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1.
Ann Vasc Surg ; 62: 70-75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31207398

RESUMO

BACKGROUND: The objective of this study was to characterize phrenic nerve and brachial plexus variation encountered during supraclavicular decompression for neurogenic thoracic outlet syndrome and to identify associated postoperative neurologic complications. METHODS: A multicenter retrospective review was performed to evaluate anatomic variation of the phrenic nerve and brachial plexus from November 2010 to July 2018. After initial characterization, the following two groups were identified: variant anatomy (VA) group and standard anatomy (SA) group. Complications were analyzed and compared between the two groups. RESULTS: In total, 105 patients were identified, and 100 patients met inclusion criteria. Any anatomic variation of the standard course or configuration of the phrenic nerve and/or brachial plexus was encountered in 47 (47%) patients. Phrenic nerve anatomic variations were identified in 28 (28%) patients. These included 9 duplicated nerves, 6 lateral accessory nerves, 8 medial displacement, and 5 lateral displacement. Brachial plexus anatomic variation was found in 34 (34%) patients. The most common variant configuration of a fused middle and inferior trunk was identified in 25 (25%) patients. Combined phrenic nerve and brachial plexus anatomic variation was demonstrated in 15 (15%) patients. The VA and SA groups consisted of 47 and 53 patients, respectively. Transient phrenic nerve injury with postoperative elevation of the ipsilateral hemidiaphragm was documented in 3 (6.4%) patients in the VA group and 6 (11.3%) patients in the SA group (P = 0.49). Permanent phrenic nerve injury was identified in 1 (2.1%) patient in the VA group (P = 0.47) and none in the SA group. Transient brachial plexopathy was encountered in 1 (1.9%) patient in the SA group (P = 1.0) with full recovery to normal function. CONCLUSIONS: Anatomic variability of the phrenic nerve and brachial plexus are encountered more frequently than previously reported. While the incidence of nerve injury is low, surgeons operating within the thoracic aperture should be familiar with variant anatomy to reduce postoperative complications.


Assuntos
Neuropatias do Plexo Braquial/etiologia , Plexo Braquial/anormalidades , Descompressão Cirúrgica/efeitos adversos , Traumatismos dos Nervos Periféricos/etiologia , Nervo Frênico/anormalidades , Síndrome do Desfiladeiro Torácico/cirurgia , Adulto , Plexo Braquial/lesões , Plexo Braquial/fisiopatologia , Neuropatias do Plexo Braquial/fisiopatologia , Feminino , Humanos , Masculino , Maryland , Traumatismos dos Nervos Periféricos/fisiopatologia , Philadelphia , Nervo Frênico/lesões , Nervo Frênico/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/fisiopatologia , Resultado do Tratamento
2.
Ulus Travma Acil Cerrahi Derg ; 25(6): 555-560, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31701508

RESUMO

BACKGROUND: In this study, we aim to assess the safe, risky and high-risky zones by measuring the proximity of the needles to the peroneal and saphenous nerves in millimeters for the repair of tears of the anterior, middle and posterior horns of the medial and lateral menisci at flexion and extension position during inside-out repair technique. METHODS: First, a cadaveric study was conducted on 10 cadaver knees in which both (lateral and medial) menisci were divided into anterior, corpus and posterior with the longitudinal tear simulating in each section. The next phase involved the suture of the simulated tears of the menisci while the knee was at 90° of flexion and full extension. Finally, the distance from the exit points of the K-wire being inserted through meniscal anterior, corpus and posterior tears to the aforementioned nerves was measured with a digital caliper. RESULTS: The distance between K-wire exit points and neurovascular structures concerning corpus and anterior horn tear repair of both menisci were considered far away and not included. However, closer posterior menisci measurements were taken to avoid the risk of iatrogenic nerve injury. The measured distances for lateral meniscus posterior tears were recorded 11±5.2 mm at 90° of flexion and 8±4.5 mm at extension, whereas those recorded 17.3±5.7 mm at 90° of flexion and 13.7±4.7 mm at extension for medial meniscus. These variables were evaluated statistically using a paired t-test; the mean of t value was not considered statistically significant. CONCLUSION: Our results show that the inside-out technique at knee flexion is safe even in the posterior meniscus tears. However, safety distance can be increased with the higher flexion degrees of the knee. Lastly, in posterior meniscal tear repair, we recommend either retractor assisted mini-open technique at knee flexion, or all-inside suture technique, to avoid nerve injury risk in this zone. Although many surgeons do not prefer inside-out techniques for posterior menisci tears, inside-out posterior meniscal repair of both menisci is as safe as an all-inside technique using retractor assisted mini-open technique with the knee at higher than 90° flexion.


