Investigation into a new denervation model of the sciatic nerve zones in rats: Selective motor or sensorial denervation.

OBJECTIVE: This study aimed to introduce a reliable and useful model of selective sensorial or motor denervations of the sciatic nerve in rats with clinical and laboratory outcomes. METHODS: The surgical technique was determined via detailed cadaveric dissections of rat sciatic nerve roots and cross-sectional histoanatomy. Forty animals were divided into the sham, sensorial denervation (SD), motor denervation (MD), and combined denervation (CD) groups and evaluated clinically via the pinch test and observation. Electrophysiological tests, retrograde neuronal labeling, and histologic and radiographic studies were performed. The weights of the muscles innervated by the sciatic nerve were measured. RESULTS: The nerve root topography at the L4 level was consistent. Hemilaminectomy satisfactorily exposed all the roots contributing to the sciatic nerve and selectively denervated its sensorial and motor zones. Sensorial denervation caused foot deformities and wound problems, which were more severe in SD than in MD and CD. Nerve histomorphometry, electrophysiological tests, retrograde neuronal labeling studies, and measurements of the muscle weights also verified the denervations. CONCLUSION: This study has shown the feasibility of selective (sensory or motor) sciatic nerve denervation through a single-level hemilaminectomy. The surgical technique is reliable and has a confounding effect on gait. Sensorial denervation had more severe foot problems than motor and combined denervation in rats.

Hand injuries with mole gun: A hidden danger.

BACKGROUND: Mole guns are handmade destructive tools used in the fight against harmful rodents in agricultural areas. Acciden-tal triggering of these tools at the wrong time can result in major hand injuries that impair hand functionality and cause permanent hand disability. This study aims to draw attention to the fact that mole gun injuries cause severe loss of hand functionality and that these tools should be considered within the scope of firearms. METHODS: Our study is a retrospective, observational cohort study. The demographic characteristics of the patients, the clinical features of the injury, and the surgical methods applied were recorded. The severity of the hand injury was assessed by the Modified Hand Injury Severity Score. The Disabilities of Arm, Shoulder, and Hand Questionnaire was used to evaluate the upper extremity-re-lated disability of the patient. The patients' hand grip strength and palmar and lateral pinch strengths, and functional disability scores were compared with healthy controls. RESULTS: Twenty-two patients with mole gun hand injuries were included in the study. The mean age of the patients was 63.0±16.9 (22-86), and all but one were male. Dominant hand injury was found in more than half of the patients (63.6%). More than half of the patients had major hand injuries (59.1%). The functional disability scores of the patients were significantly higher than the controls, and the grip strengths and palmar pinch strengths were significantly lower. CONCLUSION: Even after years from the injury, our patients had hand disabilities, and their hand strengths were lower than that of the controls. Public awareness should be raised on this issue, and mole guns should be prohibited and considered in the scope of firearms.

Regeneration of mechanical sciatic nerve injury is affected by cold and heat exposure: involvements of the TRPM2 and TRPM8 channels.

BACKGROUND: Mechanical sciatic nerve (MSN) injury has a high rate within trauma cases. Heat and cold exposure in the treatments of MSN injuries have been clinically used in human. The MSN injury results in apoptosis, overload Ca2+ influx, and reactive oxygen species (ROS) generation in the sciatic nerve. TRPM2 and TRPM8 cation channels are activated by ROS. TRPM2 is activated by warmth (36-38°C) and heat (45-47°C), although TRPM8 is activated by cold (0-25°C). Heat or cold exposure may aid recovery MSN injury through modulation of TRPM2 and TRPM8 in sciatic nerve. OBJECTIVE: The protective roles of cold and heat treatments via modulation of TRPM2 and TRPM8 were evaluated on MSN injury-induced neurotoxicity in in vitro models of mouse and the SH-SY5Y cell line. METHOD: The mice sciatic nerves and SH-SY5Y cells were divided into control (37°C), cold (10°C), and moderate heat (40°C) groups. RESULTS: Our data identified a decrease in injury diameter in the neurons following heat exposure, but not cold exposure. In addition, the results of laser confocal microscopy analyses were indicative of a protective role of TRPM8 antagonist (ACA) against cold-induced increases in Ca2+ influx in the sciatic nerve and TRPM8 expressing SH-SY5Y cells. The results of the automatic plate reader and laser confocal microscope assays indicated a protective role of heat treatment against MSN injury-induced increases in apoptosis, mitochondrial ROS, cytosolic ROS, caspase -3, and -9 in the neurons. CONCLUSIONS: The heat treatment via possible modulation of TRPM2 channel and heat shock proteins induced protective actions against injury-mediated increases of oxidative stress, excitotoxicity, and apoptosis in the sciatic nerve and SH-SY5Y cells.

