hand visual feedback. In Experiment 2, the effects of 120 and 60 Hz online TNS were characterized with the same task. Sixty-three new participants received either TNS or sham stimulation concurrently with perturbed visual feedback. Results: Experiment 1 results showed that 60 Hz stimulation was associated with slower rates of learning than both sham and 120 Hz stimulation, indicating frequency-dependent effects of TNS. Experiment 2 however showed no significant differences among stimulation groups. A post-hoc, cross-study comparison of the 60 Hz offline and online TNS results showed a statistically significant improvement in learning rates with online stimulation relative to offline, pointing to timing-dependent effects of TNS on visuomotor learning. Discussion: The results indicate that both the frequency and timing of TNS can influence rates of motor learning in healthy adults. This suggests that optimization of one or both parameters could potentially increase learning rates, which would provide new avenues for enhancing performance in healthy individuals and augmenting rehabilitation in patients with sensorimotor dysfunction resulting from stroke or other neurological disorders.

Neuroanatomical anomalies due to a defect in the FGF3 gene, associated with the Labyrinthine Aplasia, Microtia and Microdontia syndrome: insights from the placement of auditory brainstem implants in two siblings.

Here, we describe two congenitally deaf male siblings with the same compound heterozygotic, likely pathogenic mutations in the FGF3 gene, associated with the labyrinthine aplasia, microtia and microdontia (LAMM) syndrome. Both children had bilateral cochleovestibular aplasia, precluding cochlear implantation. The elder brother received an auditory brainstem implant (ABI) with very limited auditory responses. During the ABI-surgery of the younger subject, it was discovered that excellent auditory responses could be obtained when the electrode array was placed considerably more caudally and more medially than standard. It was observed that the foramen of Luschka, the entrance to the lateral recess of the fourth ventricle was located more caudally. In view of this observation the good auditory development of the latter child, it was decided to give the older child a contralateral ABI. Again, it turned out that the anatomy of the brainstem was abnormal with a more caudal location of the foramen of Luschka and the cochlear nucleus, and this child is showing good progress with his auditory development. It is concluded that one should be aware of the anatomical differences at the level of the brainstem when placing an ABI in children with this genetic disorder (and most likely also in the LAMM syndrome). This also underpins the need of a multidisciplinary approach with closely collaborating team members and good family guidance when diagnosing and treating children with rare deafness.

Deviant surgical anatomy for auditory brainstem implants with FGF3 gene defects, associated with LAMM syndrome This case series describes three placements of Auditory Brainstem Implants (ABIs) in two congenitally deaf brothers with a gene defect associated with the Labyrinthine Aplasia, Microtia and Microdontia (LAMM) syndrome. In line with this syndrome, they both had no inner ears and no hearing nerves and therefore couldn't be helped with a cochlear implant. The only option was an ABI, with a mesh electrode positioned on the cochlear nucleus, the first relay station of the hearing system in the brainstem. The first ABI electrode in the elder brother was placed in the classical position and did not yield much benefit. During the ABI surgery in the younger sibling, it was discovered that the location of the cochlear nucleus (the target site for an ABI) was located further down and the electrode had to be inserted deeper. This child showed a good auditory development, and it was decided to give the older child an ABI at the other side. Again, it turned out that the anatomy of the brainstem was abnormal with a lower location of the cochlear nucleus. With this second implant, this child's auditory development is showing good progress. It is concluded that one should be aware of the anatomical differences at the level of the brainstem when placing an ABI in children with this genetic disorder (and most likely also in the LAMM syndrome).

Outcomes of Peripheral Nerve Blocks in Elderly Patients with Fragility Hip Fractures in the Philippine General Hospital: A 6-month Prospective Study.

