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1.
Acta Chir Orthop Traumatol Cech ; 86(5): 348-352, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748110

RESUMO

PURPOSE OF THE STUDY The prevalence of nerve structure injuries accompanying pelvic and acetabular fractures is stated to be 5-25 %, with most frequent injuries to motor nerve structures associated with fractures of the posterior wall of the acetabulum. Prognostically worse outcomes of regeneration are documented mainly in iatrogenic, intraoperative injuries to nerve structures. This study aims to document the functional effect of muscle transfers restoring the movement of lower extremities with irreversible nerve lesion caused by the pelvic and acetabular fracture. MATERIAL AND METHODS A total of 18 patients with irreversible palsy of lower extremities in L4-S1 segments underwent a reconstruction surgery in the period 2006-2016, of whom 13 patients with the mean age of 42 (21-79) years arrived for a follow-up. The group included 10 patients with the loss of function of peroneal portion of the sciatic nerve, one patient sustained femoral nerve lesion and two patients suffered complete sciatic nerve lesion (both the peroneal and tibial portion). The patients were evaluated at the average follow-up of 77 (24-129) months after the reconstruction surgery. The average time interval from pelvic fracture to reconstruction by muscle transfer was 47 (18-151) months. Due to a wide spectrum of functional damage, the patients were evaluated in terms of the overall effect of the reconstruction surgery on the activities of daily living using the LEFS (The Lower Extremity Functional Scale). The surgical techniques used transposition of tensor fascie latae for femoral nerve lesion, transposition of tibialis posteriormuscle for palsy of the peroneal division of the sciatic nerve and tenodesis of tibialis anterior tendon and peroneus longustendon for the palsy of the peroneal and tibial portion of sciatic nerve. RESULTS The effect of movement restoration on daily living evaluated using the LEFS achieved 65 points (53-79) which is 85% of the average value of LEFS in healthy population. The transposition of active muscles tibialis posterior and tensor fasciae latae resulted in all the patients in active movement restoration. A loss of correction of foot position following the performed tenodesis of the paralysed tibialis anterior muscle was observed in one patient, with no significant impact on function. No infection complication was reported in the group. In 78% of patients the intervention was performed as day surgery. DISCUSSION There is a better prognosis for restoration in incomplete nerve lesion than in complete lesions and also in the loss of sensation than in the loss of motor function. The mini-invasive stabilisation of pelvic ring according to literature does not increase the risk of nerve lesions, while on the other hand a higher incidence of femoral nerve damage by INFIX fixator is documented. The type of muscle transfer is selected based on the availability of active muscles suitable for transposition and also with respect to functional requirements of the patient. CONCLUSIONS Irreversible palsy of lower extremity after the pelvic fracture is easily manageable as to the restoration of function. Surgical interventions using the preserved active muscles to restore the lost movement should be a component part of comprehensive surgical care for patients who sustained a pelvic fracture and should be performed centrally at a centre availing of comprehensive expertise. Key words: nerve lesion, tendon transfer, acetabulum, pelvis, fracture.


Assuntos
Fraturas Ósseas/complicações , Traumatismos da Perna/cirurgia , Paraplegia/cirurgia , Ossos Pélvicos/lesões , Traumatismos dos Nervos Periféricos/cirurgia , Transferência Tendinosa/métodos , Acetábulo/lesões , Atividades Cotidianas , Adulto , Idoso , Humanos , Plexo Lombossacral/lesões , Pessoa de Meia-Idade , Mononeuropatias/etiologia , Mononeuropatias/cirurgia , Músculo Esquelético/inervação , Músculo Esquelético/transplante , Paraplegia/etiologia , Traumatismos dos Nervos Periféricos/etiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos
2.
Med Sci Sports Exerc ; 51(9): 1961-1970, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31415444

RESUMO

PURPOSE: The purpose of this study was to compare the development and etiology of neuromuscular fatigue of the knee extensor muscles at different muscle-tendon unit (MTU) lengths during repeated maximal voluntary isometric contractions (MVIC) between boys and men. METHODS: Twenty-two prepubertal boys (9-11 yr) and 22 men (18-30 yr) performed three knee extensor fatigue protocols at short (SHORT), optimal (OPT), and long (LONG) MTU lengths, consisting of repeating 5-s MVIC interspersed with 5-s passive recovery periods until torque reached 60% of the initial MVIC torque. The etiology of neuromuscular fatigue was identified using noninvasive methods such as surface electromyography, near-infrared spectroscopy, magnetic nerve stimulation and twitch interpolation technique. RESULTS: The number of repetitions was significantly lower in men at OPT (14.8 ± 3.2) and LONG (15.8 ± 5.8) than boys (39.7 ± 18.4 and 29.5 ± 10.2, respectively; P < 0.001), whereas no difference was found at SHORT between both age groups (boys, 33.7 ± 15.4; men, 40.9 ± 14.2). At OPT and LONG boys showed a lower reduction in the single potentiated twitch (Qtwpot) and a greater decrease in the voluntary activation level than men. At SHORT, both populations displayed a moderate Qtwpot decrement and a significant voluntary activation reduction (P < 0.001). The differences in maximal torque between boys and men were almost twice greater at OPT (223.9 N·m) than at SHORT (123.3 N·m) and LONG (136.5 N·m). CONCLUSIONS: The differences in neuromuscular fatigue between children and adults are dependent on MTU length. Differences in maximal torque could underpin differences in neuromuscular fatigue between children and adults at OPT and SHORT. However, at LONG these differences do not seem to be explained by differences in maximal torque. The origins of this specific effect of MTU length remain to be determined.