Assuntos
Doença Iatrogênica , Meniscos Tibiais , Traumatismos dos Nervos Periféricos , Humanos , Meniscos Tibiais/inervação , Meniscos Tibiais/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Traumatismos dos Nervos Periféricos/patologia , Traumatismos dos Nervos Periféricos/fisiopatologia
3.
Expert Rev Clin Pharmacol ; 12(11): 1047-1057, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31575290

RESUMO

Introduction: The clinical use of tacrolimus is characterized by many side effects which include neurotoxicity. In contrast, tacrolimus has also shown to have neuroregenerative properties. On a molecular level, the mechanisms of action could provide us more insight into understanding the neurobiological effects. The aim of this article is to review current evidence regarding the use of tacrolimus in peripheral nerve injuries.Areas covered: Available data on tacrolimus' indications were summarized and molecular mechanisms were elucidated to possibly understand the conflicting neurotoxic and neuroregenerative effects. The potential clinical applications of tacrolimus, as immunosuppressant and enhancer of nerve regeneration in peripheral nerve injuries, are discussed. Finally, concepts of delivery are explored.Expert opinion: It is unclear what the exact neurobiological effects of tacrolimus are. Besides its known calcineurin inhibiting properties, the mechanism of action of tacrolimus is mediated by its binding to FK506-binding protein-52, resulting in a bimodal dose response. Experimental models found that tacrolimus administration is preferred up to three days prior to or within 10 days post-nerve reconstruction. Moreover, the indication for the use of tacrolimus has been expanding to fields of dermatology, ophthalmology, orthopedic surgery and rheumatology to improve outcomes after various indications.


Assuntos
Regeneração Nervosa/efeitos dos fármacos , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Tacrolimo/administração & dosagem , Animais , Inibidores de Calcineurina/administração & dosagem , Inibidores de Calcineurina/efeitos adversos , Inibidores de Calcineurina/farmacologia , Esquema de Medicação , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Imunossupressores/farmacologia , Síndromes Neurotóxicas/etiologia , Síndromes Neurotóxicas/fisiopatologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Tacrolimo/efeitos adversos , Tacrolimo/farmacologia
4.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(9): 1162-1168, 2019 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-31512460

RESUMO

Objective: To study the expressions of microRNA-221 (miR-221) and the protein of phosphatase and tension protein homologue (PTEN) in the proximal and distal stumps after sciatic nerve injury in rats and their correlation with the repair of peripheral nerve injury, so as to provide a new target for clinical diagnosis of peripheral nerve injury. Methods: Ninety-six male Sprague-Dawley rats of SPF grade were selected to establish sciatic nerve injury models. Twenty-four rats were sacrificed at 0 (immediately after operation), 1, 4, and 7 days after operation. The proximal and distal sciatic nerve fragments were taken under aseptic conditions. The expression of miR-221 was detected by real-time fluorescent quantitative PCR, and the expression of PTEN protein was detected by Western blot and immunofluorescent staining. The relationship between miR-221 and PTEN was verified by dual-luciferase reporter gene. At the same time, the ultrastructure of nerve stump was observed by transmission electron microscopy. Results: The results of real-time fluorescent quantitative PCR, Western blot, and immunofluorescence staining showed that the relative expression of miR-221 in the proximal and distal stumps increased gradually with time, and the relative expression of PTEN protein decreased gradually, and the differences between different time points after operation were significant ( P<0.05). At 1, 4, and 7 days after operation, the relative expression of miR-221 in proximal stump was significantly higher than that in distal stump, and the relative expression of PTEN protein in proximal stump was significantly lower than that in distal stump ( P<0.05). Dual-luciferase reporter gene suggested that PTEN was the target for miR-221. Transmission electron microscopy observation showed that the normal morphological structure was observed at 0 day after operation, and the proliferation of Schwann cells and degeneration of axons and myelin sheaths gradually increased with time. There was no significant difference between proximal and distal stumps at 1 day after operation. At 4 and 7 days, Schwann cells proliferated more in proximal stump than in distal stump, and the degeneration of axons and myelin sheaths was less. Conclusion: After sciatic nerve injury in rats, the up-regulation of the miR-221 expression targets the down-regulation of PTEN expression, which results in the difference of expression levels of miR-221 and PTEN in proximal and distal stumps. This phenomenon may play a role in promoting nerve repair after peripheral nerve injury.


