RESUMEN
BACKGROUND: While sciatic nerve injury has been described as a complication of acetabular fractures, iatrogenic nerve injury remains sparsely reported. This study aims to assess iatrogenic sciatic nerve injuries occurring during acetabular fracture surgery, tracking their neurological recovery and clinical outcomes, and investigating any correlation between recovery and the severity of neurologic injury to facilitate physicians in providing prediction of prognosis. CASE PRESENTATION: We present two cases of male patients, aged 56 and 22, who developed sciatic palsy due to iatrogenic nerve injury during acetabular fracture surgery. Iatrogenic sciatic nerve injury resulted from operatively treated acetabular fractures. Surgical exploration, involving internal fixation removal and nerve decompression, successfully alleviated symptoms in both cases postoperatively. At the latest follow-up, one patient achieved full recovery with excellent function, while the other exhibited residual deficits at the L5/S1 root level along with minimal pain. CONCLUSION: Sciatic nerve injury likely stemmed from reduction techniques and internal fixation procedures for the posterior column, particularly when performed with the hip flexed, thereby placing tension on the sciatic nerve. Our case reports underscore the significance of liberal utilization of electrophysiologic examinations and intraoperative monitoring for the prediction of prognosis. Surgical exploration, encompassing internal fixation removal and nerve decompression, represents an effective intervention for resolving sciatic palsy, encompassing both sensory neuropathy and motor symptoms.
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Acetábulo , Fijación Interna de Fracturas , Fracturas Óseas , Enfermedad Iatrogénica , Nervio Ciático , Neuropatía Ciática , Humanos , Masculino , Persona de Mediana Edad , Acetábulo/lesiones , Acetábulo/cirugía , Neuropatía Ciática/etiología , Neuropatía Ciática/cirugía , Fijación Interna de Fracturas/métodos , Nervio Ciático/lesiones , Nervio Ciático/cirugía , Adulto Joven , Fracturas Óseas/cirugía , Descompresión Quirúrgica/métodosRESUMEN
Attempts at body contour modifications have led to the use of different alloplastic materials that can irreversibly damage health and risk patients' lives. These modeling substances can induce a general autoimmune inflammatory response, producing a very heterogeneous clinical spectrum ranging from mild and severe systemic to local symptoms that sometimes affect peripheral nerves. We report a unique case of a tumor-like sciatic nerve impairment produced months after the injection of a modeling substance into the buttocks for esthetic purposes. The patient was treated with a surgical decompression of the sciatic nerve that encompassed the removal of the injected mass. This approach ultimately yielded a complete neurological recovery of the affected nerve. We emphasize the diagnostic approach and surgical management employed in this unique case and review the current literature on this infrequent complication.
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Neuropatía Ciática , Humanos , Neuropatía Ciática/cirugía , Femenino , Nervio Ciático , Descompresión Quirúrgica/métodos , Nalgas/cirugía , AdultoRESUMEN
PURPOSE: Various postoperative protocols have been proposed to improve outcomes and accelerate nerve regeneration. Recently, the use of physical exercise in a post-surgical neurorraphy procedure has shown good results when started early. We experimentally investigated the hypothesis that post-operative exercise speeds up results and improves clinical and morphologic parameters. METHODS: Isogenic rats were randomly divided into four groups: 1 SHAM; 2 SHAM submitted to the exercise protocol (EP); 3 Grafting of the sciatic nerve; and 4 Grafting of the sciatic nerve associated with the EP. The EP was based on aerobic activities with a treadmill, with a progressive increase in time and intensity during 6 weeks. The results were evaluated by the sciatic functional index (SFI), morphometric and morphologic analysis of nerve distal to the lesion, and the number of spinal cord motor neurons, positive to the marker Fluoro-Gold (FG), captured retrogradely through neurorraphy. RESULTS: Functional analysis (SFI) did not show a statistical difference between the group grafted with (-50.94) and without exercise (-65.79) after 90 days. The motoneurons count (Spinal cord histology) also showed no diference between these groups (834.5 × 833 respectively). Although functionally there is no difference between these groups, morphometric study showed a greater density (53.62) and larger fibers (7.762) in GRAFT group. When comparing both operated groups with both SHAM groups, all values were much lower. CONCLUSIONS: The experimental model that this aerobic treadmill exercises protocol did not modify nerve regeneration after sciatic nerve injury and repair with nerve graft.