Assuntos
Contração Isométrica/fisiologia , Fadiga Muscular/fisiologia , Músculo Esquelético/fisiologia , Tendões/fisiologia , Adolescente , Adulto , Criança , Eletromiografia , Humanos , Joelho/fisiologia , Magnetismo , Músculo Esquelético/inervação , Torque , Adulto Jovem
3.
Muscle Nerve ; 60(5): 629-636, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31397919

RESUMO

INTRODUCTION: Neuroenhancing therapies are desired because repair of nerve injuries can fail to achieve recovery. We compared two neuroenhancing therapies, electrical stimulation (ES) and systemic tacrolimus (FK506), for their capabilities to enhance regeneration in the context of a rat model. METHODS: Rats were randomized to four groups: ES 0.5 mA, ES 2.0 mA, FK506, and repair alone. All groups underwent tibial nerve transection and repair, and outcomes were assessed by using twice per week walking track analysis, cold allodynia response, relative muscle mass, and nerve histology. RESULTS: Electrical stimulation and FK506 groups demonstrated improved functional recovery and myelinated axon counts distal to the repair compared with repair alone. Electrical stimulation provided improvements in nerve regeneration that were not different from optimized FK506 systemic administration. DISCUSSION: Providing ES after nerve repair improved regeneration and recovery in rats, with minimal differences in therapeutic efficacy to FK506, further demonstrating its clinical potential to improve management of nerve injuries.


Assuntos
Estimulação Elétrica/métodos , Imunossupressores/farmacologia , Regeneração Nervosa/efeitos dos fármacos , Recuperação de Função Fisiológica/efeitos dos fármacos , Tacrolimo/farmacologia , Nervo Tibial/lesões , Animais , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/inervação , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Regeneração Nervosa/fisiologia , Procedimentos Neurocirúrgicos , Traumatismos dos Nervos Periféricos , Ratos , Recuperação de Função Fisiológica/fisiologia , Nervo Tibial/patologia , Nervo Tibial/cirurgia
4.
Muscle Nerve ; 60(5): 604-612, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31408210

RESUMO

INTRODUCTION: In this study we present a reproducible technique to assess motor recovery after nerve injury via neuromuscular junction (NMJ) immunostaining and electrodiagnostic testing. METHODS: Wild-type mice underwent sciatic nerve transection with repair. Hindlimb muscles were collected for microscopy up to 30 weeks after injury. Immunostaining was used to assess axons (NF200), Schwann cells (S100), and motor endplates (α-bungarotoxin). Compound motor action potential (CMAP) amplitude was used to assess tibialis anterior (TA) function. RESULTS: One week after injury, nearly all (98.0%) endplates were denervated. At 8 weeks, endplates were either partially (28.3%) or fully (71.7%) reinnervated. At 16 weeks, NMJ reinnervation reached 87.3%. CMAP amplitude was 83% of naive mice at 16 weeks and correlated with percentage of fully reinnervated NMJs. Morphological differences were noted between injured and noninjured NMJs. DISCUSSION: We present a reproducible method for evaluating NMJ reinnervation. Electrodiagnostic data summarize NMJ recovery. Characterization of wild-type reinnervation provides important data for consideration in experimental design and interpretation.


Assuntos
Potenciais de Ação/fisiologia , Axônios/patologia , Músculo Esquelético/inervação , Regeneração Nervosa/fisiologia , Junção Neuromuscular/patologia , Células de Schwann/patologia , Animais , Bungarotoxinas , Camundongos , Placa Motora/patologia , Placa Motora/fisiopatologia , Denervação Muscular , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Proteínas de Neurofilamentos , Junção Neuromuscular/fisiopatologia , Procedimentos Neurocirúrgicos , Recuperação de Função Fisiológica , Proteínas S100 , Nervo Isquiático/lesões , Nervo Isquiático/cirurgia , Coloração e Rotulagem , Cicatrização
5.
J Electromyogr Kinesiol ; 48: 197-204, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31442925

RESUMO

PURPOSE: People with Joint Hypermobility Syndrome (JHS) suffer with fatigue. The purpose of this project was to investigate the contribution of central and peripheral fatigue. METHODS: Electrical stimulation of the musculocutaneous nerve to biceps brachii, and transcranial magnetic stimulation over the motor cortex supplying biceps brachii were used. Peripheral and central fatigue were assessed during a control, fatiguing and recovery phase protocol. RESULTS: JHS participants perceived greater fatigue during the protocol compared to a control group and did not recover. Central and peripheral fatigue did not occur in the control group. However, the JHS group showed central fatigue. MEP amplitude increased in the JHS group during the fatiguing protocol (p < 0.01) before recovering. Superimposed twitch amplitude increased in the JHS group during the fatiguing protocol and stayed elevated during the recovery phase (p < 0.04). Time to peak (TTP) amplitude of the torque generated by the TMS was longer in the JHS group (p < 0.05). RMS during MVCs decreased during the fatiguing protocol reaching significance during the recovery phase (p < 0.01). CONCLUSION: JHS participants suffered central but not peripheral fatigue. A modified strength programme to target this is discussed.