Assuntos
Regulação da Expressão Gênica , MicroRNAs , PTEN Fosfo-Hidrolase , Traumatismos dos Nervos Periféricos , Nervo Isquiático , Animais , Axônios , Masculino , MicroRNAs/genética , Regeneração Nervosa/genética , PTEN Fosfo-Hidrolase/genética , Traumatismos dos Nervos Periféricos/fisiopatologia , Ratos , Ratos Sprague-Dawley , Nervo Isquiático/fisiopatologia
5.
J Clin Neurosci ; 69: 250-256, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31477463

RESUMO

Electroacupuncture (EA) is an adjuvant therapy for peripheral nerve injury (PNI). Both peripheral and central alterations contribute to the rehabilitation process. We employed diffusion tensor imaging (DTI) to investigate the diffusion plasticity of afferent and efferent pathways caused by EA in model of peripheral nerve injury and reparation. Twenty-four rats were divided into three groups: normal group, model group and intervention group. Rats of the model group and the intervention group underwent sciatic nerve transection and anastomosis. EA intervention was performed on the intervention group at ST-36 and GB-30 for three months. Gait assessment and DTI were conducted at days post-operative (DPO) 30, 60 and 90. We selected corticospinal tract, spinothalamic tract and internal capsule as regions of interest and analyzed diffusion metrics including fractional anisotropy (FA), axial diffusivity (AD) and radial diffusivity (RD). FA values and RD values displayed significant differences or obvious tendency while AD values maintained a stable level. RD values displayed better indicative performance than FA in internal capsule. The intervention group presented significant correlation between RD values and Regularity Index (RI) during the intervention period. The effect of EA on peripheral nerve injury repairing rats appeared to be accelerated recovery process of sensory and motor neural pathway. We proposed that RD was a potential in vivo indicator for structural plasticity caused by EA and PNI.


Assuntos
Eletroacupuntura , Cápsula Interna/fisiopatologia , Vias Neurais/fisiopatologia , Plasticidade Neuronal/fisiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Animais , Imagem de Tensor de Difusão/métodos , Modelos Animais de Doenças , Masculino , Ratos , Ratos Sprague-Dawley , Nervo Isquiático/lesões
6.
Muscle Nerve ; 60(5): 595-597, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31452215

RESUMO

INTRODUCTION: In this study we aimed to determine whether needle electromyographic assessment of voluntary motor unit recruitment in traumatic brachial plexus injuries could predict spontaneous motor recovery. METHODS: A retrospective study was performed on patients with brachial plexus injury affecting deltoid, supraspinatus/infraspinatus, and biceps brachii. The outcome measure was strength on manual muscle testing at least 1 year after injury. Good outcome was considered strength >3/5 on the Medical Research Council (MRC) scale. RESULTS: No muscles with no recruitment (n = 27) at 1-9 months improved to MRC 4/5 strength at a mean of 2.0 years postinjury. Twenty-five percent of muscles with discrete or severely reduced recruitment (n = 8) regained strength to >3/5 at a mean of 1.4 years postinjury (P = .047). DISCUSSION: Absent voluntary motor unit potential recruitment at 1-9 months predicted poor prognosis for spontaneous recovery. A high percentage of patients with discrete recruitment did not improve to >3/5 strength. These patients should be considered for early nerve transfer surgery.


Assuntos
Plexo Braquial/lesões , Eletromiografia , Traumatismos dos Nervos Periféricos/fisiopatologia , Recuperação de Função Fisiológica , Recrutamento Neurofisiológico/fisiologia , Potenciais de Ação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
8.
J Physiol Sci ; 69(5): 769-777, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31267368

RESUMO

Operant methods that allow animals to avoid painful stimuli are interpreted to assess the aversive quality of pain; however, such measurements require investigator-initiated stimuli to animals. Here we developed a shuttle maze test to repeatedly assess activity associated nociception without forced stimulation. Rats ambulate back and forth between two treat feeders by taking either a short route with a prickly surfaced arch or a longer route with a smooth floor. L5-L6 spinal nerve ligation (SNL) reduced the preference for the short route with the arch, correlated with hypersensitivity in the hind paw. Oral gabapentin restored the short route preference and reduced hypersensitivity in SNL rats, and blockade of spinal α2-adrenoceptors reduced gabapentin's effects on hypersensitivity but not on preference index. These results suggest that SNL injury alters behavior in the shuttle maze test and that the shuttle maze test shows comparable results to reflexive hypersensitivity after SNL in magnitude and response to gabapentin.


