A Systematic Review of the Tensile Biomechanical Properties of the Neonatal Brachial Plexus.

Brachial plexus (BP) birth injury has a reported incidence of 1 to 4 per 1000 live births. During complicated deliveries, neonatal, maternal, and other birth-related factors can cause over-stretching or avulsion of the neonatal brachial plexus leading to injury. Understanding biomechanical responses of the neonate brachial plexus when subjected to stretch can offer insight into the injury outcomes while guiding the development of preventative maneuvers that can help reduce the occurrence of neonatal brachial plexus injuries. This review article aims to offer a comprehensive overview of existing literature reporting biomechanical responses of the brachial plexus, in both adults and neonates, when subjected to stretch. Despite the discrepancies in the reported biomechanical properties of the brachial plexus, available studies confirm the loading rate and loading direction dependency of the brachial plexus tissue. Future studies, possibly in vivo, that utilize clinically relevant neonatal large animal models can provide translational failure values of the biomechanical parameters for the neonatal brachial plexus when subjected to stretch.

Direct Linear Transformation for the Measurement of In-Situ Peripheral Nerve Strain During Stretching.

Peripheral nerves undergo physiological and non-physiological stretch during development, normal joint movement, injury, and more recently while undergoing surgical repair. Understanding the biomechanical response of peripheral nerves to stretch is critical to the understanding of their response to different loading conditions and thus, to optimizing treatment strategies and surgical interventions. This protocol describes in detail the calibration process of the stereo-imaging camera system via direct linear transformation and the tracking of the three-dimensional in-situ tissue displacement of peripheral nerves during stretch, obtained from three-dimensional coordinates of the video files captured by the calibrated stereo-imaging camera system. From the obtained three-dimensional coordinates, the nerve length, change in the nerve length, and percent strain with respect to time can be calculated for a stretched peripheral nerve. Using a stereo-imaging camera system provides a non-invasive method for capturing three-dimensional displacements of peripheral nerves when stretched. Direct linear transformation enables three-dimensional reconstructions of peripheral nerve length during stretch to measure strain. Currently, no methodology exists to study the in-situ strain of stretched peripheral nerves using a stereo-imaging camera system calibrated via direct linear transformation. Capturing the in-situ strain of peripheral nerves when stretched can not only aid clinicians in understanding underlying injury mechanisms of nerve damage when overstretched but also help optimize treatment strategies that rely on stretch-induced interventions. The methodology described in the paper has the potential to enhance our understanding of peripheral nerve biomechanics in response to stretch to improve patient outcomes in the field of nerve injury management and rehabilitation.

In vivo biomechanical responses of neonatal brachial plexus when subjected to stretch.

Neonatal brachial plexus palsy (NBPP) results from over-stretching of the neonatal brachial plexus during complicated birthing scenarios. The lack of information on the biomechanical response of the neonatal brachial plexus complex when subjected to stretch limits our understanding of the NBPP injury mechanism. This study aims to fill that critical gap by using a neonatal piglet animal model and providing the in vivo biomechanical properties of the neonatal brachial plexus complex when subjected to stretch. Forty-seven brachial plexus levels (identified by the four brachial plexus terminal nerve branches namely musculocutaneous, median, ulnar, and radial), obtained from 16 neonatal Yorkshire piglets (3-5 days old), were subjected to stretch-induced failure. The average maximum load and corresponding strain were reported to be 16.6 ± 1.3 N and 36.1 ± 1.6%, respectively. Maximum loads reported at the musculocutaneous level were significantly lower than the median and radial levels. No differences in strains at failure were reported at all four tested levels. Proximal or distal failure locations were reported in 83% of the tests with 17% mid-length ruptures that were primarily reported at the bifurcation of the median and ulnar brachial plexus levels. Histological studies reported an overall loss of wavy pattern of the nerve fibers, an increase in nerve spacing, fiber disruptions, and blood vessel ruptures in the stretched tissue. This in vivo piglet animal study offers insight into the NBPP mechanism by reporting biomechanical, injury location, and structural damage responses in neonatal brachial plexus when subjected to stretch.

A Systematic Review of the Electrodiagnostic Assessment of Neonatal Brachial Plexus.

Despite improvements in obstetric care, neonatal brachial plexus palsy continues to significantly impact infants' lives worldwide, with an incidence of 1 to 4 per 1000 live births. While a majority of affected infants recover spontaneously by three months, 20-30% suffer permanent functional deficits that significantly impair their quality of life. Anatomical complexity of the brachial plexus results in varying degrees of injury and pathological changes at multiple levels within the plexus. Current clinical diagnosis relies on electrodiagnostic techniques such as nerve conduction (i.e., motor and sensory) and electromyography studies. These techniques not only aid clinicians to differentiate between axonal and demyelinating lesions, evident by changes in signal shape and conduction, but also provide prognostic information in cases of brachial plexus injuries. The presented study offers a comprehensive review of existing literature on electrodiagnostic techniques employed for assessing neonatal brachial plexus injuries.

