The effectiveness of early local administration of hyaluronic acid in experimental traumatic ischemia of the limb muscles

The experiments were performed on 280 male Wistar rats weighing 300-340 g. The design of the study included: modeling of compression injury of the soft tissues of the thigh, local injection of the preparation of hyaluronic acid "Gialift 3.5" into the area of damage 3 hours after the cessation of compression, taking into account the results after 7, 14 and 28 days. The introduction of hyaluronic acid into the area of compression injury of soft tissues reduces the severity of myoglobinemia, increases the immunohistochemical density of VEGF-positive cells, improves the perfusion characteristics of microcirculation, oxygen saturation, and specific oxygen consumption by tissues. Keywords: traumatic muscle ischemia, hyaluronic acid, myoglobin, microcirculation, metabolism, laser Doppler flowmetry, morphometry.

Flow cytometry analysis of immune and glial cells in a trigeminal neuralgia rat model

Microvascular compression of the trigeminal root entry zone (TREZ) is the main cause of most primary trigeminal neuralgia (TN), change of glial plasticity was previously studied in the TREZ of TN rat model induced by chronic compression. To better understand the role of astrocytes and immune cells in the TREZ, different cell markers including glial fibrillary acidic protein (GFAP), complement C3, S100A10, CD45, CD11b, glutamate-aspartate transporter (GLAST), Iba-1 and TMEM119 were used in the TN rat model by immunohistochemistry and flow cytometry. On the post operation day 28, GFAP/C3-positive A1 astrocytes and GFAP/S100A10-positive A2 astrocytes were activated in the TREZ after compression injury, there were no statistical differences in the ratios of A1/A2 astrocytes between the sham and TN groups. There was no significant difference in Iba-1-positive cells between the two groups. The ratios of infiltrating lymphocytes (CD45+CD11b−) (p = 0.0075) and infiltrating macrophages (CD45highCD11b+) (p = 0.0388) were significantly higher than those of the sham group. In conclusion, different subtypes A1/A2 astrocytes in the TREZ were activated after compression injury, infiltrating macrophages and lymphocytes increased, these neuroimmune cells in the TREZ may participate in the pathogenesis of TN rat model.

Systematic investigation and comparison of US FDA-approved immunosuppressive drugs FK506, cyclosporine and rapamycin for neuromuscular regeneration following chronic nerve compression injury

Aim: To compare therapeutic benefits of different immunophilin ligands for treating nerve injuries. Materials & methods: Cyclosporine, FK506 and rapamycin, were evaluated first in vitro on a serum-free culture of embryonic dorsal root ganglia followed by a new in vivo model of chronic nerve compression. Results: Outcomes of the in vitro study have shown a potent effect of cyclosporine and FK506, on dorsal root ganglia axonal outgrowth, comparable to the effect of nerve growth factor. Rapamycin exhibited only a moderate effect. The in vivo study revealed the beneficial effects of cyclosporine, FK506 and rapamycin for neuromuscular regeneration. Cyclosporine showed the better maintenance of the tissues and function. Conclusion: Cyclosporine, FK506 and rapamycin drugs showed potential for treating peripheral nerve chronic compression injuries.

The combined treatment of entrapped Infrapatellar Branch of the Saphenous Nerve after ACL reconstruction: Ultrasound-guided perineural injection and acupotomy

BACKGROUND: The anterior cruciate ligament (ACL) reconstruction (ACLR) under the arthroscopy is a widespread procedure for ACL rupture, which could stabilize knee and promote recovery. However, one of its complications is the injury of infrapatellar branch of saphenous nerve (IBSN). In traditional Chinese medicine, acupotomy functions via releasing and stripping adhesion tissues. Accordingly, acupotomy is suitable for the treatment of entrapped nerve injury and tissues adhesion. CASE DESCRIPTION: A 14-year-old man, who had ACLR before and returned to normal activity, presented with severe pain after a mild strain two weeks ago. The physical and imaging examinations revealed the compression injury of IBSN. METHODS: We provided the ultrasound-guided perineural injection of 0.4% lidocaine, while it only alleviates the symptoms temporally and partially. Acupotomy using a small needle knife (0.4*40 mm) was performed. RESULTS: The severe pain was immediately resolved. The visual analog pain scale (VAS) decreased from 10 to 1 and return to normal walking. The diameter of IBSN became smaller and the signal of peripheral soft tissue became hypoechoic in ultrasound. CONCLUSION : In this case, the combined treatments of ultrasound-guided perineural injection and acupotomy are thought to be innovative procedures for IBSN entrapment with relative long-lasting therapeutic effects.

Voluntary Exercise Ameliorates Neuropathic Pain by Suppressing Calcitonin Gene-Related Peptide and Ionized Calcium-Binding Adapter Molecule 1 Overexpression in the Lumbar Dorsal Horns in Response to Injury to the Cervical Spinal Cord