Assuntos
Fadiga/etiologia , Instabilidade Articular/fisiopatologia , Córtex Motor/fisiopatologia , Fadiga Muscular , Nervos Periféricos/fisiopatologia , Adulto , Fadiga/fisiopatologia , Feminino , Humanos , Instabilidade Articular/complicações , Masculino , Músculo Esquelético/inervação , Músculo Esquelético/fisiopatologia , Torque
6.
Muscle Nerve ; 60(4): 474-483, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31365129

RESUMO

INTRODUCTION: Poor recovery following nerve repair is due to progressive temporal loss of muscle function. Follistatin (FS), a glycoprotein with anabolic properties, may enhance muscle recovery following reinnervation. METHODS: Seventy-two male Sprague-Dawley rats underwent temporary (3 or 6 month) denervation or sham denervation. After reinnervation, rats were administered adeno-associated viral vectors expressing FS deoxyribonucleic acid (isoform FS-317) injected into the target muscle or sham treatment. Final assessment included muscle function testing, muscle histomorphology, nerve histomorphology, and FS protein quantification. RESULTS: FS improved muscle mass and type IIB muscle fiber size, and increased G-ratios and mean axon diameter in the 6-month temporary denervation group (P < .05). Elevated FS protein levels were detected in treated muscle (P < .05). FS increased satellite cell counts following temporary denervation and repair (P < .05). DISCUSSION: FS treatment had anabolic, neurotrophic, and satellite cell stimulatory effects when administered following prolonged (6-month) temporary denervation and repair.


Assuntos
Folistatina/genética , Denervação Muscular , Fibras Musculares Esqueléticas/metabolismo , Músculo Esquelético/metabolismo , Recuperação de Função Fisiológica/genética , Nervo Tibial/cirurgia , Animais , Contagem de Células , Dependovirus , Técnicas de Transferência de Genes , Vetores Genéticos , Força Muscular/genética , Músculo Esquelético/citologia , Músculo Esquelético/inervação , Cadeias Pesadas de Miosina/metabolismo , Ratos , Ratos Sprague-Dawley , Células Satélites de Músculo Esquelético/citologia , Nervo Tibial/metabolismo , Nervo Tibial/patologia
7.
Muscle Nerve ; 60(4): 400-408, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31330055

RESUMO

INTRODUCTION: The objective of this study was to determine compound muscle action potential (CMAP) scan parameters and MScanFit motor unit number estimation (MUNE) in patients with amyotrophic lateral sclerosis (ALS) and to compare the results in the abductor pollicis brevis (APB) to those in the abductor digiti minimi (ADM). METHODS: CMAP scans were recorded from the APB and ADM in 35 patients with ALS and 21 controls. MScanFit MUNE, neurophysiological index (NI), step%, returner%, and D50 were calculated. RESULTS: CMAP scan parameters including the returner%, MScanFit MUNE, and NI can distinguish ALS with high sensitivity and specificity. The electrophysiological parameters, with the exception of D50 (the number of largest consecutive differences of recorded responses generating 50% of maximum CMAP), showed more pronounced changes in the APB than in the ADM, even though most of the patients had normal APB/ADM amplitude ratios. DISCUSSION: CMAP scan parameters and MScanFit MUNE can be used in the evaluation of denervation and reinnervation and may herald the "split hand" in ALS.


Assuntos
Potenciais de Ação/fisiologia , Esclerose Amiotrófica Lateral/fisiopatologia , Mãos , Músculo Esquelético/inervação , Adulto , Idoso , Esclerose Amiotrófica Lateral/diagnóstico , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiologia , Regeneração Nervosa
8.
Plast Reconstr Surg ; 144(2): 218e-229e, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348345

RESUMO

BACKGROUND: Traditional approaches to amputation are not capable of reproducing the dynamic muscle relationships that are essential for proprioceptive sensation and joint control. In this study, the authors present two caprine models of the agonist-antagonist myoneural interface (AMI), a surgical approach designed to improve bidirectional neural control of a bionic limb. The key advancement of the AMI is the surgical coaptation of natively innervated agonist-antagonist muscle pairs within the residual limb. METHODS: One AMI was surgically created in the hindlimb of each of two African Pygmy goats at the time of primary transtibial amputation. Each animal was also implanted with muscle electrodes and sonomicrometer crystals to enable measurement of muscle activation and muscle state, respectively. Coupled agonist-antagonist excursion in the agonist-antagonist myoneural interface muscles was measured longitudinally for each animal. Fibrosis in the residual limb was evaluated grossly in each animal as part of a planned terminal procedure. RESULTS: Electromyographic and muscle state measurements showed coupled agonist-antagonist motion within the AMI in the presence of both neural activation and artificial muscle stimulation. Gross observation of the residual limb during a planned terminal procedure revealed a thin fibrotic encapsulation of the AMI constructs, which was not sufficient to preclude coupled muscle excursion. CONCLUSIONS: These findings highlight the AMI's potential to provide coupled motion of distal agonist-antagonist muscle pairs preserved during below- or above-knee amputation at nearly human scale. Guided by these findings, it is the authors' expectation that further development of the AMI architecture will improve neural control of advanced limb prostheses through incorporation of physiologically relevant muscle-tendon proprioception.