Evaluación de la eficacia de un extracto de Artemisia annua en leishmaniosis canina / Evaluation of the efficacy of an extract of Artemisia annua in canine leishmaniasis / Avaliação da eficácia de um extrato de Artemisia annua na leishmaniose canina

En el presente trabajo se muestran los resultados de un estudio experimental, multicéntrico, no controlado, en el que se ha comprobado la eficacia y seguridad de un extracto seco de Artemisia annua en perros con leishmaniosis. En el estudio participaron 34 perros, que recibieron una dosis media de un extracto seco de Artemisia annua equivalente a 100 mg/kg/12 h de hoja seca, en tandas de 9 días seguidos de descanso de 7 días durante tres meses. 24 de los perros fueron tratados únicamente con el extracto de A. annua, los 10 restantes habían sido tratados con medicación convencional y tras sufrir recaídas se les administró el extracto, sin interrumpir el tratamiento con alopurinol (10 mg/kg/12 h). Los animales fueron analizados al principio del tratamiento y a los tres meses mediante evaluación de los signos clínicos asociados a la enfermedad, análisis de sangre y orina (en los casos que lo requerían), y título de anticuerpos (frente a Leishmania infantum por inmunofluorescencia indirecta). En 24 de ellos, además, se midió la respuesta inmune mediante ELISA y la carga parasitaria a través del método qPCR.En todos los casos se observó una mejora clínica evidente y una disminución de la carga parasitaria, sin apreciarse diferencias significativas entre los casos tratados sólo con el extracto y aquellos que recibieron además alopurinol, excepto una normalización más precoz en el título de anticuerpos en los animales suplementados con alopurinol.La administración del extracto no provocó efectos adversos en ninguno de los animales.En base a los resultados obtenidos A. annua podría postularse como una alternativa terapéutica en leishmaniosis canina

The present work shows the results of an experimental, multicenter, not controlled study in which it has been verified the efficacy and safety of a dry extract of Artemisia annua against leishmaniasis in dogs. Thirty-four dogs participated in the study and received, along three months, a mean dose of Artemisia annua dry extract equivalent to 100 mg/kg/12 h of dry leaf, alternating periods of 9 days of treatment and 7 days of pause. Twenty-four dogs were treated only with the A. annuaextract, while the remaining 10, which were being treated with allopurinol (10 mg/kg/12 h), were additionally administered with the extract after suffering relapses. The animals were analyzed at the beginning of the treatment and at three months by evaluation of the clinical signs associated with the disease, blood and urine analysis (when required), as well as titration of antibodies against Leishmania infantum by indirect immunofluorescence. In 24 of them, immune response by ELISA and parasitic load by qPCR were additionally measured.In all cases, a clinical improvement and a decrease in the parasite load were evidenced, with no significant differences between the cases treated with the extract alone and those that also received allopurinol, except for an earlier normalization of the antibody titer in the latter. The administration of the extract did not cause adverse effects in any of the animals. Based on the results obtained, A. annua extract could be postulated as a therapeutic alternative in canine leishmaniasis

O presente trabalho mostra os resultados de um estudo experimental, multicêntrico e não controlado no qual foi verificado. a eficácia e segurança de um extrato seco de Artemisia annua em cães com leishmaniose.Trinta e quatro cães participaram do estudo e receberam, por três meses, dose média de extrato seco de Artemisia annua equivalente a 100 mg/kg/12 h de folha seca, em lotes de 9 dias, seguidos de 7 dias de repouso. Vinte e quatro dos cães foram tratados apenas com o extrato de A. annua, enquanto os 10 restantes, que estavam sendo tratados com alopurinol (10 mg / kg / 12 h), receberam adicionalmente o extrato após sofrer recaídas. Os animais foram analisados no início do tratamento e aos três meses pela avaliação dos sinais clínicos associados à doença, exames de sangue e urina (nos casos que exigiam), bem como título de anticorpos (contra Leishmania infantum por imunofluorescência indireta ) Em 24 deles, além disso, a resposta imune foi medida por ELISA e a carga parasitária pelo método qPCR.Em todos os casos foi observada melhora clínica evidente e diminuição da carga parasitária, não havendo diferenças significativas entre os casos tratados apenas com o extrato e os que também receberam alopurinol, exceto por uma normalização mais precoce do título de anticorpos nestes últimos. A administração do extrato não causou efeitos adversos em nenhum dos animais. Com base nos resultados obtidos, o extracto de A. annua pode ser postulada como alternativa terapêutica na leishmaniose canina