82 results on '"Caterina Fede"'
Search Results
2. Interventions of sestrin proteins: Insights to clinical therapy
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Yunfeng Sun, Yawei Wu, Ronghua Jing, Keping Yang, Xiaoya Wang, Xiaoxiao Zhao, Caterina Fede, and Carla Stecco
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Sestrin ,Dietary restrict ,Exercise ,Regulation ,Pathology ,Science (General) ,Q1-390 ,Social sciences (General) ,H1-99 - Abstract
Sestrin proteins, conserved family proteins which mainly induced by ROS, DNA damage, inflammation, and other injuries. Growing evidences proved sestrin proteins exert protective functions in cardiovascular diseases, chronic degenerative osteoarthritis, musculoskeletal diseases, aging and others, sestrin proteins exhibit an anti-inflammatory response, improving metabolism and other valuable character. However, there is no comprehensive and detailed summary and literature research on the intervention methods of sestrin proteins at present. As the advance of research during last several years, exercise training and other interventions are considered to be the potential methods to up-regulate expression level of protein. In view of the physiological function of this protein, a review of the main studies on regulating the expression level of this protein can provide a novel approach for the clinical treatment and scientific research. In present study, all related researches about interventions and potential mechanisms were reviewed and the mainstream methodologies were described.
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- 2024
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3. Glisson’s capsule matrix structure and function is altered in patients with cirrhosis irrespective of aetiology
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Jessica Llewellyn, Caterina Fede, Abigail E. Loneker, Chet S. Friday, Michael W. Hast, Neil D. Theise, Emma E. Furth, Maria Guido, Carla Stecco, and Rebecca G. Wells
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Liver fibrosis ,Mechanics ,Extracellular matrix ,Collagen organisation ,Visceral fascia ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background & Aims: Glisson’s capsule is the interstitial connective tissue that surrounds the liver. As part of its normal physiology, it withstands significant daily changes in liver size. The pathophysiology of the capsule in disease is not well understood. The aim of this study was to characterise the changes in capsule matrix, cellular composition, and mechanical properties that occur in liver disease and to determine whether these correlate with disease severity or aetiology. Methods: Samples from ten control patients, and six with steatosis, seven with moderate fibrosis, and 37 with cirrhosis were collected from autopsies, intraoperative biopsies, and liver explants. Matrix proteins and cell markers were assessed by staining and second harmonic generation imaging. Mechanical tensile testing was performed on a test frame. Results: Capsule thickness was significantly increased in cirrhotic samples compared with normal controls irrespective of disease aetiology (70.12 ± 14.16 μm and 231.58 ± 21.82 μm, respectively), whereas steatosis and moderate fibrosis had no effect on thickness (90.91 ± 11.40 μm). Changes in cirrhosis included an increase in cell number (fibroblasts, vascular cells, infiltrating immune cells, and biliary epithelial cells). Key matrix components (collagens 1 and 3, hyaluronan, versican, and elastin) were all deposited in the lower capsule, although only the relative amounts per area of hyaluronan and versican were increased. Organisational features, including crimping and alignment of collagen fibres, were also altered in cirrhosis. Unexpectedly, capsules from cirrhotic livers had decreased resistance to loading compared with controls. Conclusions: The liver capsule, similar to the parenchyma, is an active site of disease, demonstrating changes in matrix and cell composition as well as mechanical properties. Impact and implications: We assessed the changes in composition and response to stretching of the liver outer sheath, the capsule, in human liver disease. We found an increase in key structural components and numbers of cells as well as a change in matrix organisation of the capsule during the later stages of disease. This allows the diseased capsule to stretch more under any given force, suggesting that it is less stiff than healthy tissue.
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- 2023
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4. Urinary Incontinence and Other Pelvic Floor Dysfunctions as Underestimated Problems in People under Forty Years: What Is Their Relationship with Sport?
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Lorenza Bonaldi, Maria Vittoria Mascolini, Martina Todesco, Anna Zara, Camilla Rossato, Caterina Fede, Chiara Giulia Fontanella, and Carla Stecco
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urinary incontinence ,pelvic floor dysfunction ,sport ,gender ,aging ,Science - Abstract
Urinary incontinence is still an underestimated problem due to its anatomical complexity and social taboo. Most of the time, it is believed to affect predominantly the elderly female population, and the literature still lacks data on its presence in the younger and male populations. Its relationship with other pelvic floor dysfunctions (PFDs) and sport activity remains an open topic. Thus, the present study surveyed 342 subjects of both genders, ranging from 18 to 39 y/o and with different sport activity levels, to understand the prevalence of PFDs (such as haemorrhoids, anal fissures, involuntary urinary/faecal leakage, and urgency). The results also showed a significative prevalence in younger, sporty, and male people. Approximately one third of the population had urinary incontinence mostly during stress activities (sport activity: 17%, cough/sneeze: 13%). The statistical analysis confirmed a higher prevalence in the cases of a light (32%) and intense (41%) sport activity level and a protective role of sport if practiced between 5 and 10 h/week, with bodybuilding/CrossFit and running seeming to be the riskiest sports. The relationship with the other PFDs showed a statistically significant dependence with most of them, confirming that urinary incontinence cannot be considered a separate problem from the other PFDs.
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- 2023
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5. Innervation of human superficial fascia
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Caterina Fede, Lucia Petrelli, Carmelo Pirri, Winfried Neuhuber, Cesare Tiengo, Carlo Biz, Raffaele De Caro, Robert Schleip, and Carla Stecco
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superficial fascia ,hypodermis ,innervation ,nerve fibers ,autonomic innervation ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 ,Human anatomy ,QM1-695 - Abstract
The superficial fascia has only recently been recognized as a specific anatomical structure. Furthermore, whereas it is actually recognized that the innervation of the deep/muscular fascia plays a key role in proprioception and nociception, there are very few studies that have analyzed these characteristics in the superficial fascia. In this work, our group analyzed two different anatomical districts (abdomen and thigh), from volunteer patients, undergoing surgery procedures. Each sample was processed for histological analysis by Hematoxylin&Eosin, and by immunohistochemistry stainings (in 5-micron-paraffin embedded section and in cryosectioned free floating samples), with antibodies specific for nerve fibers: S100 antibody for myelinating and non-myelinating Schwann cells, PGP9.5 antibody as pan-neuronal marker, tyrosine hydroxylase for autonomic innervation. The results revealed a huge innervation: the nervous structures were found above all around blood vessels and close to adipocytes, but they penetrated also in the connective tissue itself and are found in the midst of fibro-adipose tissue. The tissue is pervaded by both thin (mean diameter of 4.8 ± 2.6 μm) and large nerve fiber bundles of greater diameter (21.1 ± 12.2 μm). The ratio S100/TH positivity was equal to 2.96, with a relative percentage of autonomic innervation with of 33.82%. In the light of these findings is evident that the superficial fasciae have a clear and distinct anatomical identity and a specific innervation, which should be considered to better understand their role in thermoregulation, exteroception and pain perception. The knowledge of the superficial fascia may improve grading and developing of different manual approach for treatments of fascial dysfunctions, and the understanding of how some factors like temperature or manual therapies can have an impact on sensitivity of the fascia.