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Regeneración Nerviosa , Traumatismos de los Nervios Periféricos , Condicionamiento Físico Animal , Neuropatía Ciática , Animales , Ratas , Regeneración Nerviosa/fisiología , Traumatismos de los Nervios Periféricos/cirugía , Traumatismos de los Nervios Periféricos/terapia , Ratas Endogámicas SHR , Nervio Ciático/lesiones , Nervio Ciático/trasplante , Neuropatía Ciática/cirugía , Neuropatía Ciática/terapiaRESUMEN
Objective.Acellular nerve allograft (ANA) is an effective surgical approach used to bridge the sciatic nerve gap. The molecular regulators of post-surgical recovery are not well-known. Here, we explored the effect of transgenic Schwann cells (SCs) overexpressing POU domain class 6, transcription factor 1 (POU6F1) on sciatic nerve regeneration within ANAs. We explored the functions of POU6F1 in nerve regeneration by using a cell model of H2O2-induced SCs injury and transplanting SCs overexpressing POU6F1 into ANA to repair sciatic nerve gaps.Approach.Using RNA-seq, Protein-Protein Interaction network analysis, gene ontology enrichment, and Kyoto Encyclopedia of Genes and Genomes pathway analysis, we identified a highly and differentially expressed transcription factor, POU6F1, following ANA treatment of sciatic nerve gap. Expressing a high degree of connectivity, POU6F1 was predicted to play a role in peripheral nervous system myelination.Main results.To test the role of POU6F1 in nerve regeneration after ANA, we infected SCs with adeno-associated virus-POU6F1, demonstrating that POU6F1 overexpression promotes proliferation, anti-apoptosis, and migration of SCsin vitro. We also found that POU6F1 significantly upregulated JNK1/2 and c-Jun phosphorylation and that selective JNK1/2 inhibition attenuated the effects of POU6F1 on proliferation, survival, migration, and JNK1/2 and c-Jun phosphorylation. The direct interaction of POU6F1 and activated JNK1/2 was subsequently confirmed by co-immunoprecipitation. In rat sciatic nerve injury model with a 10 mm gap, we confirmed the pattern of POU6F1 upregulation and co-localization with transplanted SCs. ANAs loaded with POU6F1-overexpressing SCs demonstrated the enhanced survival of transplanted SCs, axonal regeneration, myelination, and functional motor recovery compared to the ANA group loaded by SCs-only in line within vitrofindings.Significance.This study identifies POU6F1 as a novel regulator of post-injury sciatic nerve repair, acting through JNK/c-Jun signaling in SCs to optimize therapeutic outcomes in the ANA surgical approach.
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Traumatismos de los Nervios Periféricos , Neuropatía Ciática , Ratas , Animales , Peróxido de Hidrógeno/metabolismo , Nervio Ciático/metabolismo , Regeneración Nerviosa/genética , Células de Schwann/fisiología , Neuropatía Ciática/genética , Neuropatía Ciática/cirugía , Neuropatía Ciática/metabolismo , Traumatismos de los Nervios Periféricos/genética , Traumatismos de los Nervios Periféricos/terapia , Aloinjertos/trasplante , Factores de Transcripción/metabolismoRESUMEN
Background: Position-related compressive nerve injury is a frequently reported complication of the lithotomy position. In contrast, compartment syndrome-induced neuropathy after lithotomy with prolonged surgery is rare and prone to misdiagnosis. This case describes the successful open decompression of sciatic neuropathy due to compartment syndrome after a prolonged lithotomy position. Case presentation: A 56-year-old male patient complained of an abnormal sensation in the lower leg and difficulty in dorsiflexion and plantarflexion of the left foot and toes after laparoscopic anterior hepatic sectionectomy for 16 h in a lithotomy position. Physical examination revealed severe pain and paresthesia below the distal left thigh. In manual muscle test grading, dorsiflexion and plantarflexion of the left ankle and toes were classified as grade 1. Computed tomography and magnetic resonance imaging showed ischemic changes in the mid-thigh posterior muscles, and the sciatic nerve was severely swollen at the distal thigh, which was compressed by the proximal edge of the well-leg holder. After debridement of the necrotic tissue and decompression of the sciatic nerve, the pain subsided immediately, and the ankle and toe dorsiflexion motor function improved to grade 4. Conclusions: Most case reports of compressive neuropathy associated with the lithotomy position have been related to conservative treatment. However, if a lesion compressing the nerve is confirmed in an imaging study and the correlation with the patient's symptoms is evident, early surgical intervention can be an effective treatment method to minimize neurological deficits.