Assuntos
Comportamento de Escolha/fisiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Animais , Modelos Animais de Doenças , Alimentos , Hiperalgesia/metabolismo , Hiperalgesia/fisiopatologia , Ligadura/métodos , Masculino , Neuralgia/metabolismo , Neuralgia/fisiopatologia , Limiar da Dor/fisiologia , Ratos , Ratos Sprague-Dawley , Nervos Espinhais/metabolismo , Nervos Espinhais/fisiopatologia , Ácido gama-Aminobutírico/metabolismo
9.
Exp Brain Res ; 237(9): 2297-2304, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31273391

RESUMO

Incomplete recovery of sensory function is common after peripheral nerve injury (PNI). Despite reinnervation following injury, disorganized cortical representations persist and may contribute to functional deficits. There is a dearth of literature characterizing cortical responses after PNI in rodent models. Here we develop a quantitative electrophysiological method for mapping forepaw digit responses in primary somatosensory cortex (S1) of rats. We tested the hypothesis that PNI in the forelimb would generate significant, long lasting sensory deficits, and corresponding disorganization in S1. Rats underwent a transection of the proximal segment of the median and ulnar nerves in the forelimb followed by tubular repair. 4-12 months after nerve injury, we tested mechanosensory withdrawal thresholds and mapped S1 responses to mechanical stimulation of the digits. PNI produces persistent elevation of mechanical withdrawal thresholds, consistent with an impairment in sensory function. Assessment of cortical neurophysiology reveals a substantial disorganization of S1 somatotopy. Additionally, we document degraded timing and digit specificity of cortical responses. This quantitative measurement of long-term changes in S1 digit representations after forelimb nerve injury in rodents provides a framework for further studies focused on the development of therapeutic strategies to restore cortical and sensory function.


Assuntos
Membro Anterior/fisiopatologia , Nervo Mediano/fisiopatologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Limiar Sensorial/fisiologia , Córtex Somatossensorial/fisiopatologia , Dedos do Pé/fisiopatologia , Percepção do Tato/fisiologia , Nervo Ulnar/fisiopatologia , Animais , Modelos Animais de Doenças , Eletroencefalografia , Feminino , Nervo Mediano/lesões , Estimulação Física , Ratos , Ratos Sprague-Dawley , Nervo Ulnar/lesões
10.
Knee ; 26(5): 1041-1048, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31350156

RESUMO

BACKGROUND: This study aimed to investigate the incidence, degree, and natural course of lateral numbness following medial open-wedge high tibial osteotomy (MOWHTO). It also evaluated which predisposing factors would affect lateral numbness following MOWHTO. METHODS: One-hundred and sixty-nine knees that underwent MOWHTO for treatment of varus osteoarthritis with a minimum follow-up of three years were enrolled. Lateral numbness in the lower leg was assessed with the light-touch method using a cotton wool ball and compared with the contralateral leg. Patients were classified into groups based on a scale according to grading of sensation to light touch. To assess the improvement of lateral numbness, lower leg sensation was investigated using a sensory score compared with the contralateral leg. The predisposing factors that would affect lateral numbness were assessed. RESULTS: Lateral numbness was observed in 87 knees (51.5%) at six weeks postoperatively. Although 69 knees improved over time, 18 knees showed no improvement to the latest follow-up. The level of skin incision showed a significant association with lateral numbness on univariate and multivariate analyses: the higher the level of skin incision, the greater the degree of estimated numbness. CONCLUSIONS: About half the patients reported postoperative lateral numbness in the lower leg following MOWHTO. Of the patients with lateral numbness, approximately one-fifth remained symptom until the last follow-up. The level of skin incision might be a risk factor for lateral numbness. Pre-operative patient education concerning the likelihood of lateral numbness is recommended. LEVEL OF EVIDENCE: Level IV, case series.


Assuntos
Hipestesia/etiologia , Perna (Membro)/inervação , Osteoartrite do Joelho/cirurgia , Osteotomia/efeitos adversos , Traumatismos dos Nervos Periféricos/complicações , Complicações Pós-Operatórias , Tíbia/cirurgia , Adulto , Idoso , Feminino , Humanos , Hipestesia/diagnóstico , Hipestesia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/fisiopatologia , Fatores de Tempo
11.
Int J Mol Sci ; 20(12)2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31226852

RESUMO

The exchange of solutes between the blood and the nerve tissue is mediated by specific and high selective barriers in order to ensure the integrity of the different compartments of the nervous system. At peripheral level, this function is maintained by the Blood Nerve Barrier (BNB) that, in the presence, of specific stressor stimuli can be damaged causing the onset of neurodegenerative processes. An essential component of BNB is represented by the endothelial cells surrounding the sub-structures of peripheral nerves and increasing evidence suggests that endothelial dysfunction can be considered a leading cause of the nerve degeneration. The purpose of this review is to highlight the main mechanisms involved in the impairment of endothelial cells in specific diseases associated with peripheral nerve damage, such as diabetic neuropathy, erectile dysfunction and inflammation of the sciatic nerve.