Assuntos
Amputação/métodos , Eletromiografia/métodos , Propriocepção , Desenho de Prótese , Implantação de Prótese/métodos , Animais , Membros Artificiais , Modelos Animais de Doenças , Eletrodos Implantados , Feminino , Fêmur/cirurgia , Cabras , Masculino , Músculo Esquelético/inervação , Tíbia/cirurgia
9.
Muscle Nerve ; 60(4): 387-391, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31294856

RESUMO

BACKGROUND: This study evaluated muscle echo intensity (EI) ratio in patients with ulnar neuropathy at the elbow (UNE) and healthy controls. METHODS: In this prospective study, 28 patients with electrodiagnostically confirmed unilateral UNE and 12 healthy controls were ultrasonographically assessed for EI ratios of the hypothenar and thenar muscles. The affected and unaffected hands between the UNE patients and controls and patient subgroups (subdivided according to electrodiagnostic severity) were compared to determine any significant differences. RESULTS: In patients with UNE, the EI ratio of the hypothenar to thenar muscles was significantly higher for the affected side than for the unaffected side (1.08 ± 0.11 and 0.97 ± 0.18, respectively) or the control group (0.95 ± 0.05). A significant difference in the EI ratio was observed among the subgroups (mild vs. severe subgroup, P < 0.01). CONCLUSIONS: Ultrasonographic EI measurement may be a useful parameter in the evaluation and screening of UNE.


Assuntos
Mãos/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Neuropatias Ulnares/diagnóstico por imagem , Adulto , Idoso , Área Sob a Curva , Estudos de Casos e Controles , Eletrodiagnóstico , Feminino , Humanos , Masculino , Nervo Mediano , Pessoa de Meia-Idade , Músculo Esquelético/inervação , Projetos Piloto , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Nervo Ulnar/fisiopatologia , Neuropatias Ulnares/fisiopatologia
10.
Muscle Nerve ; 60(4): 453-463, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31314910

RESUMO

INTRODUCTION: Muscle fiber denervation increases with age, yet studies at the tissue level are sparse due to the challenging nature of establishing the relative role of regeneration and denervation. METHODS: Muscle biopsies were obtained from the vastus lateralis of 70 healthy men (aged 72 ± 6 years; range, 65-94). Messenger RNA (mRNA) levels of acetylcholine receptors (AchR) were measured, and sections were stained for embryonic myosin, neonatal myosin (MHCn ), and neural cell adhesion molecule (NCAM). RESULTS: Embryonic myosin+ fibers were rare, while MHCn + and NCAM+ fibers were observed in all samples. Age (range, 65-94 years) was negatively associated with AchRγ mRNA. DISCUSSION: Muscle from healthy older individuals expressed developmental myosins to varying degrees but more than has been previously reported for young individuals. Along with the AchR correlations, we propose that these findings support the presence of neuromuscular junction destabilization, denervation, and reinnervation in aging human skeletal muscle.


Assuntos
Envelhecimento/genética , Fibras Musculares Esqueléticas/metabolismo , Cadeias Pesadas de Miosina/genética , Moléculas de Adesão de Célula Nervosa/genética , Músculo Quadríceps/inervação , Receptores Colinérgicos/genética , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/metabolismo , Humanos , Masculino , Músculo Esquelético/inervação , Músculo Esquelético/metabolismo , Cadeias Pesadas de Miosina/metabolismo , Moléculas de Adesão de Célula Nervosa/metabolismo , Músculo Quadríceps/metabolismo , RNA Mensageiro/metabolismo , Receptores Nicotínicos/genética
11.
Gait Posture ; 72: 222-227, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31260860

RESUMO

BACKGROUND: Prior studies have analyzed the activity of the gastrocnemius (GCM) medial and lateral heads as a single unit because it is technically challenging to separately analyze the function of each component in vivo. However, functional variation between the medial and lateral heads is expected due to their anatomical differences. RESEARCH QUESTION: What is the independent function of the medial GCM? How does paralysis of the GCM medial head affect gait kinematics?. METHODS: Twelve healthy adults (two males and ten females; age: 28.2 [±7.72] years) that were scheduled to undergo neurolysis of the tibial nerve branch supplying the medial head of the GCM for aesthetic calf reduction participated in the study. Gait analysis was performed using a computerized opto-electric gait analysis system to measure kinematic data. Surface electromyography (EMG) was recorded simultaneously during the gait analysis. Surface electrodes were placed on seven muscles. Pre-procedure and 1-week and 3-month post-procedure data were compared using a linear mixed model. RESULTS: During level walking, decreased activity of the GCM medial head did not significantly change gait kinematics. However, a significant increase in GCM lateral head and hamstring activities occurred after a branch nerve block to the GCM medial head. During stair ascent, in contrast to level walking, changes in EMG activity only occurred in the GCM medial head, and post-procedure ankle dorsiflexion angles at the end of the terminal-stance phase significantly increased. Ankle plantarflexion angles during the push-off phase were also decreased when compared with pre-procedure values. SIGNIFICANCE: The human body response to dysfunction of the GCM medial head depended on the type of locomotion.