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Síndromes Compartimentales , Neuropatía Ciática , Masculino , Humanos , Persona de Mediana Edad , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Síndromes Compartimentales/patología , Nervio Ciático/patología , Nervio Ciático/cirugía , Neuropatía Ciática/etiología , Neuropatía Ciática/cirugía , Dolor , Descompresión/efectos adversosRESUMEN
Peripheral nerve injury (PNI) is a common disease that causes the partial loss of sensory, exercise, and autonomic nervous function. In clinical practice, accurate end-to-end neurorrhaphy of the epineurium without tension is the ideal treatment when there is no nerve defect. We have confirmed that peripheral blood mononuclear cells (PBMCs) can effectively improve nerve regeneration and motor function recovery after PNI. However, the global protein profile and signaling conduction pathways regulated by PBMCs remain unclear. This study employed the transection anastomosis model to detect the walking track analysis, gastrocnemius wet weight rate, and morphological examination in order to validate the effect of PBMCs on sciatic nerve injury in rats. Results showed that PBMCs improved nerve regeneration after sciatic nerve dissociation and anastomosis in rats, which reflected in the improvement of the sciatic nerve function index, wet weight rate of gastrocnemius muscles, muscle fiber structure, and the number of axons. We then used TMT labeling quantitative proteomics to explore the underlying mechanism by which PBMCs ameliorated sciatic nerve injury. Results showed that PBMCs regulated 40 differential proteins and the regulated proteins were primarily involved in the complement and coagulation cascade pathways, the notch signaling pathway, the renin angiotensin system, DNA replication, histidine metabolism, ß-alanine metabolism, and other types of O-glycan biosynthesis. Immunohistochemical results supported our findings on the changes in expression of Kininogen 1 and Psen1, the relationships between PNI and the notch pathway and the complement and coagulation level pathways.
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Traumatismos de los Nervios Periféricos , Neuropatía Ciática , Anastomosis Quirúrgica , Animales , Leucocitos Mononucleares , Regeneración Nerviosa/fisiología , Ratas , Recuperación de la Función/fisiología , Nervio Ciático/lesiones , Neuropatía Ciática/cirugíaRESUMEN
CASE: We report a very rare case of simultaneous ipsilateral floating hip and floating knee (SIFHFK) injury with the neck of the femur and patella fracture and hip dislocation associated with sciatic nerve injury in a 45-year-old man after a road traffic accident. We adopted a staged approach for surgical fixation of the fractures after stabilization. At the latest 2 years follow-up, the patient was asymptomatic with satisfactory clinical outcome. CONCLUSION: SIFHFK injuries present a challenging and emergent clinical scenario and require extensive clinical experience, careful planning, and multidisciplinary teamwork because of the paucity of specific treatment protocols for the treatment of this complex injury.
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Fracturas Óseas , Luxación de la Cadera , Traumatismos de la Rodilla , Neuropatía Ciática , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Luxación de la Cadera/complicaciones , Luxación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Rótula/diagnóstico por imagen , Rótula/cirugía , Neuropatía Ciática/etiología , Neuropatía Ciática/cirugíaRESUMEN
La neuropatía ciática es una patología que se manifiesta en alteraciones mecánicas, funcionales y sensitivas de la extremidad afectada. Se presenta el caso de un paciente con neuropatía ciática iatrogénica que mostró evolución tórpida de las heridas quirúrgicas tras intervención de dedos en garra con inmovilización por agujas de Kirschner. Con un tratamiento basado en desbridamiento, cura húmeda y abordaje de la colonización crítica se consiguió alta en 45 días, con curas realizadas en domicilio por el paciente, y resolución completa en 60 días (AU)
Sciatic neuropathy is a pathology manifested in mechanical, functional and sensitive disorders in the affected limb. We report a case of iatrogenic sciatic neuropathy in a patient showing torpid evolution of postsurgical wounds after claw toes surgery with K-wire immobilization. Treatment was based in debridement, critical colonization contention and moist environment healing. The patient was released for self-treatment at home after 45 days and reported complete healing after 60 days (AU)