Hypericum perforatum L. supplementation protects sciatic nerve injury-induced apoptotic, inflammatory and oxidative damage to muscle, blood and brain in rats.

OBJECTIVES: This study was conducted to explore whether Hypericum perforatum L. (HPL) as a potent antioxidant protects against oxidative stress, cytokine production and caspase expression in muscle (soleus), brain and blood of sciatic nerve injury (SNI)-induced rats. METHODS: Thirty-five rats were equally divided into five groups. The first and second were used as untreated control and sham control groups, respectively. The third, fourth and fifth were sham + HPL, SNI and SNI + HPL groups, respectively. The third and fifth groups received 30 mg/kg HPL via gastric gavage for 28 days. KEY FINDINGS: High levels of muscle, brain and red blood cell (RBC) lipid peroxidation, plasma cytokine (TNF-α, IL-1ß and IL-2), muscle PARP, caspase 3 and 9 expression levels were decreased by HPL treatments. Plasma glutathione peroxidase (GPx) activity, α-tocopherol and melatonin, muscle, brain and RBC reduced glutathione (GSH) concentrations were decreased by SNI induction, whereas their values were increased by HPL treatments. ß-carotene and retinol concentrations did not change in the five groups. CONCLUSION: HPL may play a role in preventing SNI-induced inflammatory, oxidative and apoptotic blood, muscle and brain damages through upregulation of the GSH and GPx values but downregulation of PARP, caspase level and cytokine production in SNI-induced rats.

Comparison of Unilateral Fasciocutaneous V-Y Flap Technique with Cleft Lift Procedure in the Treatment of Recurrent Pilonidal Sinus Disease: A Retrospective Clinical Study.

BACKGROUND This study aimed to assess treatment outcomes of the cleft lift procedure and V-Y flap technique in the treatment of recurrent pilonidal sinus disease (PSD). MATERIAL AND METHODS A total of 51 patients who underwent cleft lift procedure and 43 patients who underwent fasciocutaneous V-Y flap technique were evaluated. The demographic characteristics, previous operations, duration of symptoms, perioperative complications, duration of operation and hospital stay, duration of draining of all patients, and recurrence of PSD were recorded. RESULTS The mean operation time was 35.61±5.254 min in the cleft lift group (CLG) and 57.42±7.327 min in the V-Y flap group (VYFG) (p=0.001). No wound dehiscence was found in the VYFG and 5 patients (9.8%) had wound dehiscence in the CLG (p=0.035). Draining time was 1.39±0.603 days in the CLG and 2.79±0.638 days in VYFG (p=0.001). The mean hospital stay was 1.75±0.523 days in the CLG and 3.77±1.02 days in the VYFG (p=0.001). Two patients (3.9%) in the CLG had recurrence and no recurrence was reported in the VYFG (p=0.189) in the given time interval. CONCLUSIONS Both methods in treatment of recurrent PSD can be preferred because of low complication and recurrence rates. Because no recurrence was found after the V-Y flap technique, it appears to be a preferable method despite some disadvantages.

Long term exposure to cell phone frequencies (900 and 1800 MHz) induces apoptosis, mitochondrial oxidative stress and TRPV1 channel activation in the hippocampus and dorsal root ganglion of rats.