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- 2022
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6. Evidence of a new hidden neural network into deep fasciae
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Caterina Fede, Lucia Petrelli, Diego Guidolin, Andrea Porzionato, Carmelo Pirri, Chenglei Fan, Raffaele De Caro, and Carla Stecco
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Medicine ,Science - Abstract
Abstract It is recognized that different fasciae have different type of innervation, but actually nothing is known about the specific innervation of the two types of deep fascia, aponeurotic and epymisial fascia. In this work the aponeurotic thoracolumbar fascia and the epymisial gluteal fascia of seven adult C57-BL mice were analysed by Transmission Electron Microscopy and floating immunohistochemistry with the aim to study the organization of nerve fibers, the presence of nerve corpuscles and the amount of autonomic innervation. The antibodies used were Anti-S100, Anti-Tyrosine Hydroxylase and Anti-PGP, specific for the Schwann cells forming myelin, the sympathetic nerve fibers, and the peripheral nerve fibers, respectively. The results showed that the fascial tissue is pervaded by a rhomboid and dense network of nerves. The innervation was statistically significantly lower in the gluteal fascia (2.78 ± 0.6% of positive area, 140.3 ± 31.6/mm2 branching points, nerves with 3.2 ± 0.6 mm length and 4.9 ± 0.2 µm thickness) with respect to the thoracolumbar fascia (9.01 ± 0.98% of innervated area, 500.9 ± 43.1 branching points/mm2, length of 87.1 ± 1.0 mm, thickness of 5.8 ± 0.2 µm). Both fasciae revealed the same density of autonomic nerve fibers (0.08%). Lastly, corpuscles were not found in thoracolumbar fascia. Based on these results, it is suggested that the two fasciae have different roles in proprioception and pain perception: the free nerve endings inside thoracolumbar fascia may function as proprioceptors, regulating the tensions coming from associated muscles and having a role in nonspecific low back pain, whereas the epymisial fasciae works to coordinate the actions of the various motor units of the underlying muscle.
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- 2021
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7. Detection of Lymphatic Vessels in the Superficial Fascia of the Abdomen
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Giovanna Albertin, Laura Astolfi, Caterina Fede, Edi Simoni, Martina Contran, Lucia Petrelli, Cesare Tiengo, Diego Guidolin, Raffaele De Caro, and Carla Stecco
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lymphatics vessels ,subcutaneous tissue ,reconstructive surgery ,superficial fascia ,hypodermis ,immunohistochemistry ,Science - Abstract
Recently, the superficial fascia has been recognized as a specific anatomical structure between the two adipose layers—the superficial adipose tissue (SAT) and the deep adipose tissue (DAT). The evaluation of specific characteristics of cells, fibers, blood circulation, and innervation has shown that the superficial fascia has a clear and distinct anatomical identity, but knowledge about lymphatic vessels in relation to the superficial fascia has not been described. The aim of this study was to evaluate the presence of lymphatic vessels in the hypodermis, with a specific focus on the superficial fascia and in relation to the layered subdivision of the subcutaneous tissue into SAT and DAT. Tissue specimens were harvested from three adult volunteer patients during abdominoplasty and stained with D2-40 antibody for the lymphatic endothelium. In the papillary dermis, a huge presence of lymphatic vessels was highlighted, parallel to the skin surface and embedded in the loose connective tissue. In the superficial adipose tissue, thin lymphatic vessels (mean diameter of 11.6 ± 7.71 µm) were found, close to the fibrous septa connecting the dermis to the deeper layers. The deep adipose tissue showed a comparable overall content of lymphatic vessels with respect to the superficial layer; they followed the blood vessel and had a larger diameter. In the superficial fascia, the lymphatic vessels showed higher density and a larger diameter, in both the longitudinal and transverse directions along the fibers, as well as vessels that intertwined with one another, forming a rich network of vessels. This study demonstrated a different distribution of the lymphatic vessels in the various subcutaneous layers, especially in the superficial fascia, and the demonstration of the variable gauge of the vessels leads us to believe that they play different functional roles in the collection and transport of interstitial fluid—important factors in various surgical and rehabilitation fields.
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- 2023
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8. Ultrasound Imaging of Head/Neck Muscles and Their Fasciae: An Observational Study
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Carmelo Pirri, Caterina Fede, Chenglei Fan, Diego Guidolin, Veronica Macchi, Raffaele De Caro, and Carla Stecco
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masticatory muscles ,temporal muscle ,deep fascia ,ultrasonography ,masseter muscle ,sternocleidomastoid muscle ,Other systems of medicine ,RZ201-999 ,Medical technology ,R855-855.5 - Abstract
Background: Masticatory muscle thickness provides objective measurements of the temporomandibular motor function, which may change in patients with oral myofascial pain. Moreover, they are considered as being part of the craniocervical unit by a crucial relationship with cervical muscles and their fasciae. In this study, we aimed to assess by ultrasound (US) imaging the fasciae of the masseter, temporal, and sternocleidomastoid muscles to understand their mean thickness and eventual variation in relationship with the muscles, sides, and sex.Methods: We studied 16 healthy volunteers without temporomandibular joint dysfunction. Concerning each subject were evaluated the range of motion of the temporomandibular joint and of the neck, the thickness of muscles and their fasciae of both sides, and the delta of muscle thickness.Results: All the motor evaluations of the subjects showed normal ranges. The US results showed that the fasciae have a mean thickness of 0.50 ± 0.1 mm, which did not change during muscle contraction. The evaluated muscles presented a symmetry between right and left (p > 0.05), even if the delta of muscle (US) thickness had a huge range between different subjects, for example in the masseter muscle from 0.7 to 4.2 mm.Conclusions: Ultrasound imaging is a suitable and reliable tool to study the muscles and fasciae of the head and neck region, permitting also the evaluation of the ability of the muscles to contract. Finally, identifying functional asymmetry that could become symptomatic, US imaging could allow an early rehabilitation treatment.
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- 2021
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9. Immediate Effects of Extracorporeal Shock Wave Therapy in Fascial Fibroblasts: An In Vitro Study
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Carmelo Pirri, Caterina Fede, Lucia Petrelli, Enrico De Rose, Carlo Biz, Diego Guidolin, Raffaele De Caro, and Carla Stecco
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fascia ,hyaluronan ,vesicles ,myofascial pain ,focused extracorporeal shock waves ,3D printer ,Biology (General) ,QH301-705.5 - Abstract
Extracorporeal shock waves (ESWs) are used in the treatment of soft tissue injuries, but their role in the treatment of myofascial pain has not yet been demonstrated. The aim of this study was to investigate changes in cell biology of fibroblasts derived from deep/muscular fascia following treatment with ESWs. Primary fascial fibroblasts were collected from small samples of human fascia lata of the thigh of three volunteer patients (two men, one woman) during orthopedic surgery, and put in culture. These cells were exposed to 100 impulses of 0.05 mJ/mm2 with a frequency of 2.5 Hz, using 3D-printed support. This study demonstrated for the first time that ESWs can lead to in vitro production of hyaluronan-rich vesicles immediately after the treatment. At 1, 4, and 24 h after treatment, Alcian blue and Toluidine blue staining; immunocytochemistry to detect hyaluronic acid binding protein (HABP), collagen I, and collagen III; and transmission electron microscopy demonstrated that these vesicles are rich in hyaluronan and collagen I and III. The diameter of these vesicles was assessed, highlighting a small size at 1 h after ESW treatment, whereas at 4 and 24 h, they had an increase in the size. Particularly evident was the release of hyaluronan-rich vesicles, collagen-I, and collagen-III starting at 1 h, with an increase at 4 h and maintenance by 24 h. These in vitro data indicate that fascial cells respond to ESW treatment by regulating and remodeling the formation of extracellular matrix.