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Humanos , Masculino , Adulto , Neuropatía Ciática/cirugía , Infección de la Herida Quirúrgica/enfermería , Desbridamiento , Resultado del TratamientoRESUMEN
BACKGROUND: Mesenchymal stem cells have the potential to produce neurotrophic growth factors and establish a supportive microenvironment for neural regeneration. The purpose of this study was to determine the effect of undifferentiated and differentiated mesenchymal stem cells dynamically seeded onto decellularized nerve allografts on functional outcomes when used in peripheral nerve repair. METHODS: In 80 Lewis rats, a 10-mm sciatic nerve defect was reconstructed with (1) autograft, (2) decellularized allograft, (3) decellularized allograft seeded with undifferentiated mesenchymal stem cells, or (4) decellularized allograft seeded with mesenchymal stem cells differentiated into Schwann cell-like cells. Nerve regeneration was evaluated over time by cross-sectional tibial muscle ultrasound measurements, and at 12 and 16 weeks by isometric tetanic force measurements, compound muscle action potentials, muscle mass, histology, and immunofluorescence analyses. RESULTS: At 12 weeks, undifferentiated mesenchymal stem cells significantly improved isometric tetanic force measurement and compound muscle action potential outcomes compared to decellularized allograft alone, whereas differentiated mesenchymal stem cells significantly improved compound muscle action potential outcomes. The autografts outperformed both stem cell groups histologically at 12 weeks. At 16 weeks, functional outcomes normalized between groups. At both time points, the effect of undifferentiated versus differentiated mesenchymal stem cells was not significantly different. CONCLUSIONS: Undifferentiated and differentiated mesenchymal stem cells significantly improved functional outcomes of decellularized allografts at 12 weeks and were similar to autograft results in the majority of measurements. At 16 weeks, outcomes normalized as expected. Although differences between both cell types were not statistically significant, undifferentiated mesenchymal stem cells improved functional outcomes of decellularized nerve allografts to a greater extent and had practical benefits for clinical translation by limiting preparation time and costs.
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Trasplante de Células Madre Mesenquimatosas/métodos , Transferencia de Nervios/métodos , Células de Schwann/trasplante , Nervio Ciático/trasplante , Neuropatía Ciática/cirugía , Aloinjertos/fisiología , Aloinjertos/trasplante , Animales , Autoinjertos/fisiología , Autoinjertos/trasplante , Diferenciación Celular , Modelos Animales de Enfermedad , Humanos , Masculino , Células Madre Mesenquimatosas/fisiología , Regeneración Nerviosa , Ratas , Células de Schwann/fisiología , Nervio Ciático/lesiones , Nervio Ciático/fisiología , Trasplante Autólogo/métodos , Trasplante Homólogo/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: The nerve autograft remains the gold standard when reconstructing peripheral nerve defects. However, although autograft repair can result in useful functional recovery, poor outcomes are common, and better treatments are needed. The purpose of this study was to evaluate the effect of purified exosome product on functional motor recovery and nerve-related gene expression in a rat sciatic nerve reverse autograft model. METHODS: Ninety-six Sprague-Dawley rats were divided into three experimental groups. In each group, a unilateral 10-mm sciatic nerve defect was created. The excised nerve was reversed and used to reconstruct the defect. Group I animals received the reversed autograft alone, group II animals received the reversed autograft with fibrin glue, and group III animals received the reversed autograft with purified exosome product suspended in the fibrin glue. The animals were killed at 3 and 7 days and 12 and 16 weeks after surgery. Evaluation included compound muscle action potentials, isometric tetanic force, tibialis anterior muscle wet weight, nerve regeneration-related gene expression, and nerve histomorphometry. RESULTS: At 16 weeks, isometric tetanic force was significantly better in group III (p = 0.03). The average axon diameter of the peroneal nerve was significantly larger in group III at both 12 and 16 weeks (p = 0.015 at 12 weeks; p < 0.01 at 16 weeks). GAP43 and S100b gene expression was significantly up-regulated by purified exosome product. CONCLUSIONS: Local administration of purified exosome product demonstrated improved nerve regeneration profiles in the reverse sciatic nerve autograft rat model. Thus, purified exosome product may have beneficial effects on nerve regeneration, gene profiles, and motor outcomes.