Assuntos
Marcha , Músculo Esquelético/inervação , Paraplegia/fisiopatologia , Subida de Escada , Nervo Tibial , Caminhada , Adulto , Fenômenos Biomecânicos , Eletromiografia , Feminino , Humanos , Masculino
12.
Einstein (Sao Paulo) ; 17(3): eAO4489, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31271607

RESUMO

OBJECTIVE: To analyze the anatomical variations of the innervation of the flexor digitorum superficialis muscle and to determine if the branch of the median nerve that supply this muscle is connected to the branches to the extensor carpi radialis brevis and the pronator teres muscles, without tension, and how close to the target-muscles the transfer can be performed. METHODS: Fifty limbs of 25 cadavers were dissected to collect data on the anatomical variations of the branches to the flexor digitorum superficialis muscle. RESULTS: This muscle received innervation from the median nerve in the 50 limbs. In 22 it received one branch, and in 28 more than one. The proximal branch was identified in 22 limbs, and in 12 limbs it shared branches with other muscles. The distal branch was present in all, and originated from the median nerve as an isolated branch, or a common trunk with the anterior interosseous nerve in 3 limbs, and from a common trunk with the flexor carpi radialis muscle and anterior interosseous nerve in another. It originated distally to the anterior interosseous nerve at 38, in 5 on the same level, and in 3 proximal to the anterior interosseous nerve. In four limbs, innervation came from the anterior interosseous nerve, as well as from the median nerve. Accessory branches of the median nerve for the distal portion of the flexor digitorum superficialis muscle were present in eight limbs. CONCLUSION: In 28 limbs with two or more branches, one of them could be connected to the branches to the extensor carpi radialis brevis and pronator teres muscles without tension, even during the pronation and supination movements of the forearm and flexion-extension of the elbow.


Assuntos
Denervação/métodos , Dedos/inervação , Antebraço/inervação , Nervo Mediano/anatomia & histologia , Músculo Esquelético/inervação , Punho/inervação , Adulto , Cadáver , Dissecação , Dedos/cirurgia , Humanos , Masculino , Nervo Mediano/cirurgia , Músculo Esquelético/cirurgia , Tendões
13.
Bone Joint J ; 101-B(7): 867-871, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256676

RESUMO

AIMS: Improvements in the evaluation of outcomes following peripheral nerve injury are needed. Recent studies have identified muscle fatigue as an inevitable consequence of muscle reinnervation. This study aimed to quantify and characterize muscle fatigue within a standardized surgical model of muscle reinnervation. PATIENTS AND METHODS: This retrospective cohort study included 12 patients who underwent Oberlin nerve transfer in an attempt to restore flexion of the elbow following brachial plexus injury. There were ten men and two women with a mean age of 45.5 years (27 to 69). The mean follow-up was 58 months (28 to 100). Repeated and sustained isometric contractions of the elbow flexors were used to assess fatigability of reinnervated muscle. The strength of elbow flexion was measured using a static dynamometer (KgF) and surface electromyography (sEMG). Recordings were used to quantify and characterize fatigability of the reinnervated elbow flexor muscles compared with the uninjured contralateral side. RESULTS: The mean peak force of elbow flexion was 7.88 KgF (sd 3.80) compared with 20.65 KgF (sd 6.88) on the contralateral side (p < 0.001). Reinnervated elbow flexor muscles (biceps brachialis) showed sEMG evidence of fatigue earlier than normal controls with sustained (60-second) isometric contraction. Reinnervated elbow flexor muscles also showed a trend towards a faster twitch muscle fibre type. CONCLUSION: The assessment of motor outcomes must involve more than peak force alone. Reinnervated muscle shows a shift towards fast twitch fibres following reinnervation with an earlier onset of fatigue. Our findings suggest that fatigue is a clinically relevant characteristic of reinnervated muscle. Adoption of these metrics into clinical practice and the assessment of outcome could allow a more meaningful comparison to be made between differing forms of treatment and encourage advances in the management of motor recovery following nerve transfer. Cite this article: Bone Joint J 2019;101-B:867-871.