Mobile phone providers use electromagnetic radiation (EMR) with frequencies ranging from 900 to 1800 MHz. The increasing use of mobile phones has been accompanied by several potentially pathological consequences, such as neurological diseases related to hippocampal (HIPPON) and dorsal root ganglion neuron (DRGN). The TRPV1 channel is activated different stimuli, including CapN, high temperature and oxidative stress. We investigated the contribution TRPV1 to mitochondrial oxidative stress and apoptosis in HIPPON and DRGN following long term exposure to 900 and 1800 MHz in a rat model. Twenty-four adult rats were equally divided into the following groups: (1) control, (2) 900 MHz, and (3) 1800 MHz exposure. Each experimental group was exposed to EMR for 60 min/ 5 days of the week during the one year. The 900 and 1800 MHz EMR exposure induced increases in TRPV1 currents, intracellular free calcium influx (Ca2+), reactive oxygen species (ROS) production, mitochondrial membrane depolarization (JC-1), apoptosis, and caspase 3 and 9 activities in the HIPPON and DRGN. These deleterious processes were further increased in the 1800 MHz experimental group compared to the 900 MHz exposure group. In conclusion, mitochondrial oxidative stress, programmed cell death and Ca2+ entry pathway through TRPV1 activation in the HIPPON and DRGN of rats were increased in the rat model following exposure to 900 and 1800 MHz cell frequencies. Our results suggest that exposure to 900 and 1800 MHz EMR may induce a dose-associated, TRPV1-mediated stress response.

Risk factors for complex regional pain syndrome in patients with surgically treated traumatic injuries attending hand therapy.

STUDY DESIGN: Prospective cohort study. INTRODUCTION: Identification of risk factors for CRPS development in patients with surgically treated traumatic injuries attending hand therapy allows to watch at-risk patients more closely for early diagnosis and to take precautionary measures as required. PURPOSE OF THE STUDY: The aim of this study was to evaluate the risk factors for the development of complex regional pain syndrome (CRPS) after surgical treatment of traumatic hand injuries. METHODS: In this prospective cohort, 291 patients with traumatic hand injuries were evaluated 3 days after surgery and monitored for 3 months for the development of CRPS. The factors assessed for the development of CRPS were age, sex, manual work, postoperative pain within 3 days measured on a Pain Numerical Rating Scale (0-10), and injury type (crush injury, blunt trauma, and cut laceration injury). RESULTS: CRPS was diagnosed in 68 patients (26.2 %) with a duration of 40.10 ± 17.01 days between the surgery and CRPS diagnosis. The mean postoperative pain score was greater in patients with CRPS than in those without CRPS (P < .001). Patients with pain scores ≥ 5 had a high risk of developing CRPS compared with patients with pain scores <5 (odds ratio: 3.61, confidence interval = 1.94-6.70). Patients with crush injuries were more likely to develop CRPS (odds ratio: 4.74, confidence interval = 2.29-9.80). CONCLUSIONS: The patients with a pain score of ≥5 in the first 3 days after surgery and the patients with crush injury were at high risk for CRPS development after surgical treatment of traumatic hand injuries. LEVEL OF EVIDENCE: II b.

Inhibition of the TRPM2 and TRPV1 Channels through Hypericum perforatum in Sciatic Nerve Injury-induced Rats Demonstrates their Key Role in Apoptosis and Mitochondrial Oxidative Stress of Sciatic Nerve and Dorsal Root Ganglion.

Sciatic nerve injury (SNI) results in neuropathic pain, which is characterized by the excessive Ca2+ entry, reactive oxygen species (ROS) and apoptosis processes although involvement of antioxidant Hypericum perforatum (HP) through TRPM2 and TRPV1 activation has not been clarified on the processes in SNI-induced rat, yet. We investigated the protective property of HP on the processes in the sciatic nerve and dorsal root ganglion neuron (DRGN) of SNI-induced rats. The rats were divided into five groups as control, sham, sham+HP, SNI, and SNI+HP. The HP groups received 30 mg/kg HP for 4 weeks after SNI induction. TRPM2 and TRPV1 channels were activated in the neurons by ADP-ribose or cumene peroxide and capsaicin, respectively. The SNI-induced TRPM2 and TRPV1 currents and intracellular free Ca2+ and ROS concentrations were reduced by HP, N-(p-amylcinnamoyl) anthranilic acid (ACA), and capsazepine (CapZ). SNI-induced increase in apoptosis and mitochondrial depolarization in sciatic nerve and DRGN of SNI group were decreased by HP, ACA, and CapZ treatments. PARP-1, caspase 3 and 9 expressions in the sciatic nerve, DRGN, skin, and musculus piriformis of SNI group were also attenuated by HP treatment. In conclusion, increase of mitochondrial ROS, apoptosis, and Ca2+ entry through inhibition of TRPM2 and TRPV1 in the sciatic nerve and DRGN neurons were decreased by HP treatment. The results may be relevant to the etiology and treatment of SNI by HP.