Assuntos
Barreira Hematoneural/patologia , Neuropatias Diabéticas/patologia , Endotélio/patologia , Disfunção Erétil/patologia , Neuralgia/patologia , Animais , Barreira Hematoneural/metabolismo , Barreira Hematoneural/fisiopatologia , Neuropatias Diabéticas/metabolismo , Neuropatias Diabéticas/fisiopatologia , Endotélio/metabolismo , Endotélio/fisiopatologia , Disfunção Erétil/metabolismo , Disfunção Erétil/fisiopatologia , Humanos , Masculino , Neuralgia/metabolismo , Neuralgia/fisiopatologia , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase/metabolismo , Traumatismos dos Nervos Periféricos/metabolismo , Traumatismos dos Nervos Periféricos/patologia , Traumatismos dos Nervos Periféricos/fisiopatologia
12.
Pak J Pharm Sci ; 32(2 (Supplementary)): 785-792, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31103973

RESUMO

Peripheral nerve injury is a common condition with a multitude of signs and symptoms. The major consequence of injury is limited physical activity. Presently, we are lacking effective therapies for PNI and it is need of the hour is to explore potential remedies for the recovery of functional loss. Here, we have investigated the role of crude Cannabis sativa L. leaf powder in promoting functions recovery, in mouse model subjected to a traumatic sciatic nerve injury. A dose of 200mg/kg of the body weight per day was administered orally from the day of nerve crush till the end of the experiment. The motor functions were evaluated by measuring sciatic functional index, muscle grip strength and muscle mass; whereas the sensory functions were assessed by hotplate test. The haematology and serum analyses were carried out to estimate the effect of treatment on the systemic index and oxidative stress. The gain of motor functions was significantly improved and was early noticed in the treated mice. Restoration of muscle mass and elevated haemoglobin level were statistically significant in the treatment group. This study indicates that Cannabis sativa L. supplementation accelerates the motor functions recovery after nerve compression injury.


Assuntos
Cannabis , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Nervo Isquiático/lesões , Animais , Glicemia/metabolismo , Peso Corporal/efeitos dos fármacos , Suplementos Nutricionais , Modelos Animais de Doenças , Ingestão de Alimentos/efeitos dos fármacos , Hemoglobinas/metabolismo , Masculino , Camundongos , Atividade Motora/efeitos dos fármacos , Estresse Oxidativo/efeitos dos fármacos , Traumatismos dos Nervos Periféricos/sangue , Traumatismos dos Nervos Periféricos/fisiopatologia , Folhas de Planta/química , Pós/farmacologia , Recuperação de Função Fisiológica
13.
Medicine (Baltimore) ; 98(19): e15488, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083184

RESUMO

INTRODUCTION: An isolated injury to the tibial division is rare among compressive sciatic neuropathy. To date, isolated injury to the tibial division of the sciatic nerve after self-massage of the gluteal muscle has not been reported. Here, we report a case of compressive sciatic neuropathy diagnosed after self-massage of the gluteal muscle using magnetic resonance image (MRI) and ultrasound images and its associated therapeutic process. PATIENT CONCERNS: A 50-year-old woman presented right lower extremity pain for the past 7 days. DIAGNOSIS: Electrophysiological findings were consistent with right tibial neuropathy proximal to the branch to hamstring muscles. However, T2-weighted MRI showed high signal intensity and swelling in the right sciatic nerves from the superior gemellus level to the quadratus femoris level. After considering both radiologic and electrophysiological findings, the patient was diagnosed with an isolated injury to the tibial division of the right sciatic nerve. INTERVENTIONS: The patient agreed to an ultrasound-guided perineural steroid injection upon receiving detailed explanation of the procedure. OUTCOMES: After the injection, there was significant improvement in pain. CONCLUSION: Therefore, in making a diagnosis of sciatic neuropathy, it may be important to find the lesion via MRI than relying solely on the patient's history or electrophysiologic study.


Assuntos
Massagem/instrumentação , Traumatismos dos Nervos Periféricos/etiologia , Nervo Tibial/lesões , Nádegas , Diagnóstico Diferencial , Feminino , Humanos , Massagem/métodos , Pessoa de Meia-Idade , Músculo Esquelético , Dor/diagnóstico por imagem , Dor/tratamento farmacológico , Dor/etiologia , Dor/fisiopatologia , Traumatismos dos Nervos Periféricos/diagnóstico por imagem , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Traumatismos dos Nervos Periféricos/fisiopatologia , Nervo Tibial/diagnóstico por imagem , Nervo Tibial/fisiopatologia
14.
Muscle Nerve ; 60(2): 192-201, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31093982