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- 2022
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10. Fetal Fascial Reinforcement Development: From 'a White Tablet' to a Sculpted Precise Organization by Movement
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Carmelo Pirri, Lucia Petrelli, Albert Pérez-Bellmunt, Sara Ortiz-Miguel, Caterina Fede, Raffaele De Caro, Maribel Miguel-Pérez, and Carla Stecco
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fetus ,fascia development ,retinacula ,gross functional movements ,Biology (General) ,QH301-705.5 - Abstract
Fasciae have received much attention in recent years due to their important role in proprioception and muscular force transmission, but few studies have focused on fetal fasciae development and there is no study on the retinacula. The latter are fascial reinforcements that play a key role in proprioception and motor coordination. Furthermore, it is still unclear if they are genetically determined or if they are defined by movements, and if they are present during gestation or if they appear only later in the childhood. We aim to identify their structural organization by qualitative and quantitative assessments to establish their role the myofascial development, highlighting their appearance and organization. Samples from the wrist retinacula, posterior forearm, ankle retinacula, anterior leg, iliotibial tract and anterior thigh of six fetus body donors (from 24th to 40th week of gestation) and histological sections were obtained and a gross anatomy dissection was performed. Sections were stained with hematoxylin-eosin to observe their overall structure and measure their thicknesses. Using Weigert Van Gieson, Alcian blue and immunostaining to detect Hyaluronic Acid Binding Protein (HABP), Collagens I and III (Col I and III) were realized to assess the presence of elastic fibers and hyaluronan. This study confirms that the deep fasciae initially do not have organized layers and it is not possible to highlight any reinforcement. The fascial development is different according to the various area: while the deep fascia and the iliotibial tract is already evident by the 27th week, the retinacula begin to be defined only at the end of pregnancy, and their complete maturation will probably be reached only after birth. These findings suggest that the movement models the retinacula, structuring the fascial system, in particular at the end of pregnancy and in the first months of life. The fasciae can be imagined, initially, as “white tablets” composed of few elastic fibers, abundant collagens and HA, on which various forces, u movements, loads and gravity, “write their history”.
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- 2022
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11. Ultrasound imaging of a scar on the knee: Sonopalpation for fascia and subcutaneous tissues
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Carmelo Pirri, Antonio Stecco, Caterina Fede, Raffaele De Caro, Carla Stecco, and Levent Özçakar
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Ultrasonography ,scar ,fascia ,knee ,pain ,Medicine ,Human anatomy ,QM1-695 - Abstract
Persistent scar pain associated with healed surgical incisions after a trauma is a common and potentially debilitating type of fascial pain. At present, there is no universally effective treatment for persistent surgical or post-trauma scar pain. Herein we describe the successful objective diagnosis of debilitating scar pain by Ultrasound (US) imaging. The sonopalpation of the fasciae and subcutaneous tissues seems to be relevant to diagnose the real cause of the pain and why not to monitor the treatment.
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- 2020
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12. Ultrasound Imaging of Brachial and Antebrachial Fasciae
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Carmelo Pirri, Diego Guidolin, Caterina Fede, Veronica Macchi, Raffaele De Caro, and Carla Stecco
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deep fascia ,ultrasonography ,arm ,forearm ,thickness ,reliability ,Medicine (General) ,R5-920 - Abstract
Knowledge about fasciae has become increasingly relevant in connection to regional anesthesiology, given the growing interest in fascial plane, interfascial, and nerve blocks. Ultrasound (US) imaging, thanks to high definition, provides the possibility to visualize and measure their thickness. The purpose of this study was to measure and compare, by US imaging, the thickness of deep/muscular fasciae in different points of the arm and forearm. An observational study has been performed using US imaging to measure brachial and antebrachial fasciae thickness at anterior and posterior regions, respectively, of the arm and forearm at different levels with a new protocol in a sample of 25 healthy volunteers. Results of fascial thickness revealed statistically significant differences (p < 0.0001) in the brachial fascia between the anterior and the posterior regions; in terms of the antebrachial fascia, no statistically significant difference was present (p > 0.05) between the regions/levels. Moreover, regarding the posterior region/levels, the brachial fascia had a greater thickness (mean 0.81 ± 0.20 mm) than the antebrachial fascia (mean 0.71 ± 0.20 mm); regarding the anterior region/levels, the antebrachial fascia was thicker (mean 0.70 ± 0.2 mm) than the brachial fascia (mean 0.61 ± 0.11 mm). In addition, the intra-rater reliability reported good reliability (ICC2,k: 0.88). US imaging helps to improve grading of fascial dysfunction or disease by revealing subclinical lesions, clinically invisible fascial changes, and one of the US parameters to reliably evaluate is the thickness in the different regions and levels.
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- 2021
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13. Fascia Lata Alterations in Hip Osteoarthritis: An Observational Cross-Sectional Study
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Ilaria Fantoni, Carlo Biz, Chenglei Fan, Carmelo Pirri, Caterina Fede, Lucia Petrelli, Pietro Ruggieri, Raffaele De Caro, and Carla Stecco
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fascia ,hip osteoarthritis ,hyaluronan ,collagen ,stiffness ,myofascial pain ,Science - Abstract
The present study compares the structure and composition of fascia lata in healthy subjects and in patients with hip osteoarthritis (OA), to evaluate any differences in the amount of Collagen type I, Collagen type III, and Hyaluronan. Fascia lata samples from voluntary healthy subjects and patients with OA were harvested during surgery. Collagen type I (COL I), III (COL III) antibody, and biotinylated hyaluronan binding protein (HABP) immunohistochemistry stainings were used to evaluate fascial morphology and COL I, COL III, and Hyaluronan (HA) content in both groups. Ten samples from healthy subjects and 11 samples from OA patients were collected. COL I was significantly more abundant in the OA group (p = 0.0015), with a median percentage positivity of 75.2 (IQR 13.11)%, while representing only 67 (IQR: 8.71)% in control cases. COL III, with median values of 9.5 (IQR 3.63)% (OA group) and 17.10 (IQR 11)% (control cases), respectively, showed significant reduction in OA patients (p = 0.002). HA showed a median value of 10.01 (IQR 8.11)% in OA patients, denoting significant decrease (p < 0.0001) with respect to the control group median 39.31 (IQR 5.62)%. The observed differences suggest a relationship between fascial pathology and hip OA. The observed increase in COL I in OA patients, along with the reduction of COL III and HA, could lead to fascial stiffening, which could alter fascial mechanics and be linked to the development and symptoms of OA.
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- 2021
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14. Diabetic Foot: The Role of Fasciae, a Narrative Review
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Carmelo Pirri, Caterina Fede, Nina Pirri, Lucia Petrelli, Chenglei Fan, Raffaele De Caro, and Carla Stecco
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wounds ,fascia ,diabetes ,superficial fascia ,stiffness ,collagen ,Biology (General) ,QH301-705.5 - Abstract
Wound healing is an intricate, dynamic process, in which various elements such as hyperglycemia, neuropathy, blood supply, matrix turnover, wound contraction, and the microbiome all have a role in this “out of tune” diabetic complex symphony, particularly noticeable in the complications of diabetic foot. Recently it was demonstrated that the fasciae have a crucial role in proprioception, muscular force transmission, skin vascularization and tropism, and wound healing. Indeed, the fasciae are a dynamic multifaceted meshwork of connective tissue comprised of diverse cells settled down in the extracellular matrix and nervous fibers; each constituent plays a particular role in the fasciae adapting in various ways to the diverse stimuli. This review intends to deepen the discussion on the possible fascial role in diabetic wounds. In diabetes, the thickening of collagen, the fragmentation of elastic fibers, and the changes in glycosaminoglycans, in particular hyaluronan, leads to changes in the stiffness, gliding, and the distribution of force transmission in the fasciae, with cascading repercussions at the cellular and molecular levels, consequently feeding a vicious pathophysiological circle. A clear scientific perception of fascial role from microscopic and macroscopic points of view can facilitate the identification of appropriate treatment strategies for wounds in diabetes and create new perspectives of treatment.