Background and Objective: Hip fractures among the elderly continue to be a serious public health concern. Hip fractures result in extremely painful injuries and given the higher risk of the elderly for complications, managing pain in this population can be challenging. This study aimed to describe the outcomes of peripheral nerve blocks on elderly patients with fragility hip fractures who will undergo elective or emergency hip surgery. Methods: A single-center prospective cohort study was conducted at the Philippine General Hospital from May 2022 to November 2022. Patients included were aged 60 years old and above with fragility hip fracture, for elective or emergency hip surgery, and with American Society of Anesthesiologists (ASA) Physical Status Score 1-3. Patients' baseline profile, intraoperative characteristics, and postoperative outcomes were collected using a standard data collection form. The data collector was blinded to the type of block performed. Results: A total of 29 patients who underwent hip surgery were included in the study. Most (65.5%) had Subarachnoid block + Peripheral Nerve Block (SAB+PNB) while 24.1% had General Anesthesia + Peripheral Nerve Block (GA+PNB) and 10.3% had no Peripheral Nerve Block (PNB). The median Numerical Rating Scale (NRS) 30 minutes post block was similar (p=0.977) in those who had PNB blocks (GA+PNB = 0, SAB+PNB = 0). The median NRS at rest during Postoperative day 1 (POD1) was significantly highest (p=0.023) in the No PNB group (3) than in both GA+PNB (0) and SAB+PNB (0). In contrast, the median NRS at rest during POD2 was similar (p=0.713) in the three groups (GA+PNB = 0, SAB+PNB = 0, No PNB = 0). The median NRS at motion during POD1 was significantly highest (p=0.008) in the No PNB group (6) than in both GA+PNB (0) and SAB+PNB (1). Also, the median NRS at motion during POD2 was significantly highest (p=0.009) in No PNB group (4) than in both GA+PNB (0) and SAB+PNB (1). Median Morphine Milligram Equivalent (MME) of postoperative opioid was significantly higher in the No PNB group among the three groups (p=0.047). The median satisfaction score (p=0.210), median delirium score at POD2 (p=0.993), and median length of hospitalization (p=0.173) were all similar in the three groups. Conclusion: Peripheral nerve block is effective in elderly patients undergoing surgery for fragility hip fractures. It results in lower pain scores and can be administered with equal effectiveness either with general anesthesia or with subarachnoid block. Mortality rate, incidence of delirium, and hospital length of stay did not vary between those with and without peripheral nerve block.

Brachial Plexus Injury Following Fracture-Dislocation of the Proximal Humerus: A Case Report.

Fracture-dislocations of the proximal humerus with brachial plexus injury are exceedingly rare, and although infrequently encountered, it is important to recognize this complication due to its potentially devastating impact. We present the case of a 75-year-old female who sustained the described injury following a fall onto their left arm, demonstrating combined sensory and motor deficits in the radial, median, and ulnar distribution of the left forearm and hand shortly afterward. Immediate management involved closed reduction under anesthesia, resulting in the improvement of neurological symptoms. For definitive management, surgical fixation of the fracture-dislocation is normally recommended in cases with an associated brachial plexus injury. However, due to a range of personal factors, the patient decided against this. Physiotherapy plays an important role in the management of these injuries, aiding mobility and recovery, with another key part of the follow-up being electrodiagnostic studies. These allow the physician to assess the extent of injury, monitor recovery for prognostication, and aid decisions regarding further surgical management. The importance of these studies is highlighted by the finding of severe brachial plexus injury, despite minimal pathological changes on MRI. Rare but significant, it is important to maintain a high index of suspicion for these injuries and consider underlying risk factors, with prompt surgical input required to optimize outcomes. Alongside surgical management, a considered approach must be taken by the anesthetic team, as regional anesthesia can confound post-procedure neurological assessment.

A deep learning-based image analysis for assessing the extent of abduction in abducens nerve palsy patients before and after strabismus surgery.

Purpose: This study aimed to propose a novel deep learning-based approach to assess the extent of abduction in patients with abducens nerve palsy before and after strabismus surgery. Methods: This study included 13 patients who were diagnosed with abducens nerve palsy and underwent strabismus surgery in a tertiary hospital. Photographs of primary, dextroversion and levoversion position were collected before and after strabismus surgery. The eye location and eye segmentation network were trained via recurrent residual convolutional neural networks with attention gate connection based on U-Net (R2AU-Net). Facial images of abducens nerve palsy patients were used as the test set and parameters were measured automatically based on the masked images. Absolute abduction also was measured manually, and relative abduction was calculated. Agreements between manual and automatic measurements, as well as repeated automatic measurements were analyzed. Preoperative and postoperative results were compared. Results: The intraclass correlation coefficients (ICCs) between manual and automatic measurements of absolute abduction ranged from 0.985 to 0.992 (P＜0.001), and the bias ranged from -0.25 â€‹mm to -0.05 â€‹mm. The ICCs between two repeated automatic measurements ranged from 0.994 to 0.997 (P＜0.001), and the bias ranged from -0.11 â€‹mm to 0.05 â€‹mm. After strabismus surgery, absolute abduction of affected eye increased from 2.18 â€‹± â€‹1.40 â€‹mm to 3.36 â€‹± â€‹1.93 â€‹mm (P＜0.05). The relative abduction was improved in 76.9% patients (10/13) after surgery (P＜0.01). Conclusions: This image analysis technique demonstrated excellent accuracy and repeatability for automatic measurements of ocular abduction, which has promising application prospects in objectively assessing surgical outcomes in patients with abducens nerve palsy.