Background Neuropathic pain (NP) is a frequent finding in patients diagnosed with spinal cord injuries (SCIs). We aimed to investigate the effects of voluntary exercise on NP after SCI and to elucidate its potential mechanisms. MethodsA rat model of post-SCI NP induced by compression of the posterior or lateral cervical spinal cord was used to evaluate the effects of voluntary exercise by measuring the bilateral withdrawal of the hind paws using the Von Frey filament and Hargreaves tests. The place escape/avoid paradigm was used to evaluate supraspinal pain processing and somatosensory evoked potentials (SEPs) were used to examine disturbances in proprioception. Locomotor function was evaluated using Basso, Beattie, and Bresnahan (BBB) scoring. Pathologic findings in hematoxylin and eosin-stained tissue and magnetic resonance imaging were used to evaluate the morphological changes after SCI. The lesion size within the cervical spinal cord was evaluated by staining with Eriochrome cyanine R. Quantitative polymerase chain reaction and immunohistochemistry were used to assess the expression of calcitonin gene-related peptide (CGRP) and ionized calcium-binding adapter molecule 1 (Iba-1) in the lumbar dorsal horns. ResultsAll injured rats developed mechanical hypersensitivity, hyposensitivity, and thermal hyperalgesia in the contralateral hind paws at one week post-injury. Rats that underwent lateral compression injury developed NP in the ipsilateral hind paws one week later than rats with a posterior compression injury. Our findings revealed that voluntary exercise ameliorated mechanical allodynia and thermal hyperalgesia, and significantly improved proprioception as measured by SEP, but had no impact on mechanical hypoalgesia or motor recovery and provided no significant neuroprotection after recovery from an acute SCI. SCI-induced NP was accompanied by increased expression of CGRP and Iba-1 in the lumbar dorsal horn. These responses were reduced in rats that underwent voluntary exercise. ConclusionsVoluntary exercise ameliorates NP that develops in rats after compression injury. Increased expression of CGRP and Iba-1 in the lumbar dorsal horns of rats exhibiting symptoms of NP suggests that microglial activation might play a crucial role in its development. Collectively, voluntary exercise may be a promising therapeutic modality to treat NP that develops clinically in response to SCI.

Microscopic analysis of compression injury over neck: One-year prospective study

The present study was conducted in Department of Forensic Medicine and Toxicology of a Government Medical College and Hospital in year 2017. Total 2781 postmortem examinations were conducted in 2017. Out of that total 2781 cases, 176 compression of neck cases came for postmortem and amongst these 105 cases were studied in detail as per inclusion criteria. Out of 105 cases of compression around neck, which were studied, there were 93 cases of hanging, 10 cases of ligature strangulation, 01 case of manual strangulation and 01 case of accidental strangulation studied. On gross in total 11 cases of strangulation hemorrhage in subcutaneous tissue, strap muscle and sternocleidomastoid muscle observed and in only 20 cases of hanging there was hemorrhage observed in subcutaneous tissue and no hemorrhage observed in strap and sternocleidomastoid muscle in hanging cases. In this present study on histopathology vascular congestion and extravasation of red blood cells observed in 28 cases of compression of neck. These findings indicate the importance of histopathology of underlying neck structure in neck compression cases in documenting antemortem nature of hanging and strangulation in doubtful cases.

Trehalose Augments Neuron Survival and Improves Recovery from Spinal Cord Injury via mTOR-Independent Activation of Autophagy

Spinal cord injury (SCI) is a major cause of irreversible nerve injury and leads to serious tissue loss and neurological dysfunction. Thorough investigation of cellular mechanisms, such as autophagy, is crucial for developing novel and effective therapeutics. We administered trehalose, an mTOR-independent autophagy agonist, in SCI rats suffering from moderate compression injury to elucidate the relationship between autophagy and SCI and evaluate trehalose’s therapeutic potential. 60 rats were divided into 4 groups and were treated with either control vehicle, trehalose, chloroquine, or trehalose + chloroquine 2 weeks prior to administration of moderate spinal cord crush injury. 20 additional sham rats were treated with control vehicle. H&E staining, Nissl staining, western blot, and immunofluorescence studies were conducted to examine nerve morphology and quantify autophagy and mitochondrial-dependent apoptosis at various time points after surgery. Functional recovery was assessed over a period of 4 weeks after surgery. Trehalose promotes autophagosome recruitment via an mTOR-independent pathway, enhances autophagy flux in neurons, inhibits apoptosis via the intrinsic mitochondria-dependent pathway, reduces lesion cavity expansion, decreases neuron loss, and ultimately improves functional recovery following SCI (all p < 0.05 ). Furthermore, these effects were diminished upon administration of chloroquine, an autophagy flux inhibitor, indicating that trehalose’s beneficial effects were due largely to activation of autophagy. This study presents new evidence that autophagy plays a critical neuroprotective and neuroregenerative role in SCI, and that mTOR-independent activation of autophagy with trehalose leads to improved outcomes. Thus, trehalose has great translational potential as a novel therapeutic agent after SCI.

Irreducible Overlapping Pubic Symphysis Dislocation Managed with Distraction Osteotomy of the Contralateral Superior Pubic Ramus: A Rare Case Report

Introduction: Overlapping pubic symphysis dislocation (OPSD) or a locked pubic symphysis is a compression of the pelvic ring with the intact pubis trapped into the contralateral obturator foramen. Reduction can be difficult and contralateral suprapubic osteotomy is a good way to address the irreducible OPSD. The technique has only been discussed thrice in the available literature. Case Report: We report the case of a 26-year-old man who had his right pubic ramus entrapped within the contralateral obturator foramen, having an overlap of >4 cm with associated ipsilateral sacroiliac joint (SI joint) disruption and urethral injury. When all the maneuvers of closed and instrumented open reduction failed, we performed a superior pubic ramus osteotomy on the left side and unlocked the incarcerated right pubic ramus. The osteotomy site was stabilized with a 6-hole recon plate and SI joint was stabilized with a 6.5mm percutaneous sacroiliac screw. The patient underwent delayed urethral repair at 10 weeks after the index surgery. At 3-year follow-up, the patient did not report any pubic discomfort, urinary and sexual problems. Conclusion: Locked OPSD is a rare injury and is frequently associated with sacroiliac and urethral injuries. Distraction osteotomy of the contralateral superior pubic ramus is a viable option for irreducible cases. Keywords: Lateral compression injury, locked symphysis pubis, superior pubic ramus osteotomy, overlapping pubic symphysis dislocation.