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Exosomas , Regeneración Tisular Dirigida/métodos , Traumatismos de los Nervios Periféricos/cirugía , Nervio Ciático/trasplante , Neuropatía Ciática/cirugía , Animales , Autoinjertos/fisiología , Modelos Animales de Enfermedad , Humanos , Masculino , Regeneración Nerviosa , Ratas , Ratas Sprague-Dawley , Nervio Ciático/lesiones , Nervio Ciático/fisiologíaRESUMEN
Peripheral compressive neuropathy causes significant neuropathic pain, muscle weakness and prolong neuroinflammation. Surgical decompression remains the gold standard of treatment but the outcome is suboptimal with a high recurrence rate. From mechanical compression to chemical propagation of the local inflammatory signals, little is known about the distinct neuropathologic patterns and the genetic signatures after nerve decompression. In this study, controllable mechanical constriction forces over rat sciatic nerve induces irreversible sensorimotor dysfunction with sustained local neuroinflammation, even 4 weeks after nerve release. Significant gene upregulations are found in the dorsal root ganglia, regarding inflammatory, proapoptotic and neuropathic pain signals. Genetic profiling of neuroinflammation at the local injured nerve reveals persistent upregulation of multiple genes involving oxysterol metabolism, neuronal apoptosis, and proliferation after nerve release. Further validation of the independent roles of each signal pathway will contribute to molecular therapies for compressive neuropathy in the future.
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Lesiones por Aplastamiento/patología , Descompresión Quirúrgica , Neuropatía Ciática/patología , Animales , Axones/patología , Constricción , Lesiones por Aplastamiento/genética , Lesiones por Aplastamiento/inmunología , Lesiones por Aplastamiento/cirugía , Desnervación , Ganglios Espinales/patología , Perfilación de la Expresión Génica , Hiperalgesia/etiología , Inmunidad Innata , Inflamación , Masculino , Músculo Esquelético/inervación , Músculo Esquelético/patología , Atrofia Muscular/etiología , Neuralgia/etiología , Periodo Posoperatorio , Ratas , Ratas Sprague-Dawley , Remielinización , Neuropatía Ciática/genética , Neuropatía Ciática/inmunología , Neuropatía Ciática/cirugíaRESUMEN
BACKGROUND: A lot of options have been tried for bridging the two ends of the injured nerves. Researchers have used decellularized nerve grafts, artificial materials and even nerve growth factors to augment functional recovery. These materials are either costly or inaccessible in developing world. OBJECTIVE: The study aimed to evaluate the efficacy of the silicone conduit in a rat sciatic nerve injury model. MATERIALS AND METHODS: 24 healthy Sprague-Dawley (SD) rats (250-300 grams; 8-10 weeks) were used and right sciatic nerve was exposed; transected and re-anastomosed by two different methods in 16 rats. In control group, n = 8 (Group I) the sciatic nerve was untouched; Group II (reverse nerve anastomosis, n = 8): 1-centimeter of nerve was cut and re-anastomosed by using 10-0 monofilament suture; Group III (silicone conduit, n = 8) 1-centimeter nerve segment was cut, replaced by silicone conduit and supplemented by fibrin glue]. Evaluation of nerve recovery was done functionally (pain threshold and sciatic functional index) over 3 months and histologically and electron microscopically. RESULTS: Functional results showed a trend of clinical improvement in Group III and II but recovery was poor and never reached up to normal. Histopathological and electron microscopic results showed an incomplete axonal regeneration in Groups II and III. Psychological analyses showed that no outwards signs of stress were present and none of the rats showed paw biting and teeth chattering. CONCLUSION: The silicone conduit graft may be an economical and effective alternative to presently available interposition grafts, however for short segments only.
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Regeneración Nerviosa , Neuropatía Ciática , Animales , Ratas , Ratas Sprague-Dawley , Nervio Ciático/cirugía , Neuropatía Ciática/cirugía , SiliconasRESUMEN
After peripheral nerve injury, Schwann cells (SCs) are crucially involved in several steps of the subsequent regenerative processes, such as the Wallerian degeneration. They promote lysis and phagocytosis of myelin, secrete numbers of neurotrophic factors and cytokines, and recruit macrophages for a biological debridement. However, nerve injuries with a defect size of >1 cm do not show proper tissue regeneration and require a surgical nerve gap reconstruction. To find a sufficient alternative to the current gold standard-the autologous nerve transplant-several cell-based therapies have been developed and were experimentally investigated. One approach aims on the use of adipose tissue stem cells (ASCs). These are multipotent mesenchymal stromal cells that can differentiate into multiple phenotypes along the mesodermal lineage, such as osteoblasts, chondrocytes, and myocytes. Furthermore, ASCs also possess neurotrophic features, that is, they secrete neurotrophic factors like the nerve growth factor, brain-derived neurotrophic factor, neurotrophin-3, ciliary neurotrophic factor, glial cell-derived neurotrophic factor, and artemin. They can also differentiate into the so-called Schwann cell-like cells (SCLCs). These cells share features with naturally occurring SCs, as they also promote nerve regeneration in the periphery. This review gives a comprehensive overview of the use of ASCs in peripheral nerve regeneration and peripheral nerve tissue engineering both in vitro and in vivo. While the sustainability of differentiation of ASCs to SCLCs in vivo is still questionable, ASCs used with different nerve conduits, such as hydrogels or silk fibers, have been shown to promote nerve regeneration.