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- 2021
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15. Pilot Study of Sacroiliac Joint Dysfunction Treated with a Single Session of Fascial Manipulation® Method: Clinical Implications for Effective Pain Reduction
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Dennis Bertoldo, Carmelo Pirri, Barbara Roviaro, Luigi Stecco, Julie Ann Day, Caterina Fede, Diego Guidolin, and Carla Stecco
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fascia ,sacroiliac joint dysfunction ,pain ,Fascial Manipulation ,manual treatment ,connective tissue ,Medicine (General) ,R5-920 - Abstract
Background and Objectives: Sacroiliac joint dysfunction (SIJD) generally refers to pain in the lower back due to abnormal sacroiliac joint movement, either from hypomobility or hypermobility. It is considered to be the principal cause in up to 40% of low back pain cases. In literature, it emerges that the “fascia”, by its anatomical continuity, if altered or densified in different regions of the body with respect to the sacroiliac joint and its surroundings, may have a fundamental role in the genesis of SIJD and low back pain. The purpose of the present study is to evaluate the effectiveness of incorporating a single session of Fascial Manipulation®-Stecco method®, treating the muscular fasciae at distance from the painful region. Materials and Methods: Twenty patients with acute and chronic sacroiliac joint dysfunction (SIJD) were recruited (16 males and 4 females, mean age of 46.6 ± 12.98 years). Patients underwent a predefined assessment protocol, followed by an evaluation of myofascial pain and subsequent manipulation of the fascia at points at least 20 cm away from the posterior inferior iliac spines (PIIS). Each patient underwent three pain evaluations: pre-treatment (t0), post-treatment (t1), and at a 1-month follow-up (t2). For the evaluation in t0, t1 the numerical rating scale (NRS) for the intensity of pain and the algometer for the pain threshold at the PIIS were used; in t2 only the NRS scale. Results: The results obtained by comparing the algometer measurements with the NRS values between t0 and t1 were in both cases statistically significant (p < 0.0001), whereas the comparison between the NRS values at t1 and at t2 was not statistically significant (p > 0.05). Conclusions: A single Fascial Manipulation treatment, even when applied at least 20 cm from the PIIS, can potentially decrease pain around the SIJ. The inclusion of this type of approach in SIJD can allow for improved patient management, better tolerance for other treatments and a more rapid application of pain-free exercise programs.
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- 2021
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16. The crural interosseous membrane re-visited: a histological and microscopic study
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Joseph Morley, Chenglei Fan, Kena McDermott, Caterina Fede, Emmett Hughes, and Carla Stecco
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crural interosseous membrane ,sensory nerve ending ,mechanoreceptor ,Medicine ,Human anatomy ,QM1-695 - Abstract
The aim of this study was to characterize the microscopic structure and sensory nerve endings of the crural interosseous membrane (IM). 13 IMs from 7 cadavers were used to analyze the organization of the collagen fibers, IM’s thickness, distribution of elastic fibers and nerve elements. The IM is mainly a two-layer collagen fascicle structure with the collagen fibers of adjacent layers orientated along different directions, forming angles of 30.5 +/- 1.7° at proximal and 26.6 +/- 2.1° at distal part (P>0.05). The percentage of elastic fibers between the two layers and inside the collagen fascicle layer is 10.1 +/- 0.5% and 2.2 +/- 0.1% (P
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- 2019
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17. Sensitivity of the fasciae to sex hormone levels: Modulation of collagen-I, collagen-III and fibrillin production.
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Caterina Fede, Carmelo Pirri, Chenglei Fan, Giovanna Albertin, Andrea Porzionato, Veronica Macchi, Raffaele De Caro, and Carla Stecco
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Medicine ,Science - Abstract
Although it is now recognized that women suffer from myofascial pain to a greater extent than men, and that the muscular fasciae can respond to hormonal stimuli, thanks to the expression of sex hormone receptors, how the fasciae can modify their structure under hormonal stimulation is not clear. In this work, an immunocytochemical analysis of collagen-I, collagen-III and fibrillin were carried out on fibroblasts isolated from human fascia lata after in vitro treatment with various levels of sex hormones β-estradiol and/or relaxin-1, according to the phases of a woman's period (follicular, periovulatory, luteal, post-menopausal phases and pregnancy). This study demonstrates for the first time that fascial cells can modulate the production of some components of the extracellular matrix according to hormone levels, when treated with β-estradiol: collagen-I falls from 6% of positivity in the follicular phase to 1.9 in the periovulatory phase. However, after the addition of relaxin-1 to the cell culture, the production of extracellular matrix decreased and remained at the same level (1.7% of collagen-I, at both follicular and periovulatory levels of hormones). These results confirm the antifibrotic function of relaxin-1, thanks to its ability to reduce matrix synthesis. They are also a first step in our understanding of how some hormonal dysfunctions in women can cause a dysregulation of extracellular matrix production in fasciae.
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- 2019
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18. Ultrasound Imaging of Crural Fascia and Epimysial Fascia Thicknesses in Basketball Players with Previous Ankle Sprains Versus Healthy Subjects
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Carmelo Pirri, Caterina Fede, Antonio Stecco, Diego Guidolin, Chenglei Fan, Raffaele De Caro, and Carla Stecco
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connective tissue ,fascia ,basketball sport ,Muscle-skeletal Ultrasound ,Y-balance test ,ankle sprain ,Medicine (General) ,R5-920 - Abstract
Background: Fascial layers may play an important role in locomotor mechanics. Recent researches have revealed an association between increases of fascia thickness and reduced joint flexibility in patients with chronic pain. The purpose of this study was to measure and compare, through the use of ultrasound imaging, the thickness of the deep/crural fascia in different points of the leg as well as the epimysial fascia thickness at level 2 of anterior compartment of leg, in male basketball players with history of recurrent ankle sprain and in healthy participants. Methods: A cross-sectional study has been performed using ultrasound imaging to measure deep/crural fascia thickness of anterior, lateral and posterior compartment of the leg at different levels with a new protocol in a sample of 30 subjects, 15 basketball players and 15 healthy participants. Results: Findings of fascial thickness revealed statistically significant differences (p < 0.01) in epimysial fascia thickness and in deep/crural fascia thickness between levels/compartments of the same group and between two groups. Moreover, Post 3 deep/crural fascia thicknesses (p < 0.001) were decreased showing statistically significant difference for the basketball players group respect the healthy participants group. Conclusions: These findings suggested that the posterior compartment was thicker than anterior compartment, probably due to a postural reason in both groups. Moreover, they showed an increase of thickness of the epimysial fascia in basketball players with previous ankle sprains. This variability underlines the importance to assess the fasciae and to make results comparable.
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- 2021
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19. Fascial or Muscle Stretching? A Narrative Review
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Carla Stecco, Carmelo Pirri, Caterina Fede, Can A. Yucesoy, Raffaele De Caro, and Antonio Stecco
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fascia ,biomechanics ,exercise ,injury and prevention ,musculoskeletal ,stretching ,Technology ,Engineering (General). Civil engineering (General) ,TA1-2040 ,Biology (General) ,QH301-705.5 ,Physics ,QC1-999 ,Chemistry ,QD1-999 - Abstract
Stretching exercises are integral part of the rehabilitation and sport. Despite this, the mechanism behind its proposed effect remains ambiguous. It is assumed that flexibility increases, e.g., action on muscle and tendon, respectively, but this is not always present in the stretching protocol of the exercises used. Recently, the fasciae have increased popularity and seems that they can have a role to define the flexibility and the perception of the limitation of the maximal range of motion (ROM). Deep fascia is also considered a key element to transmit load in parallel bypassing the joints, transmitting around 30% of the force generated during a muscular contraction. So, it seems impossible dividing the action of the muscles from the fasciae, but they have to be considered as a “myofascial unit”. The purpose of this manuscript is to evaluate the mechanical behavior of muscles, tendons, and fasciae to better understand how they can interact during passive stretching. Stress-strain values of muscle, tendon and fascia demonstrate that during passive stretching, the fascia is the first tissue that limit the elongation, suggesting that fascial tissue is probably the major target of static stretching. A better understanding of myofascial force transmission, and the study of the biomechanical behavior of fasciae, with also the thixotropic effect, can help to design a correct plan of stretching.