Assuntos
Plexo Braquial/lesões , Fadiga Muscular , Músculo Esquelético/fisiopatologia , Transferência de Nervo , Traumatismos dos Nervos Periféricos/cirurgia , Complicações Pós-Operatórias/diagnóstico , Adulto , Idoso , Plexo Braquial/cirurgia , Articulação do Cotovelo/fisiologia , Eletromiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Músculo Esquelético/inervação , Músculo Esquelético/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
14.
Cell Mol Neurobiol ; 39(7): 1029-1037, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31172341

RESUMO

Previous studies reported that RNA-binding protein human antigen R (HuR) mediates changes in the stability of AChR ß-subunit mRNA after skeletal muscle denervation; also, p38 pathway regulated the stability of AChR ß-subunit mRNA in C2C12 myotubes. However, the relationship between HuR and p38 in regulating the stability of AChR ß-subunit mRNA have not been clarified. In this study, we wanted to examine the effect of inhibiting p38 on HuR in denervated skeletal muscle. Denervation model was built and 10% DMSO or SB203580 were administered respectively follow denervation. Tibialis muscles were collected in 10% DMSO-administered contralateral (undenervated) leg, 10% DMSO-administered denervated leg, SB203580-administered contralateral (undenervated) leg, and SB203580-administered denervated leg, respectively. P38 protein, ß-AChR mRNA and protein, HuR protein, ß-AChR mRNA stability, and HuR binding with AChR ß-subunit mRNAs were measured. Results demonstrated that the administration of SB203580 can inhibit the increase of ß-AChR protein expression and mRNA expression and stability, and RNA-binding protein human antigen R (HuR) expression, in cytoplasmic and nuclear fractions in skeletal muscle cells following denervation. Importantly, we observed that SB203580 also inhibited the increased level of binding activity between HuR and AChR ß-subunit mRNAs following denervation. Collectively, these results suggested that inhibition of p38 can post-transcriptionally inhibit ß-AChR upregulation via HuR in denervated skeletal muscle.


Assuntos
Proteína Semelhante a ELAV 1/metabolismo , Músculo Esquelético/inervação , Músculo Esquelético/metabolismo , Receptores Nicotínicos/metabolismo , Transcrição Genética , Proteínas Quinases p38 Ativadas por Mitógeno/antagonistas & inibidores , Animais , Ativação Enzimática/efeitos dos fármacos , Extremidades/inervação , Imidazóis/farmacologia , Masculino , Camundongos , Denervação Muscular , Fosforilação/efeitos dos fármacos , Ligação Proteica/efeitos dos fármacos , Estabilidade Proteica/efeitos dos fármacos , Subunidades Proteicas/genética , Subunidades Proteicas/metabolismo , Piridinas/farmacologia , Estabilidade de RNA/efeitos dos fármacos , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos Sprague-Dawley , Receptores Nicotínicos/genética , Transcrição Genética/efeitos dos fármacos , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
15.
J Surg Oncol ; 120(3): 348-358, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31197851

RESUMO

BACKGROUND: We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation. METHODS: Our TMR cohort was compared to a cross-sectional sample of unselected oncologic amputees not treated at our institution (N = 58). Patient-Reported Outcomes Measurement Information System (NRS, PROMIS) were used to assess postamputation pain. RESULTS: Thirty-one patients underwent amputation with concurrent TMR during the study; 27 patients completed pain surveys; 15 had greater than 1 year follow-up (mean follow-up 14.7 months). Neuroma symptoms occurred significantly less frequently and with less intensity among the TMR cohort. Mean differences for PROMIS pain intensity, behavior, and interference for phantom limb pain (PLP) were 5.855 (95%CI 1.159-10.55; P = .015), 5.896 (95%CI 0.492-11.30; P = .033), and 7.435 (95%CI 1.797-13.07; P = .011) respectively, with lower scores for TMR cohort. For residual limb pain, PROMIS pain intensity, behavior, and interference mean differences were 5.477 (95%CI 0.528-10.42; P = .031), 6.195 (95%CI 0.705-11.69; P = .028), and 6.816 (95%CI 1.438-12.2; P = .014), respectively. Fifty-six percent took opioids before amputation compared to 22% at 1 year postoperatively. CONCLUSIONS: Multidisciplinary care of amputees including concurrent amputation and TMR, multimodal postoperative pain management, amputee-centered rehabilitation, and peer support demonstrates reduced incidence and severity of neuroma and PLP.


Assuntos
Cotos de Amputação/inervação , Amputação/métodos , Amputação/reabilitação , Músculo Esquelético/inervação , Neoplasias/cirurgia , Transferência de Nervo/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/reabilitação , Neoplasias Ósseas/cirurgia , Estudos de Coortes , Continuidade da Assistência ao Paciente , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/reabilitação , Osteossarcoma/reabilitação , Osteossarcoma/cirurgia , Equipe de Assistência ao Paciente , Membro Fantasma/prevenção & controle , Sarcoma/reabilitação , Sarcoma/cirurgia , Adulto Jovem
16.
Wien Klin Wochenschr ; 131(23-24): 599-607, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31201567

RESUMO

BACKGROUND: Loss of an extremity at any level has a major impact on a patient's life. Using bionic reconstruction, extremity function can be restored and the patient reintegrated into daily life. Surgical procedures including selective nerve transfer and anchoring of prostheses into bone are combined with structured rehabilitation and modern prosthetic fitting. The patient is thereby able to use the prostheses intuitively and with multiple degrees of freedom. METHODS: This article presents the concept and approach for modern bionic reconstruction in detail and the relevant literature. The nerve transfer matrices for targeted muscle reinnervation (TMR) and the concept of osseointegration to optimally fit a patient with a modern prosthesis are described in detail. As a clinical example, the case of a patient who suffered from traumatic amputation and subsequently received TMR in combination with an osseointegrated implant and structured rehabilitation is presented. RESULTS: Using bionic reconstruction, basic hand functions can be restored and bimanual dexterity can expand the range of daily activities. Besides this approach to bionic reconstruction, its advantages and disadvantages are compared to hand transplantation. The limitations and perspectives of modern bionic reconstruction are also discussed. CONCLUSIONS: Bionic reconstruction is a sophisticated method for restoring extremity function and nowadays can be considered a standard of care for all levels of upper extremity amputations. An interdisciplinary approach and structured rehabilitation are necessary to master prosthetic function to ultimately reintegrate patients into daily life.