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Tejido Adiposo/citología , Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas/citología , Regeneración Nerviosa , Traumatismos de los Nervios Periféricos/terapia , Nervios Periféricos/fisiología , Animales , Diferenciación Celular , Células Cultivadas , Humanos , Células Madre Mesenquimatosas/metabolismo , Factores de Crecimiento Nervioso/metabolismo , Regeneración Nerviosa/fisiología , Traumatismos de los Nervios Periféricos/fisiopatología , Traumatismos de los Nervios Periféricos/cirugía , Conejos , Ratas , Células de Schwann/fisiología , Células de Schwann/trasplante , Neuropatía Ciática/cirugía , Neuropatía Ciática/terapia , Ingeniería de Tejidos , Andamios del Tejido , Trasplante AutólogoRESUMEN
OBJECTIVE: Sciatic nerve injury in the deep gluteal space is a major clinical problem due to microsurgical manipulations in this region are limited in scope. We offer new endoscopic approach to the sciatic nerve in the deep gluteal space which allows to perform microsurgical manipulations, neurophysiological mapping and electrode installation for the chronic nerve stimulation. MATERIAL AND METHOD: 3 patients with sciatic neuropathy have been operated. Before the operation they suffered from neuropathic pain in the the posterior thigh and calf, reaching 7-8 points on the visual analog scale (VAS). Paresis of triceps surae and biceps femur also was occurred. We performed endoscopic approach to the deep gluteal space through a small incision under the gluteal fold. Microsurgical external and internal decompression of sciatic nerve was performed under the endoscopic control. Next, intra-trunk nerve mapping was performed to visualize sensory fibers. Cylindrical electrodes for chronic neurostimulation were directly placed on the sensory fibers of sciatic nerve. RESULTS: Pain relief was obtained in all cases after activating the simulator, the patient noted a 50% reduction in pain. Muscle straight restoration was observed in all cases 2-3 months later. The clinical effect was stable in the follow up (6 months). CONCLUSION: This technique, combining minimal invasiveness and intraoperative neurophysiological control, makes it possible to optimally position the electrode, both to achieve positive analgesic effect and for potential restoration of nerve function.
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Neuralgia , Neuropatía Ciática , Nalgas , Endoscopía , Humanos , Neuralgia/etiología , Neuralgia/terapia , Nervio Ciático , Neuropatía Ciática/etiología , Neuropatía Ciática/cirugíaRESUMEN
PURPOSE: To investigate the effects of Chemically Extracted Acellular Nerves (CEANs) when combined with Adipose-Derived mesenchymal Stem Cell (ADSC) transplantation on the repair of sciatic nerve defects in rabbits. METHODS: A total of 71 six-month-old Japanese rabbit were used in this study. Twenty rabbits served as sciatic nerve donors, while the other 51 rabbits were randomly divided into Autologous Nerve Transplantation Group (ANT, n=17), CEAN group (n=17) and CEAN-ADSCs group (n=17). In all these groups, the rabbit's left sciatic nerves were injured before the experiment, and the uninjured sciatic nerves on their right side were used as the control (CON). Electrophysiological tests were carried out and sciatic nerves were prepared for histomorphology and stretch testing at 24 weeks post-transplant. RESULTS: There were significant differences between ANT and Con groups in amplitude (AMP): P=0.031; motor nerve conduction velocity (MNCV): P=0.029; Maximum stress: P=0.029; and Maximum strain P=0.027. There were also differences between the CEAN and CEAN+ADSCs groups in AMP: P=0.026, MNCV: P=0.024; Maximum stress: P=0.025 and Maximum strain: P=0.030. No significant differences in these parameters were observed when comparing the ANT and CEAN+SACN groups (MNCV: P=0.071) or the CEAN and ANT groups (Maximum stress: P=0.069; Maximum strain P=0.077). CONCLUSION: Addition of ADSCs has a significant impact on the recovery of nerve function, morphology, and tensile mechanical properties following sciatic nerve injury.