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- 2020
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20. Quantitative Evaluation of the Echo Intensity of Paraneural Area and Myofascial Structure around Median Nerve in Carpal Tunnel Syndrome
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Chenglei Fan, Caterina Fede, Carmelo Pirri, Diego Guidolin, Carlo Biz, Veronica Macchi, Raffaele De Caro, and Carla Stecco
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paraneural area ,myofascial structure ,echo intensity ,median nerve ,carpal tunnel syndrome ,ultrasound ,Medicine (General) ,R5-920 - Abstract
The aim of this study was to investigate whether the echo intensity (EI) of the paraneural area (PA), the median nerve (MN) at the carpal tunnel, the EI of the myofascial structure (MS) around MN, the ‘PA and MN’ at the mid-forearm, and the MN transversal displacement at both sites differs between persons with carpal tunnel syndrome (CTS) and control subjects. Methods: In total, 16 CTS patients and 16 controls, age- and gender-matched, were recruited. Cross-sectional ultrasound images of MN were obtained to evaluate the EI of the PA, the MN at carpal tunnel, the EI of MS, and the ‘PA and MN’ at the mid-forearm in a natural position, then images were taken after a whole-hand grasp movement, to evaluate MN transversal displacement. Inter-rater and intra-rater reliability in control, and differences in the EI and MN displacement between CTS and control, were analyzed. In addition, the correlations between ultrasound parameters and MN displacement were evaluated. Results: The quantitative EI of PA, MN, EI of MS, ‘PA and MN’ had high inter-rater and intra-rater reliability in the control. The EI of PA, MS and ‘PA and MN’ were significantly higher in CTS subjects (p < 0.01), whilst there was no significant difference in the EI of MN at the carpal tunnel. MN displacement was significantly decreased both at the carpal tunnel and the mid-forearm in CTS subjects (p < 0.01). In addition, there were negative correlations among the EI of PA (rs = −0.484, p = 0.004), EI of MS (rs = −0.479, p = 0.002), EI of ‘PA and MN’ (rs = −0.605, p < 0.001) and MN transversal displacement. Conclusions: The higher EI of PA and MS around MN in CTS may indicate greater fibrosis along the course of MN, reducing fascial adaptability, influencing the synergy and coordination of the MS, and increasing the shear stress between MS and MN, and it may further increase the abnormal pressure on the MN not only at the carpal tunnel, but also at the mid-forearm. These results may partly explain the role of PA and MS in CTS pathogenesis.
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- 2020
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21. Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae
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Chenglei Fan, Diego Guidolin, Serena Ragazzo, Caterina Fede, Carmelo Pirri, Nathaly Gaudreault, Andrea Porzionato, Veronica Macchi, Raffaele De Caro, and Carla Stecco
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caesarean section ,vaginal delivery ,fascia ,abdominal muscles ,pain ,ultrasound ,Medicine (General) ,R5-920 - Abstract
Background and objectives: Possible disorders after delivery may interfere with the quality of life. The aim of this study was to ascertain whether abdominal muscles and fasciae differ in women depending on whether they experienced transverse cesarean section (CS) or vaginal delivery (VA) in comparison with healthy nulliparous (NU). Materials and methods: The thicknesses of abdominal muscles and fasciae were evaluated by ultrasound in 13 CS, 10 VA, and 13 NU women (we examined rectus abdominis (RA); external oblique (EO); internal oblique (IO); transversus abdominis (TrA); total abdominal muscles (TAM = EO + IO + TrA); inter-rectus distance (IRD); thickness of linea alba (TLA); rectus sheath (RS), which includes anterior fascia of RS and posterior fascia of RS (P-RS); loose connective tissue between sublayers of P-RS (LCT); abdominal perimuscular fasciae (APF), which includes anterior fascia of EO, fasciae between EO, IO, and TrA, and posterior fascia of TrA). Data on pain intensity, duration, and location were collected. Results: Compared with NU women, CS women had wider IRD (p = 0.004), thinner left RA (p = 0.020), thicker right RS (p = 0.035) and APF (left: p = 0.001; right: p = 0.001), and IO dissymmetry (p = 0.009). VA women had thinner RA (left: p = 0.008, right: p = 0.043) and left TAM (p = 0.024), mainly due to left IO (p = 0.027) and RA dissymmetry (p = 0.035). However, CS women had thicker LCT (left: p = 0.036, right: p < 0.001), APF (left: p = 0.014; right: p = 0.007), and right IO (p = 0.028) than VA women. There were significant correlations between pain duration and the affected fasciae/muscles in CS women. Conclusions: CS women showed significant alterations in both abdominal fasciae and muscle thicknesses, whereas VA women showed alterations mainly in muscles. Thinner RA and/or dissymmetric IO, wider IRD, and thicker LCT and APF after CS may cause muscle deficits and alteration of fascial gliding, which may induce scar, abdominal, low back, and/or pelvic pain.
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- 2020
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22. Effects of Lower Limbs Stretching on the Neck Range of Motion: Preliminary Evidence for Myofascial Sequence?
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Jenny Calgaro, Lorenza Bonaldi, Simona Mrakic Sposta, Caterina Fede, Antonio Stecco, Carmelo Pirri, and Carla Stecco
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Automotive Engineering - Abstract
In recent years, various studies have demonstrated that the fascia can transmit the mechanical tensions generated by muscle activity over a distance. However, it is not yet clear whether this transmission follows precise anatomical lines. The present study aims to understand if the exercises at a distance can influence the range of motion of the neck, and if the effects are different by performing the exercises in various directions. The study was attended by 30 healthy volunteers aged between 19 and 32 years. Anterior flexion of the neck was checked before the protocols and retested to compare the difference after stretching the hamstrings and adductors. All evaluations were performed by the same operator using an electronic goniometer. Cervical ROM increased during both procedures, but after the hamstrings stretch it increased significantly more than after the adductors stretch (6.22° versus 1.44°). This study highlighted how fascia can transmit forces at a distance, but only according to precise myofascial sequences. Consequently, it is important to know the fascial organization in order to properly train the fascial system.
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- 2023
23. Blood supply to the superficial fascia of the abdomen: An anatomical study
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Carmelo Pirri, Lucia Petrelli, Caterina Fede, Diego Guidolin, Cesare Tiengo, Raffaele De Caro, and Carla Stecco
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superficial fascia ,Histology ,anterior abdominal wall ,arteries ,arterio-venous anastomoses ,capillaries ,flaps ,hypodermis ,lymphatics ,plastic surgery ,reconstructive surgery ,subcutaneous tissue ,vascularization ,veins ,General Medicine ,Anatomy - Abstract
The aim of this study was to examine data demonstrating that Scarpa's fascia, a superficial fascia of the anterior abdominal wall, is a vascularized tissue. Specimens of the fascia of seven volunteers undergoing abdominoplasty surgical procedures at the Plastic Surgery Unit of the University of Padova Medical Center were collected. Fractal analysis and quantitative assessment of the vascular network of the fascia was carried out, exploiting the presence of blood in the vessels. Each sample was divided and processed for histological/immunohistochemical analysis (into 5 micron-paraffin embedded sections and cryo-sectioned free-floating samples) as well as for electron microscopy study. A rich vascular pattern forming a fine, dense meshwork with an area percentage of 6.20±2.10% von Willebrand factor stained vessels was noted in all the specimens of the fascia examined; the area percentage of the αSMA-stained vessels was 2.93 ± 1.80 %. The diameters of the vessels fell between the 13 - 65 μm range; the network was composed of arteries, veins, capillaries and lymphatic segments. Topological results showed that the vascular network within Scarpa's fascia is well-branched (segments: 6615 ± 3070 and 8.40 ± 3.40 per mm
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- 2023
24. From Muscle to the Myofascial Unit: Current Evidence and Future Perspectives
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Antonio Stecco, Federico Giordani, Caterina Fede, Carmelo Pirri, Raffaele De Caro, and Carla Stecco
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muscle ,Organic Chemistry ,review ,General Medicine ,Catalysis ,Computer Science Applications ,Inorganic Chemistry ,connective tissue ,fascia ,motor control ,motor unit ,muscle spindle ,myofascial unit ,Physical and Theoretical Chemistry ,Molecular Biology ,Spectroscopy - Abstract
The “motor unit” or the “muscle” has long been considered the quantal element in the control of movement. However, in recent years new research has proved the strong interaction between muscle fibers and intramuscular connective tissue, and between muscles and fasciae, suggesting that the muscles can no longer be considered the only elements that organize movement. In addition, innervation and vascularization of muscle is strongly connected with intramuscular connective tissue. This awareness induced Luigi Stecco, in 2002, to create a new term, the “myofascial unit”, to describe the bilateral dependent relationship, both anatomical and functional, that occurs between fascia, muscle and accessory elements. The aim of this narrative review is to understand the scientific support for this new term, and whether it is actually correct to consider the myofascial unit the physiological basic element for peripheral motor control.