Assuntos
Amputação/reabilitação , Membros Artificiais , Músculo Esquelético/inervação , Osseointegração , Extremidade Superior/cirurgia , Biônica , Humanos , Osseointegração/fisiologia , Desenho de Prótese , Implantação de Prótese , Procedimentos Cirúrgicos Reconstrutivos/métodos
17.
Biomed Res ; 40(3): 115-123, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31231094

RESUMO

Nerve transfer involves the use of a portion of a healthy nerve to repair an injured nerve, and the process has been used to alleviate traumatic brachial plexus injuries in humans. Study of the neural mechanisms that occur during nerve transfer, however, requires the establishment of reliable experimental models. In this study, we developed an ulnar-musculocutaneous nerve-transfer model wherein the biceps muscle of a mouse was re-innervated using a donor ulnar nerve. Similar muscle action potentials were detected in both the end-to-end suture of the transected nerve (correctrepair) group and the ulnar-musculocutaneous nerve-transfer group. Also, re-innervated acetylcholine receptor (AChR) clusters and muscle spindles were observed in both procedures. There were fewer re-innervated AChR clusters in the nerve transfer group than in the correct repair group at 4 weeks, but the numbers were equal at 24 weeks following surgery. Thus, our ulnar-musculocutaneous nerve-transfer model allowed physiological and morphological evaluation for re-innervation process in mice and revealed the delay of this process during nerve transfer procedure. This model will provide great opportunities to study regeneration, re-innervation, and functional recovery induced via nerve transfer procedures.


Assuntos
Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/cirurgia , Transferência de Nervo , Animais , Modelos Animais de Doenças , Eletromiografia , Feminino , Imunofluorescência , Camundongos , Neurônios Motores/metabolismo , Músculo Esquelético/inervação , Nervo Musculocutâneo/transplante , Transferência de Nervo/métodos , Junção Neuromuscular/fisiologia , Células Receptoras Sensoriais/metabolismo , Resultado do Tratamento , Nervo Ulnar/transplante
18.
J Stroke Cerebrovasc Dis ; 28(8): 2343-2350, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31208821

RESUMO

BACKGROUND AND PURPOSE: Cerebral small vessel disease (CSVD) is related to motor function disturbance. It includes several types: lacunar infarction, white matter hyperintensity, cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVS). Transcranial magnetic stimulation (TMS) has been successfully used to evaluate the function of the pyramidal tract. Central motor conduction time (CMCT) is one of the indicators of pyramidal tract dysfunction in motor evoked potential (MEP). The aim of this study was to investigate the association between each type of CSVD and CMCT. METHODS: We enrolled 350 patients with vascular risk factors or a history of cerebrovascular events, who showed signs of CSVD in magnetic resonance imaging in the prospective registry. Among them, 138 patients agreed to the evaluation of MEP. CMCT, resting motor threshold (RMT), and silent period are indicators of the function of motor pathways in MEP. A total of 276 hemispheres were divided into 45 symptomatic hemispheres with a history of pyramidal tract dysfunction and 231 without it. Correlation between each type of CSVD and CMCT were examined in total, symptomatic, and asymptomatic hemispheres. RESULTS: The mean age was 70.5 ± 10.3 (mean ± SD) years, and 89 (65%) were men. In the symptomatic hemisphere, CMCT and RMT were significantly higher than in the asymptomatic hemisphere. In the symptomatic hemisphere, significant association was observed between the number of EPVS in the white matter and CMCT (R2 = 0.201, p < .01). CONCLUSIONS: In the symptomatic hemispheres, CMCT was associated with the number of EPVS in the white matter. The EPVS in the white matter may be involved in the motor disturbance due to CSVD.


Assuntos
Doenças de Pequenos Vasos Cerebrais/fisiopatologia , Potencial Evocado Motor , Atividade Motora , Córtex Motor/fisiopatologia , Músculo Esquelético/inervação , Condução Nervosa , Tratos Piramidais/fisiopatologia , Substância Branca/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Estudos Transversais , Eletromiografia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Córtex Motor/diagnóstico por imagem , Contração Muscular , Tratos Piramidais/diagnóstico por imagem , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estimulação Magnética Transcraniana , Substância Branca/diagnóstico por imagem
19.
Curr Med Sci ; 39(3): 419-425, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31209813