RESUMO

INTRODUCTION: We recently demonstrated the beneficial effects of 4-aminopyridine (4-AP), a potassium channel blocker, in enhancing remyelination and recovery of nerve conduction velocity and motor function after sciatic nerve crush injury in mice. Although muscle atrophy occurs very rapidly after nerve injury, the effect of 4-AP on muscle atrophy and intrinsic muscle contractile function is largely unknown. METHODS: Mice were assigned to sciatic nerve crush injury and no-injury groups and were followed for 3, 7, and 14 days with/without 4-AP or saline treatment. Morphological, functional, and transcriptional properties of skeletal muscle were assessed. RESULTS: In addition to improving in vivo function, 4-AP significantly reduced muscle atrophy with increased muscle fiber diameter and contractile force. Reduced muscle atrophy was associated with attenuated expression of atrophy-related genes and increased expression of proliferating stem cells. DISCUSSION: These findings provide new insights into the potential therapeutic benefits of 4-AP against nerve injury-induced muscle atrophy and dysfunction. Muscle Nerve 60: 192-201, 2019.


Assuntos
4-Aminopiridina/farmacologia , Lesões por Esmagamento/fisiopatologia , Músculo Esquelético/efeitos dos fármacos , Atrofia Muscular/patologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Bloqueadores dos Canais de Potássio/farmacologia , Remielinização/efeitos dos fármacos , Nervo Isquiático/efeitos dos fármacos , Animais , Lesões por Esmagamento/metabolismo , Lesões por Esmagamento/patologia , Proteína Forkhead Box O1/efeitos dos fármacos , Proteína Forkhead Box O1/genética , Proteína Forkhead Box O3/efeitos dos fármacos , Proteína Forkhead Box O3/genética , Camundongos , Proteínas Musculares/efeitos dos fármacos , Proteínas Musculares/genética , Músculo Esquelético/inervação , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Atrofia Muscular/genética , Traumatismos dos Nervos Periféricos/genética , Traumatismos dos Nervos Periféricos/patologia , Regeneração/efeitos dos fármacos , Nervo Isquiático/lesões , Nervo Isquiático/patologia , Nervo Isquiático/fisiopatologia , Proteínas com Motivo Tripartido/efeitos dos fármacos , Proteínas com Motivo Tripartido/genética , Ubiquitina-Proteína Ligases/efeitos dos fármacos , Ubiquitina-Proteína Ligases/genética
15.
Arch Orthop Trauma Surg ; 139(7): 1021-1023, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31011794

RESUMO

Nerve injuries, mostly to the median nerve, are common following distal radius fractures. Ulnar nerve injuries are rarely encountered, with only few case reports of motor or motor and sensory loss described in the literature. In this paper, we report two consecutive cases of young patients with a distal radius fracture and a pure sensory ulnar neuropathy. Both patients had a radially displaced fracture and presented with sensory loss and paresthesia in the distribution of the dorsal cutaneous branch of the ulnar nerve (DCBUN), which resolved after fracture reduction. We believe this clinical scenario is the result of traction or compressive neuropraxia of the DCBUN in the subcutaneous tissue around the ulnar styloid-a neurologic injury which had not yet been described for distal radius fractures.


Assuntos
Redução Fechada/métodos , Fratura-Luxação , Traumatismos dos Nervos Periféricos , Fraturas do Rádio , Transtornos das Sensações , Nervo Ulnar/lesões , Punho/diagnóstico por imagem , Adulto , Fratura-Luxação/complicações , Fratura-Luxação/diagnóstico , Fratura-Luxação/fisiopatologia , Fratura-Luxação/cirurgia , Fixação de Fratura/métodos , Humanos , Masculino , Exame Neurológico , Parestesia/diagnóstico , Parestesia/etiologia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Traumatismos dos Nervos Periféricos/terapia , Radiografia/métodos , Fraturas do Rádio/complicações , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/cirurgia , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/etiologia , Pele/inervação , Tato , Resultado do Tratamento
16.
Turk J Med Sci ; 49(4): 1221-1227, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-30866612

RESUMO

Background/aim: The aim of this study was to determine validity and reliability of the Turkish version of the Cold Intolerance Symptom Severity (CISS-T) Questionnaire. Materials and methods: The translation and back translation steps of the study were based on the Beaton guidelines. Sixty-eight patients between 18 and 65 years old with cold intolerance after amputation, replantation, multiple crush syndrome, and peripheral nerve injury were included in the study. Patients completed the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), the SF-36 Quality of Life Questionnaire, and the single questions assessing the cold sensitivity and cold intolerance once and the final version of the CISS-T twice with a 7-day interval. Results: The internal consistency (Cronbach α = 0.844) and test-retest reliability (r = 0.938) of CISS-T were assessed and both were considerably high. Also, the correlations between the scores of the CISS-T, DASH-T, SF-36-T, and the single questions were analyzed by Spearman's correlation coefficient. The CISS-T showed an excellent correlation with the single questions (rho = 0.8 and 0.877), a good and negative correlation with the pain subscale of the SF-36 (rho = 0.617), and a moderate correlation with the DASH-T (rho = 0.592). Conclusion: As a result, the CISS-T is a valid and reliable instrument to assess the severity of cold intolerance.