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- 2023
25. Age-Related Alterations of Hyaluronan and Collagen in Extracellular Matrix of the Muscle Spindles
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Chenglei Fan, Carmelo Pirri, Caterina Fede, Diego Guidolin, Carlo Biz, Lucia Petrelli, Andrea Porzionato, Veronica Macchi, Raffaele De Caro, and Carla Stecco
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collagen ,extracellular matrix ,Aging ,Collagen ,Collagen type I ,Collagen type III ,Extracellular matrix ,Hyaluronan ,Intramuscular connective tissue ,Muscle spindle ,aging ,collagen type I ,muscle spindle ,collagen type III ,hyaluronan ,intramuscular connective tissue ,General Medicine ,Article ,Medicine - Abstract
Background: Muscle spindles (MSs) play a crucial role in proprioception and locomotor coordination. Although the elasticity and viscosity of the extracellular matrix (ECM) within which MSs are embedded may play a key role in MS function, the impact of aging on ECM components is unclear. The aim of the current study was to investigate the age-related physiological changes of the ECM and to verify if these could be due to alterations of the environment directly surrounding MSs. Methods: Hematoxylin Eosin and picrosirius-red staining was carried out; collagen types I (COLI) and III (COLIII) were assessed, and biotinylated hyaluronan binding protein (HABP) immunohistochemical analysis was undertaken to evaluate alterations of the ECM in the intramuscular connective tissue (IMCT) of the hindlimbs of C57BL/6J male mice. Assessments were carried out on 6-week-old (Group A), 8-month-old (Group B), and 2-year-old (Group C) laboratory mice. Results: The capsule’s outer layer became progressively thicker with aging (it was 3.02 ± 0.26 μm in Group A, 3.64 ± 0.31 μm in Group B, and 5.81 ± 0.85 μm in Group C). The collagen in IMCT around and within the MSs was significantly higher in Group C, but there were no significant differences between Groups A and B. The MS capsules and continuous IMCT were primarily made up of COLI and COLIII. The average optical density (AOD) values of COLI in IMCT surrounding MS were significantly higher after aging (p < 0.05), but there were no significant differences in COLIII in the three groups (p > 0.05). HA was present in IMCT and filled the MSs capsule. The AOD of HABP of MS showed that there were lower HA levels in Group C with respect to Group A (p = 0.022); no significant differences were noted neither between Groups A and B nor between Groups B and C (p > 0.05). Conclusion: Age-related collagen accumulation and lower HA in the ECM in which the MSs were embedded may probably cause more stiffness in the ECM in vivo, which could help to partly explain the peripheral mechanisms underlying the age-related decline in functional changes related to MSs.
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- 2022
26. Elastic Fibres in the subcutaneous tissue: Is there a difference between superficial and muscular fascia? A cadaver study
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Chenglei Fan, Raffaele De Caro, Carmelo Pirri, Diego Guidolin, Lucia Petrelli, Carla Stecco, and Caterina Fede
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musculoskeletal diseases ,deep fascia ,Scars ,Dermatology ,Thigh ,Dermis ,Cadaver ,medicine ,Van Gieson's stain ,Humans ,Fascia ,connective tissue ,superficial fascia ,elastic fibres ,elasticity ,subcutaneous tissue ,thigh ,business.industry ,Anatomy ,Elastic Tissue ,musculoskeletal system ,eye diseases ,body regions ,medicine.anatomical_structure ,Deep fascia ,medicine.symptom ,business ,Subcutaneous tissue - Abstract
BACKGROUND In last years the role of fascia in proprioception and pain has been confirmed in numerous papers, but the real structure of fasciae is not still entirely known. To date, many studies have evaluated the elastic fibres in arteries, ligaments, lungs, epidermis and dermis, but only two studies exist about the elastic fibres in the fasciae, and they did not distinguish between superficial (in the subcutaneous tissue) and deep/muscular fasciae. The aim of the study was to assess the percentage of elastic fibres between superficial and deep fascia. MATERIALS AND METHODS Three full thickness specimens (proximal, middle and distal respectively) were taken from each of four regions of the thigh of three non-embalmed cadavers: the anterior (Ant), the lateral (Lat), the posterior (Post) and the medial (Med) aspect. Thus, a total of 12 specimens were collected from each analysed thigh and histological Weigert Van Gieson stains was performed. Three sections per specimen were considered for the morphometric analysis. RESULTS In all the specimens the superficial and deep fasciae were clearly recognizable. The difference in percentage of elastic fibres between superficial and deep fasciae in same region for all four was highly significant (p
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- 2021
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27. Glisson’s capsule structure and function is altered in cirrhotic patients irrespective of etiology
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Jessica Llewellyn, Caterina Fede, Abigail E. Loneker, Chet S. Friday, Michael W. Hast, Neil D. Theise, Emma E. Furth, Maria Guido, Carla Stecco, and Rebecca G. Wells
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Background and AimsGlisson’s capsule is the interstitial connective tissue that surrounds the liver. As part of its normal physiology, it withstands significant daily changes in liver size. The pathophysiology of the capsule in disease is not well understood. The aim of this study was to characterize the changes in capsule matrix, cellular composition, and mechanical properties that occur in liver disease and to determine whether these correlate with disease severity or etiology.Methods10 control, 6 steatotic, 7 moderately fibrotic and 37 cirrhotic patient samples were collected from autopsies, intraoperative biopsies and liver explants. Matrix proteins and cell markers were assessed by staining and second harmonic generation imaging. Mechanical tensile testing was performed on a test frame.ResultsCapsule thickness was significantly increased in cirrhotic samples compared to normal controls irrespective of disease etiology (69.62 ± 9.99 and 171.269 ± 16.65 µm respectively), whereas steatosis and moderate fibrosis had no effect on thickness (62.15 ± 4.97 µm). Changes in cirrhosis included an increase in cell number (fibroblasts, vascular cells, infiltrating immune cells and biliary epithelial cells). Key matrix components (collagens 1 and 3, hyaluronan, versican and elastin) were all deposited in the lower capsule although only the relative amounts per area of hyaluronan and versican were increased. Organizational features including crimping and alignment of collagen fibers were also altered in cirrhosis. Unexpectedly, capsules from cirrhotic livers had decreased resistance to loading in comparison to controls.ConclusionsThe liver capsule, like the parenchyma, is an active site of disease, demonstrating changes in matrix and cell composition as well as mechanical properties.Lay summaryWe assessed the changes in composition and response to stretching of the liver outer sheath, the capsule, in human liver disease. We find an increase in key structural components and numbers of cells as well as a change in matrix organization of the capsule in the later stages of disease. This allows the diseased capsule to stretch more under any given force, suggesting it is less stiff than healthy tissue.Graphical abstractHighlightsThe capsule is an active site of disease: thickness and cellularity increase markedly in cirrhosisExtracellular matrix composition and organization change in cirrhosisThe cirrhotic capsule stretches more and is less stiff