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Trasplante de Células Madre Mesenquimatosas/métodos , Células Madre Mesenquimatosas , Tejido Nervioso/trasplante , Neuropatía Ciática/fisiopatología , Neuropatía Ciática/cirugía , Animales , Fenómenos Biomecánicos , Electromiografía , Masculino , Regeneración Nerviosa/fisiología , Tejido Nervioso/citología , Conejos , Valores de Referencia , Reproducibilidad de los Resultados , Nervio Ciático/fisiopatología , Nervio Ciático/cirugía , Resultado del TratamientoRESUMEN
Several studies have investigated the use of invasive and non-invasive stimulation methods to enhance nerve regeneration, and varying degrees of effectiveness have been reported. However, due to the use of different parameters in these studies, a fair comparison between the effectiveness of invasive and non-invasive stimulation methods is not possible. The present study compared the effectiveness of invasive and non-invasive stimulation using similar parameters. Eighteen Sprague Dawley rats were classified into three groups: the iES group stimulated with fully implantable device, the tES group stimulated with transcutaneous electrical nerve stimulation (TENS), and the injury group (no stimulation). The iES and tES groups received stimulation for 6 weeks starting immediately after the injury. Motor function was evaluated using the sciatic functional index (SFI) every week. The SFI values increased over time in all groups; faster and superior functional recovery was observed in the iES group than in the tES group. Histological evaluation of the nerve sections and gastrocnemius muscle sections were performed every other week. The axon diameter and muscle fiber area in the iES group were larger, and the g-ratio in the iES group was closer to 0.6 than those in the tES group. To assess the cause of the difference in efficiency, a 3D rat anatomical model was used to simulate the induced electric fields in each group. A significantly higher concentration and intensity around the sciatic nerve was observed in the iES group than in the tES group. Vector field distribution showed that the field was orthogonal to the sciatic nerve spread in the tES group, whereas it was parallel in the iES group; this suggested that the tES group was less effective in nerve stimulation. The results indicated that even though rats in the TENS group showed better recovery than those in the injury group, it cannot replace direct stimulation yet because rats stimulated with the invasive method showed faster recovery and superior outcomes. This was likely attributable to the greater concentration and parallel distribution of electric field with respect to target nerve.
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Lesiones por Aplastamiento/terapia , Regeneración Nerviosa/fisiología , Neuropatía Ciática/terapia , Estimulación Eléctrica Transcutánea del Nervio , Animales , Axones/efectos de la radiación , Lesiones por Aplastamiento/fisiopatología , Lesiones por Aplastamiento/cirugía , Modelos Animales de Enfermedad , Humanos , Fibras Musculares Esqueléticas/fisiología , Fibras Musculares Esqueléticas/efectos de la radiación , Músculo Esquelético/fisiopatología , Músculo Esquelético/efectos de la radiación , Compresión Nerviosa/métodos , Ratas , Ratas Sprague-Dawley , Recuperación de la Función/fisiología , Nervio Ciático/crecimiento & desarrollo , Nervio Ciático/fisiopatología , Nervio Ciático/cirugía , Neuropatía Ciática/fisiopatología , Neuropatía Ciática/cirugíaRESUMEN
This article reports the case of a 42-year-old male patient, who sustained a gluteal compartment syndrome after drug-induced immobilization with subsequent rhabdomyolysis and sciatic nerve palsy. Unlike compartment syndrome of the forearm or lower leg, this is a rare condition. After immediate surgical decompression and installation of negative pressure wound treatment, hemofiltration in acute renal failure could be averted using forced diuresis. The sensorimotor function of the lower extremity improved already after the first treatment and secondary wound closure was possible after 1 week. The patient was discharged 11 days after admission with complete recovery of sensorimotor and renal functions.