Assuntos
Síndromes Periódicas Associadas à Criopirina/classificação , Síndromes Periódicas Associadas à Criopirina/diagnóstico , Mãos/fisiopatologia , Inquéritos e Questionários/normas , Traduções , Adolescente , Adulto , Idoso , Síndromes Periódicas Associadas à Criopirina/etiologia , Síndromes Periódicas Associadas à Criopirina/fisiopatologia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/complicações , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/fisiopatologia , Reprodutibilidade dos Testes , Turquia , Adulto Jovem
17.
Injury ; 50(4): 834-847, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30922661

RESUMO

The use of suture associated with heterologous fibrin sealant has been highlighted for reconstruction after peripheral nerve injury, having the advantage of being safe for clinical use. In this study we compared the use of this sealant associated with reduced number of stitches with conventional suture after ischiatic nerve injury. 36 Wistar rats were divided into 4 groups: Control (C), Denervated (D), ischiatic nerve neurotmesis (6 mm gap); Suture (S), epineural anastomosis after 7 days from neurotmesis, Suture + Fibrin Sealant (SFS), anastomosis with only one suture point associated with Fibrin Sealant. Catwalk, electromyography, ischiatic and tibial nerve, soleus muscle morphological and morphometric analyses were performed. The amplitude and latency values of the Suture and Suture + Fibrin Sealant groups were similar and indicative of nerve regeneration.The ischiatic nerve morphometric analysis in the Suture + Fibrin Sealant showed superior values related to axons and nerve fibers area and diameter when compared to Suture group. In the Suture and Suture + Fibrin Sealant groups, there was an increase in muscle weight and in fast fibers frequency, it was a decrease in the percentage of collagen compared to group Denervated and in the neuromuscular junctions, the synaptic boutons were reestablished.The results suggest a protective effect at the lesion site caused by the fibrin sealant use. The stitches reduction minimizes the trauma caused by the needle and it accelerates the surgical practice. So the heterologous fibrin sealant use in nerve reconstruction should be considered.


Assuntos
Adesivo Tecidual de Fibrina/farmacologia , Regeneração Nervosa/efeitos dos fármacos , Traumatismos dos Nervos Periféricos/fisiopatologia , Nervos Periféricos/efeitos dos fármacos , Células Receptoras Sensoriais/efeitos dos fármacos , Animais , Axônios , Axotomia , Masculino , Modelos Animais , Regeneração Nervosa/fisiologia , Ratos , Ratos Wistar , Procedimentos Cirúrgicos Reconstrutivos , Suturas
18.
Pain ; 160(5): 1146-1155, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30920428

RESUMO

Oxytocin reduces primary sensory afferent excitability and produces analgesia in part through a peripheral mechanism, yet its actions on physiologically characterized, mechanically sensitive afferents in normal and neuropathic conditions are unknown. We recorded intracellularly from L4 dorsal root ganglion neurons characterized as low-threshold mechanoreceptors (LTMRs) or high-threshold mechanoreceptors (HTMRs) in female rats 1 week after L5 partial spinal nerve injury or sham control (n = 24 rats/group) before, during, and after ganglionic perfusion with oxytocin, 1 nM. Nerve injury desensitized and hyperpolarized LTMRs (membrane potential [Em] was -63 ± 1.8 mV in sham vs -76 ± 1.4 mV in nerve injury; P < 0.001), and sensitized HTMRs without affecting Em. In nerve-injured rats, oxytocin depolarized LTMRs towards normal (Em = -69 ± 1.9 mV) and, in 6 of 21 neurons, resulted in spontaneous action potentials. By contrast, oxytocin hyperpolarized HTMRs (Em = -68 ± 2.7 mV before vs -80 ± 3.2 mV during oxytocin exposure; P < 0.01). These effects were reversed after removal of oxytocin, and oxytocin had minimal effects in neurons from sham surgery animals. Sensory afferent neurons immunopositive for the vasopressin 1a receptor were larger (34 ± 6.3 µm, range 16-57 µm) than immunonegative neurons (26 ± 3.4 µm, range 15-43 µm; P < 0.005). These data replicate findings that neuropathic injury desensitizes LTMRs while sensitizing HTMRs and show rapid and divergent oxytocin effects on these afferent subtypes towards normal, potentially rebalancing input to the central nervous system. Vasopressin 1a receptors are present on medium to large diameter afferent neurons and could represent oxytocin's target.