RESUMO

In order to investigate the role of the Notch signaling pathway in skeletal muscle fibrosis after nerve injury, 60 Sprague-Dawley rats were selected and divided randomly into a control and two experimental groups. Group A served as controls without any treatment. Rats in groups B were injected intraperitoneally with 0.2 mL PBS and those in group C were injected intraperitoneally with 0.2 mL PBS+100 µmol/L, 0.2 mL N-[N-(3,5-difluorophenacetyl)-l-alanyl]- S-phenylglycine t-butyl ester (DAPT, a gamma-secretase inhibitor that suppresses Notch signaling) respectively, on postoperative days 1, 3, 7, 10, and 14 in a model of denervation-induced skeletal muscle fibrosis by right sciatic nerve transection. Five rats from each group were euthanized on postoperative days 1, 7, 14, and 28 to collect the right gastrocnemii, and hematoxylin and eosin (HE) staining, immunohistochemistry test, real-time PCR, and Western blotting were performed to assess connective tissue hyperplasia and fibroblast density as well as expression of Notch 1, Jagged 1, and Notch downstream molecules Hes 1 and collagen I (COL I) on day 28. There was no significant difference in HE-stained fibroblast density between group B and C on postoperative day 1. However, fibroblast density was significantly higher in group B than in group C on postoperative days 7, 14, and 28. Notch 1, Jagged 1, Hes 1, and COL I proteins in the gastrocnemius were expressed at very low levels in group A but at high levels in group B. Expression levels of these proteins were significantly lower in group C than in group B (P<0.05), but they were higher in group C than in group A (P<0.05) on postoperative day 28. We are led to conclude that locking the Notch signaling pathway inhibits fibrosis progression of denervated skeletal muscle. Thus, it may be a new approach for treatment of fibrosis of denervated skeletal muscle.


Assuntos
Secretases da Proteína Precursora do Amiloide/genética , Dipeptídeos/farmacologia , Inibidores Enzimáticos/farmacologia , Fibroblastos/metabolismo , Receptor Notch1/genética , Nervo Isquiático/efeitos dos fármacos , Secretases da Proteína Precursora do Amiloide/antagonistas & inibidores , Secretases da Proteína Precursora do Amiloide/metabolismo , Animais , Colágeno Tipo I/genética , Colágeno Tipo I/metabolismo , Fibroblastos/efeitos dos fármacos , Fibroblastos/patologia , Fibrose/prevenção & controle , Regulação da Expressão Gênica , Músculos Isquiotibiais/efeitos dos fármacos , Músculos Isquiotibiais/inervação , Músculos Isquiotibiais/metabolismo , Injeções Intraperitoneais , Proteína Jagged-1/genética , Proteína Jagged-1/metabolismo , Masculino , Denervação Muscular/métodos , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/inervação , Músculo Esquelético/metabolismo , Ratos , Ratos Sprague-Dawley , Receptor Notch1/antagonistas & inibidores , Receptor Notch1/metabolismo , Nervo Isquiático/lesões , Nervo Isquiático/metabolismo , Transdução de Sinais , Fatores de Transcrição HES-1/genética , Fatores de Transcrição HES-1/metabolismo
20.
Hypertension ; 74(2): 349-358, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31203727

RESUMO

Nerve traffic recordings (muscle sympathetic nerve traffic [MSNA]) have shown that sympathetic activation may occur in obesity. However, the small sample size of the available studies, presence of comorbidities, heterogeneity of the subjects examined represented major weaknesses not allowing to draw definite conclusions. This is the case for the overweight state. The present meta-analysis evaluated 1438 obese or overweight subjects recruited in 45 microneurographic studies. The analysis was primarily based on MSNA quantification in obesity and overweight, excluding as concomitant conditions hypertension, metabolic syndrome, and other comorbidities. Assessment was extended to the relationships of MSNA with other neuroadrenergic markers, such as plasma norepinephrine and heart rate, anthropometric variables, as body mass index, waist-to-hip ratio, presence/absence of obstructive sleep apnea, and metabolic profile. Compared with normoweights MSNA was significantly greater in overweight and more in obese individuals (37.0±4.1 versus 43.2±3.5 and 50.4±5.0 burts/100 heartbeats, P<0.01). This was the case even in the absence of obstructive sleep apnea. MSNA was significantly directly related to body mass index and waist-to-hip ratio ( r=0.41 and r=0.64, P<0.04 and <0.01, respectively), clinic blood pressure ( r=0.68, P<0.01), total cholesterol, LDL (low-density lipoprotein) cholesterol, and triglycerides ( r=0.91, r=0.94, and r=0.80, respectively, P<0.01) but unrelated to plasma insulin, glucose, and homeostatic model assessment for insulin resistance. No significant correlation was found between MSNA, heart rate, and norepinephrine. Thus, obesity and overweight are characterized by sympathetic overactivity which mirrors the severity of the clinical condition and reflects metabolic alterations, with the exclusion of glucose/insulin profile. Neither heart rate nor norepinephrine appear to represent faithful markers of the muscle sympathetic overdrive.


Assuntos
Índice de Massa Corporal , Músculo Esquelético/inervação , Vias Neurais/fisiopatologia , Obesidade/fisiopatologia , Sistema Nervoso Simpático/fisiopatologia , Adulto , Idoso , Antropometria , Estudos de Casos e Controles , Feminino , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/fisiopatologia , Valores de Referência , Medição de Risco
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