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- 2022
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28. Are Patellofemoral Ligaments and Retinacula Distinct Structures of the Knee Joint? An Anatomic, Histological and Magnetic Resonance Imaging Study
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Carlo Biz, Carla Stecco, Alberto Crimì, Carmelo Pirri, Michele Fosser, Caterina Fede, Chenglei Fan, Pietro Ruggieri, and Raffaele De Caro
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Adult ,Aged, 80 and over ,Retinaculum ,Adolescent ,Knee Joint ,Health, Toxicology and Mutagenesis ,Knee anatomy ,Public Health, Environmental and Occupational Health ,Middle Aged ,Magnetic Resonance Imaging ,Young Adult ,Knee imaging ,Ligaments, Articular ,Cadaver ,Medicine ,Humans ,knee anatomy ,knee imaging ,patellofemoral ligament ,retinaculum ,Patellofemoral ligament ,Aged - Abstract
There is disagreement regarding the description of the patellofemoral ligaments (PFLs), considered by some authors as capsular thickening and by others as independent ligaments. It was hypothesised that the PFLs and retinacula are structures with different histological features. The aim of this study was to describe the stabilising structures of the patella in detail and to determine if the PFLs and retinacula are different and separable structures from a macroscopic, microscopic and imaging viewpoint. An anatomical study was performed on eight knees from five cadavers (mean age, 56.2 years; range, 35–63 years), and a histological study was conducted on specimens from nine patients having a mean age of 65 years (range 35–84 years) who had undergone surgical knee procedures. The imaging study was based on 100 MRIs (96 patients). The mean age was 46 years (range 16–88), and the study analysed the capsular-ligamentous structures. In the medial compartment, the layers and structures were as follows: superficial layer, medial retinaculum; intermediate layer, Medial Collateral Ligament (MCL), Posterior Oblique Ligament (POL) and Medial Patellofemoral Ligament (MPFL); deep layer, deep part of the MCL and joint capsule. In the lateral compartment, the layers and structures were the following: superficial layer, lateral retinaculum; intermediate layer, Lateral Collateral Ligament (LCL) and Lateral Patellofemoral Ligament (LPFL); deep layer, joint capsule. All of the knees examined presented a clearly distinguishable MPFL and LPFL separable from the capsular layer. Histological study: there was a higher density of nerve fibres in retinacula compared to ligaments (p = 0.0034) and a higher content of elastic fibres in retinacula (p < 0.0005). In imaging, there was no difference between medial and lateral retinaculum thickness (p > 0.05). In conclusion, both the lateral and medial compartment can be described using the three-layer scheme. PFLs and retinacula are separate structures both macroscopically and according to imaging analysis. The retinacula respond to their specific function with a higher nerve fibre content and higher number of elastic fibres compared to the ligaments.
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- 2022
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29. Ultrasound Imaging of Brachial and Antebrachial Fasciae
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Carla Stecco, RAFFAELE DE CARO, Carmelo Pirri, VERONICA MACCHI, Caterina Fede, and Diego Guidolin
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body regions ,Medicine (General) ,Arm ,Deep fascia ,Forearm ,Reliability ,Thickness ,Ultrasonography ,R5-920 ,Clinical Biochemistry ,Article ,deep fascia ,ultrasonography ,arm ,forearm ,thickness ,reliability - Abstract
Knowledge about fasciae has become increasingly relevant in connection to regional anesthesiology, given the growing interest in fascial plane, interfascial, and nerve blocks. Ultrasound (US) imaging, thanks to high definition, provides the possibility to visualize and measure their thickness. The purpose of this study was to measure and compare, by US imaging, the thickness of deep/muscular fasciae in different points of the arm and forearm. An observational study has been performed using US imaging to measure brachial and antebrachial fasciae thickness at anterior and posterior regions, respectively, of the arm and forearm at different levels with a new protocol in a sample of 25 healthy volunteers. Results of fascial thickness revealed statistically significant differences (p < 0.0001) in the brachial fascia between the anterior and the posterior regions; in terms of the antebrachial fascia, no statistically significant difference was present (p > 0.05) between the regions/levels. Moreover, regarding the posterior region/levels, the brachial fascia had a greater thickness (mean 0.81 ± 0.20 mm) than the antebrachial fascia (mean 0.71 ± 0.20 mm); regarding the anterior region/levels, the antebrachial fascia was thicker (mean 0.70 ± 0.2 mm) than the brachial fascia (mean 0.61 ± 0.11 mm). In addition, the intra-rater reliability reported good reliability (ICC2,k: 0.88). US imaging helps to improve grading of fascial dysfunction or disease by revealing subclinical lesions, clinically invisible fascial changes, and one of the US parameters to reliably evaluate is the thickness in the different regions and levels.
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- 2021
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30. Fascia Lata Alterations in Hip Osteoarthritis: An Observational Cross-Sectional Study
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Carla Stecco, Pietro Ruggieri, Ilaria Fantoni, Carlo Biz, Raffaele De Caro, Lucia Petrelli, Carmelo Pirri, Caterina Fede, and Chenglei Fan
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collagen ,medicine.medical_specialty ,Cross-sectional study ,Science ,Gastroenterology ,Collagen ,Fascia ,Hip osteoarthritis ,Hyaluronan ,Myofascial pain ,Stiffness ,Article ,General Biochemistry, Genetics and Molecular Biology ,hyaluronan ,Collagen Type III ,stiffness ,Fascia lata ,Internal medicine ,medicine ,In patient ,Ecology, Evolution, Behavior and Systematics ,fascia ,business.industry ,Healthy subjects ,Paleontology ,body regions ,medicine.anatomical_structure ,Space and Planetary Science ,hip osteoarthritis ,Immunohistochemistry ,myofascial pain ,business - Abstract
The present study compares the structure and composition of fascia lata in healthy subjects and in patients with hip osteoarthritis (OA), to evaluate any differences in the amount of Collagen type I, Collagen type III, and Hyaluronan. Fascia lata samples from voluntary healthy subjects and patients with OA were harvested during surgery. Collagen type I (COL I), III (COL III) antibody, and biotinylated hyaluronan binding protein (HABP) immunohistochemistry stainings were used to evaluate fascial morphology and COL I, COL III, and Hyaluronan (HA) content in both groups. Ten samples from healthy subjects and 11 samples from OA patients were collected. COL I was significantly more abundant in the OA group (p = 0.0015), with a median percentage positivity of 75.2 (IQR 13.11)%, while representing only 67 (IQR: 8.71)% in control cases. COL III, with median values of 9.5 (IQR 3.63)% (OA group) and 17.10 (IQR 11)% (control cases), respectively, showed significant reduction in OA patients (p = 0.002). HA showed a median value of 10.01 (IQR 8.11)% in OA patients, denoting significant decrease (p <, 0.0001) with respect to the control group median 39.31 (IQR 5.62)%. The observed differences suggest a relationship between fascial pathology and hip OA. The observed increase in COL I in OA patients, along with the reduction of COL III and HA, could lead to fascial stiffening, which could alter fascial mechanics and be linked to the development and symptoms of OA.