Assuntos
Gânglios Espinais/patologia , Nociceptores/efeitos dos fármacos , Ocitocina/uso terapêutico , Traumatismos dos Nervos Periféricos/patologia , Células Receptoras Sensoriais/efeitos dos fármacos , Tato , Potenciais de Ação/efeitos dos fármacos , Vias Aferentes/fisiopatologia , Animais , Modelos Animais de Doenças , Estimulação Elétrica , Feminino , Mecanorreceptores/efeitos dos fármacos , Nociceptores/fisiologia , Ocitocina/farmacologia , Limiar da Dor/efeitos dos fármacos , Traumatismos dos Nervos Periféricos/fisiopatologia , Ratos , Ratos Sprague-Dawley , Receptores de Vasopressinas/metabolismo , Células Receptoras Sensoriais/fisiologia
19.
Neurosci Lett ; 703: 132-138, 2019 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-30904573

RESUMO

Many trigeminal neuropathic pain patients suffer severe chronic pain. The neuropathic pain might be related with cross-excitation of the neighboring neurons and satellite glial cells (SGCs) in the sensory ganglia and increasing the pain signals from the peripheral tissue to the central nervous system. We induced trigeminal neuropathic pain by infraorbital nerve constriction injury (IONC) in Sprague-Dawley rats. We tested cytokine (CXCL2 and IL-10) levels in trigeminal ganglia (TGs) after trigeminal neuropathic pain induction, and the effect of direct injection of the anti-CXCL2 and recombinant IL-10 into TG. We found that IONC induced pain behavior. Additionally, IONC induced satellite glial cell activation in TG and cytokine levels of TGs were changed after IONC. CXCL2 levels increased on day 1 of neuropathic pain induction and decreased gradually, with IL-10 levels showing the opposite trend. Recombinant IL-10 or anti-CXCL2 injection into TG decreased pain behavior. Our results show that IL-10 or anti-CXCL2 are therapy options for neuropathic pain.


Assuntos
Quimiocina CXCL2/metabolismo , Interleucina-10/metabolismo , Neuralgia/metabolismo , Gânglio Trigeminal/metabolismo , Animais , Anticorpos/farmacologia , Quimiocina CXCL2/imunologia , Constrição Patológica , Interleucina-10/farmacologia , Masculino , Neuralgia/fisiopatologia , Medição da Dor , Traumatismos dos Nervos Periféricos/fisiopatologia , Ratos Sprague-Dawley , Proteínas Recombinantes/farmacologia
20.
Muscle Nerve ; 59(6): 707-711, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30847944

RESUMO

INTRODUCTION: Brachial plexus trauma related to gunshot (GS) injury requires early examination and characterization to ensure appropriate treatment. Magnetic resonance imaging (MRI) may be contraindicated when there are metal fragments in a patient's body. Ultrasound (US) may present an alternative to imaging GS-related brachial plexus injury. METHODS: Three patients with GS-related brachial plexus injury who underwent US imaging evaluation at our institution were identified. A retrospective review of the patients' medical records was performed. RESULTS: US characterization of nerve abnormalities after GS injury to the brachial plexus was in agreement with electrodiagnostic and intraoperative findings. DISCUSSION: Information from the US reports was useful in preparation for brachial plexus reconstruction surgery. As such, US has unique utility when MRI cannot be performed. US imaging can provide useful characterization of the brachial plexus after GS injury when performed by an experienced operator. Muscle Nerve 59:707-711, 2019.


Assuntos
Plexo Braquial/diagnóstico por imagem , Traumatismos dos Nervos Periféricos/diagnóstico por imagem , Ferimentos por Arma de Fogo/diagnóstico por imagem , Adulto , Plexo Braquial/lesões , Plexo Braquial/fisiopatologia , Plexo Braquial/cirurgia , Neurite do Plexo Braquial/diagnóstico por imagem , Neurite do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/diagnóstico por imagem , Neuropatias do Plexo Braquial/etiologia , Eletromiografia , Humanos , Masculino , Neuroma/diagnóstico por imagem , Neuroma/etiologia , Procedimentos Neurocirúrgicos , Traumatismos dos Nervos Periféricos/complicações , Traumatismos dos Nervos Periféricos/fisiopatologia , Traumatismos dos Nervos Periféricos/cirurgia , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/etiologia , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/fisiopatologia , Ferimentos por Arma de Fogo/cirurgia , Adulto Jovem
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