Gelatin Methacrylic Acid Hydrogel-Based Nerve Growth Factors Enhances Neural Stem Cell Growth and Differentiation to Promote Repair of Spinal Cord Injury.

Background: The challenge in treating irreversible nerve tissue damage has resulted in suboptimal outcomes for spinal cord injuries (SCI), underscoring the critical need for innovative treatment strategies to offer hope to patients. Methods: In this study, gelatin methacrylic acid hydrogel scaffolds loaded with nerve growth factors (GMNF) were prepared and used to verify the performance of SCI. The physicochemical and biological properties of the GMNF were tested. The effect of GMNF on activity of neuronal progenitor cells (NPCs) was investigated in vitro. Histological staining and motor ability was carried out to assess the ability of SCI repair in SCI animal models. Results: Achieving nerve growth factors sustained release, GMNF had good biocompatibility and could effectively penetrate into the cells with good targeting permeability. GMNF could better enhance the activity of NPCs and promote their directional differentiation into mature neuronal cells in vitro, which could exert a good neural repair function. In vivo, SCI mice treated with GMNF recovered their motor abilities more effectively and showed better wound healing by macroscopic observation of the coronal surface of their SCI area. Meanwhile, the immunohistochemistry demonstrated that the GMNF scaffolds effectively promoted SCI repair by better promoting the colonization and proliferation of neural stem cells (NSCs) in the SCI region and targeted differentiation into mature neurons. Conclusion: The application of GMNF composite scaffolds shows great potential in SCI treatment, which are anticipated to be a potential therapeutic bioactive material for clinical application in repairing SCI in the future.

Deep peroneal neuropathy induced by prolonged squatting: a case report.

Prolonged squatting is a well-documented cause of common peroneal neuropathy, wherein the common peroneal nerve is thought to be compressed between the biceps femoris tendon and the lateral head of the gastrocnemius muscle or the fibular head. However, deep peroneal neuropathy resulting from prolonged squatting has not been previously reported. We present the case of a tile installer who developed unilateral deep peroneal neuropathy following extended squatting, diagnosed through ultrasonography, which identified the bilateral division of the common peroneal nerves between the knee joint and the fibular head. This case underscores the value of ultrasonography, particularly when electrodiagnostic results are inconsistent with clinical expectations.

Pediatric regional anesthesia and acute pain management: State of the art.

Pediatric regional anesthesia has been in existence for over 125 years, but significant progress and widespread use has occurred in the last few decades, with the increasing availability of ultrasound guidance. Evidence supporting the safety of regional anesthesia when performed under general anesthesia has also allowed the field to flourish. Newer techniques allow for more precise nerve blockade and in general this has resulted in more peripheral blocks replacing central blocks, such as caudal epidurals and spinal anesthesia. Current controversial topics in the field include the method of obtaining loss of resistance when placing epidural catheters, the role of regional anesthesia in compartment syndrome and post-hypospadias repair complications, and utility of test doses.

Vagus nerve stimulation in dementia: A scoping review of clinical and pre-clinical studies.