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Lesión Renal Aguda/prevención & control , Nalgas/lesiones , Nalgas/cirugía , Síndromes Compartimentales/cirugía , Trastornos Relacionados con Opioides/terapia , Lesión Renal Aguda/etiología , Adulto , Síndromes Compartimentales/etiología , Descompresión Quirúrgica , Diuresis , Diuréticos/uso terapéutico , Humanos , Masculino , Terapia de Presión Negativa para Heridas , Trastornos Relacionados con Opioides/complicaciones , Recuperación de la Función , Rabdomiólisis/etiología , Rabdomiólisis/cirugía , Neuropatía Ciática/etiología , Neuropatía Ciática/cirugía , Técnicas de Cierre de HeridasAsunto(s)
Glucósidos/farmacología , Regeneración Tisular Dirigida/métodos , Regeneración Nerviosa/efectos de los fármacos , Fenoles/farmacología , Células de Schwann/efectos de los fármacos , Nervio Ciático/lesiones , Neuropatía Ciática/cirugía , Animales , Masculino , Movimiento , Músculo Esquelético/inervación , Músculo Esquelético/fisiología , Vaina de Mielina/metabolismo , Ratas , Ratas Sprague-Dawley , Células de Schwann/metabolismo , Nervio Ciático/fisiologíaRESUMEN
OBJECTIVE: Hydrogel scaffolds hold promise for a myriad of tissue engineering applications, but often lack tissue-mimetic architecture. Therefore, in this work, we sought to develop a new technology for the incorporation of aligned tubular architecture within hydrogel scaffolds engineered from the bottom-up. APPROACH: We report a platform fabrication technology-magnetic templating-distinct from other approaches in that it uses dissolvable magnetic alginate microparticles (MAMs) to form aligned columnar structures under an applied magnetic field. Removal of the MAMs yields scaffolds with aligned tubular microarchitecture that can promote cell remodeling for a variety of applications. This approach affords control of microstructure diameter and biological modification for advanced applications. Here, we sought to replicate the microarchitecture of the native nerve basal lamina using magnetic templating of hydrogels composed of glycidyl methacrylate hyaluronic acid and collagen I. MAIN RESULTS: Magnetically templated hydrogels were characterized for particle alignment and micro-porosity. Overall MAM removal efficacy was verified by 96.8% removal of iron oxide nanoparticles. Compressive mechanical properties were well-matched to peripheral nerve tissue at 0.93 kPa and 1.29 kPa, respectively. In vitro, templated hydrogels exhibited approximately 36% faster degradation over 12 h, and were found to guide axon extension from dorsal root ganglia. Finally, in a pilot in vivo study utilizing a 10 mm rat sciatic nerve defect model, magnetically templated hydrogels demonstrated promising results with qualitatively increased remodeling and axon regeneration compared to non-templated controls. SIGNIFICANCE: This simple and scalable technology has the flexibility to control tubular microstructure over long length scales, and thus the potential to meet the need for engineered scaffolds for tissue regeneration, including nerve guidance scaffolds.
Asunto(s)
Ganglios Espinales/fisiología , Hidrogeles/química , Regeneración Nerviosa/fisiología , Neuropatía Ciática/cirugía , Ingeniería de Tejidos/métodos , Andamios del Tejido/química , Alginatos/química , Animales , Animales Recién Nacidos , Fenómenos Biomecánicos/fisiología , Células Cultivadas , Nanopartículas Magnéticas de Óxido de Hierro/química , Fenómenos Magnéticos , Ratas , Ratas Sprague-Dawley , Neuropatía Ciática/fisiopatologíaRESUMEN
Abstract Purpose To investigate the effects of Chemically Extracted Acellular Nerves (CEANs) when combined with Adipose-Derived mesenchymal Stem Cell (ADSC) transplantation on the repair of sciatic nerve defects in rabbits. Methods A total of 71 six-month-old Japanese rabbit were used in this study. Twenty rabbits served as sciatic nerve donors, while the other 51 rabbits were randomly divided into Autologous Nerve Transplantation Group (ANT, n=17), CEAN group (n=17) and CEAN-ADSCs group (n=17). In all these groups, the rabbit's left sciatic nerves were injured before the experiment, and the uninjured sciatic nerves on their right side were used as the control (CON). Electrophysiological tests were carried out and sciatic nerves were prepared for histomorphology and stretch testing at 24 weeks post-transplant. Results There were significant differences between ANT and Con groups in amplitude (AMP): P=0.031; motor nerve conduction velocity (MNCV): P=0.029; Maximum stress: P=0.029; and Maximum strain P=0.027. There were also differences between the CEAN and CEAN+ADSCs groups in AMP: P=0.026, MNCV: P=0.024; Maximum stress: P=0.025 and Maximum strain: P=0.030. No significant differences in these parameters were observed when comparing the ANT and CEAN+SACN groups (MNCV: P=0.071) or the CEAN and ANT groups (Maximum stress: P=0.069; Maximum strain P=0.077). Conclusion Addition of ADSCs has a significant impact on the recovery of nerve function, morphology, and tensile mechanical properties following sciatic nerve injury.