Background: Dementia is a prevalent, progressive, neurodegenerative condition with multifactorial causes. Due to the lack of effective pharmaceutical treatments for dementia, there are growing clinical and research interests in using vagus nerve stimulation (VNS) as a potential non-pharmacological therapy for dementia. However, the extent of the research volume and nature into the effects of VNS on dementia is not well understood. This study aimed to examine the extent and nature of research activities in relation to the use of VNS in dementia and disseminate research findings for the potential utility in dementia care. Methods: We performed a scoping review of literature searches in PubMed, HINARI, Google Scholar, and the Cochrane databases from 1980 to November 30th, 2023, including the reference lists of the identified studies. The following search terms were utilized: brain stimulation, dementia, Alzheimer's disease, vagal stimulation, memory loss, Deme*, cognit*, VNS, and Cranial nerve stimulation. The included studies met the following conditions: primary research articles pertaining to both humans and animals for both longitudinal and cross-sectional study designs and published in English from January 1st, 1980, to November 30th, 2023; investigated VNS in either dementia or cognitive impairment; and were not case studies, conference proceedings/abstracts, commentaries, or ordinary review papers. Findings and conclusions: We identified 8062 articles, and after screening for eligibility (sequentially by titles, abstracts and full text reading, and duplicate removal), 10 studies were included in the review. All the studies included in this literature review were conducted over the last three decades in high-income geographical regions (i.e., Europe, the United States, the United Kingdom, and China), with the majority of them (7/10) being performed in humans. The main reported outcomes of VNS in the dementia cases were enhanced cognitive functions, an increased functional connectivity of various brain regions involved in learning and memory, microglial structural modifications from neurodestructive to neuroprotective configurations, a reduction of cerebral spinal fluid tau-proteins, and significant evoked brain tissue potentials that could be utilized to diagnose neurodegenerative disorders. The study outcomes highlight the potential for VNS to be used as a non-pharmacological therapy for cognitive impairment in dementia-related diseases such as Alzheimer's disease.

Analysis of safety and efficacy of proton radiotherapy for optic nerve sheath meningioma.

Background: Primary optic nerve sheath meningiomas (ONSMs) represent a group of benign tumors originating from the optic nerve sheath, typically causing painless, gradual onset monocular visual loss, which can result in blindness if left untreated. Radiation therapy represents an important treatment option for patients with ONSM, allowing for preservation and potential improvement in visual function. In particular, proton radiotherapy may enable a reduction of the side effects due to its physical advantage of an inverted dose profile with a steep dose gradient. The study investigates the visual acuity, local tumor control, and treatment-related toxicities following proton beam radiotherapy with a single institutional cohort comprising 32 patients treated for ONSM. Methods: Patients with primary ONSM, either histologically (16/32) or radiologically confirmed (16/32), which were treated at the Department of Radiation Oncology at the University Hospital Heidelberg (Germany) were assessed in regard to their visual outcomes, treatment toxicity, and local tumor control following radiotherapy according to response assessment in neuro-oncology criteria. Results: After a median follow-up time of 39.5 months, the 5-year local progression-free survival was estimated at 100%, with 84.4% of patients reporting improvement or stability in visual acuity during their last follow-up. Radiation-induced optic neuropathy (RION) was encountered in 9.4%. Conclusions: Our study demonstrates proton beam therapy as a safe and effective treatment alternative in the therapeutic management of ONSMs. RION represents a rare but dreaded complication after treatment. Future head-to-head comparisons with photon radiotherapy in a prospective setting are required to demonstrate a potential, additional clinical benefit.

Transient facial paresis as a complication of buccal fat removal.

Aim: This case highlights the rarely reported complication of facial paresis following buccal fat pad removal and its management. Background: The buccal fat pad is a vital structure in facial aesthetics. In recent years, buccal fat pad removal for mid facial sculpting has gained popularity among patients owing in part to the rise of social media in plastic surgery. Although buccal fat pad removal is usually a safe procedure, potential complications can be quite severe, and can include infection, over-resection, asymmetry, hematoma, facial nerve or parotid duct injury and trismus. Case description: Herein we describe a case of iatrogenic left facial paresis secondary to buccal fat removal, and discuss the importance of appropriate patient counseling, meticulous technique, and post-operative care in the event of a complication. Conclusion: High dose corticosteroids and facial therapy can be effective in treating iatrogenic facial palsy secondary to buccal fat pad removal. Clinical significance: Although buccal fat pad removal has become a common procedure for midface sculpting, the risks remain serious and patient counseling regarding possible complications, including transient facial palsy, is paramount. Meticulous technique as well as knowledge of the relationships between the buccal fat pad, the parotid duct, and the buccal branches of the facial nerve are vital in the prevention of facial paresis when removing buccal fat.