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- 2021
31. Inter‐rater reliability and variability of ultrasound measurements of abdominal muscles and fasciae thickness
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Carla Stecco, Caterina Fede, Piero G. Pavan, Silvia Pianigiani, Silvia Todros, Carmelo Pirri, Chenglei Fan, and Calogero Foti
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medicine.medical_specialty ,Histology ,Supine position ,Intraclass correlation ,Umbilicus (mollusc) ,Axillary lines ,Abdominal wall ,03 medical and health sciences ,abdominal muscles ,0302 clinical medicine ,medicine ,Humans ,Fascia ,Ultrasonography ,Observer Variation ,abdominal fasciae ,0303 health sciences ,reliability ,ultrasound ,business.industry ,Ultrasound ,Reproducibility of Results ,030206 dentistry ,General Medicine ,Anatomy ,Settore MED/34 - Medicina Fisica e Riabilitativa ,body regions ,medicine.anatomical_structure ,030301 anatomy & morphology ,Orthopedic surgery ,Linea alba (abdomen) ,business - Abstract
Ultrasound (US) imaging is being increasingly used by Physical and Rehabilitation Medicine (PRM) specialists to measure the thickness of abdominal muscles. The current study set out to assess the inter-rater reliability of US measurements of the thickness of the abdominal muscles/fasciae. Three raters (1 = orthopedic specialist, expert on fasciae; 2 = PRM resident; 3 = PRM specialist) with different levels of US training examined the abdominal muscles and fasciae of a healthy volunteer under supine resting and dynamic conditions following a standard US protocol. The probe was positioned along the right lateral abdominal wall at the height of the 12th rib: (1) above the umbilicus at the linea alba, (2) to the side of and approximately 2 cm from the umbilicus, (3) along the mammillary line, and (4) along the anterior axillary line. Each rater measured 17 anatomical structures six times during two sessions. The relative error of the measurements (intra-rater variability) was slightly higher for the fasciae than for the muscles, and during the dynamic condition than the resting condition. Inter-rater reliability was good under both conditions for the fasciae (Intraclass Correlation Coefficient = ICC = 0.83) and excellent for the muscles (ICC = 0.99). Knowledge of the fascial anatomy of the abdominal wall is essential for accurate ultrasound examinations and for improving reliability. These findings confirm that US imaging is a reliable, non-invasive, cost-effective instrument for evaluating the abdominal muscles/fasciae. Clin. Anat. 32:948-960, 2019. © 2019 Wiley Periodicals, Inc.
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- 2019
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32. The Effects of Aging on the Intramuscular Connective Tissue
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Caterina Fede, Chenglei Fan, Carmelo Pirri, Lucia Petrelli, Carlo Biz, Andrea Porzionato, Veronica Macchi, Raffaele De Caro, and Carla Stecco
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Male ,Aging ,muscle ,extracellular matrix ,Collagen Type I ,Catalysis ,hyaluronan ,Inorganic Chemistry ,Mice ,motor control ,Animals ,Humans ,Hyaluronic Acid ,Physical and Theoretical Chemistry ,intramuscular connective tissue ,Muscle, Skeletal ,Molecular Biology ,Spectroscopy ,Aged ,aging ,collagen ,Organic Chemistry ,General Medicine ,Computer Science Applications ,Mice, Inbred C57BL ,Connective Tissue ,Female ,Alcian Blue ,Collagen - Abstract
The intramuscular connective tissue plays a critical role in maintaining the structural integrity of the muscle and in providing mechanical support. The current study investigates age-related changes that may contribute to passive stiffness and functional impairment of skeletal muscles. Variations in the extracellular matrix in human quadriceps femoris muscles in 10 young men, 12 elderly males and 16 elderly females, and in the hindlimb muscles of 6 week old, 8 month old and 2 year old C57BL/6J male mice, were evaluated. Picrosirius red, Alcian blue and Weigert Van Gieson stainings were performed to evaluate collagen, glycosamynoglycans and elastic fibers. Immunohistochemistry analyses were carried out to assess collagen I, collagen III and hyaluronan. The percentage area of collagen was significantly higher with aging (p < 0.01 in humans, p < 0.001 in mice), mainly due to an increase in collagen I, with no differences in collagen III (p > 0.05). The percentage area of elastic fibers in the perimysium was significantly lower (p < 0.01) in elderly men, together with a significant decrease in hyaluronan content both in humans and in mice. No significant differences were detected according to gender. The accumulation of collagen I and the lower levels of hyaluronan and elastic fibers with aging could cause a stiffening of the muscles and a reduction of their adaptability.
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- 2022
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33. Diabetic Foot: The Role of Fasciae, a Narrative Review
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Raffaele De Caro, Caterina Fede, Chenglei Fan, Carla Stecco, Carmelo Pirri, Lucia Petrelli, and Nina Pirri
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collagen ,QH301-705.5 ,Connective tissue ,Review ,Biology ,Matrix (biology) ,General Biochemistry, Genetics and Molecular Biology ,Extracellular matrix ,hyaluronan ,stiffness ,medicine ,Biology (General) ,Process (anatomy) ,fascia ,superficial fascia ,integumentary system ,General Immunology and Microbiology ,diabetes ,Fascia ,medicine.disease ,Diabetic foot ,body regions ,Collagen ,Diabetes ,Hyaluronan ,Stiffness ,Superficial fascia ,Wounds ,medicine.anatomical_structure ,wounds ,Narrative review ,General Agricultural and Biological Sciences ,Wound healing ,Neuroscience ,diabetic foot - Abstract
Simple Summary Diabetes mellitus and its complications are increasingly prevalent worldwide with severe impacts on patients and health care systems. Diabetic foot ulcers have an important impact on disability, morbidity, and mortality. The mechanism of diabetic wound chronicity has not yet been understood in a complete way. Regarding the involved soft tissues, little space has been given to the fasciae, even if nowadays there is more and more evidence of their role in proprioception, muscular force transmission, skin vascularization and tropism, and wound healing. Thus, we aimed to deepen the fascial involvement in diabetic wounds. Based on this review, we suggest that a clear scientific perception of fascial role can improve treatment strategies and create new perspectives of treatment. Abstract Wound healing is an intricate, dynamic process, in which various elements such as hyperglycemia, neuropathy, blood supply, matrix turnover, wound contraction, and the microbiome all have a role in this “out of tune” diabetic complex symphony, particularly noticeable in the complications of diabetic foot. Recently it was demonstrated that the fasciae have a crucial role in proprioception, muscular force transmission, skin vascularization and tropism, and wound healing. Indeed, the fasciae are a dynamic multifaceted meshwork of connective tissue comprised of diverse cells settled down in the extracellular matrix and nervous fibers; each constituent plays a particular role in the fasciae adapting in various ways to the diverse stimuli. This review intends to deepen the discussion on the possible fascial role in diabetic wounds. In diabetes, the thickening of collagen, the fragmentation of elastic fibers, and the changes in glycosaminoglycans, in particular hyaluronan, leads to changes in the stiffness, gliding, and the distribution of force transmission in the fasciae, with cascading repercussions at the cellular and molecular levels, consequently feeding a vicious pathophysiological circle. A clear scientific perception of fascial role from microscopic and macroscopic points of view can facilitate the identification of appropriate treatment strategies for wounds in diabetes and create new perspectives of treatment.
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- 2021
34. Evidence of a new hidden neural network into deep fasciae
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Carla Stecco, Raffaele De Caro, Chenglei Fan, Diego Guidolin, Carmelo Pirri, Lucia Petrelli, Andrea Porzionato, and Caterina Fede
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musculoskeletal diseases ,Male ,Science ,Thoracolumbar fascia ,Sympathetic nerve ,Article ,03 medical and health sciences ,Myelin ,Mice ,0302 clinical medicine ,Microscopy, Electron, Transmission ,Medicine ,Animals ,Autonomic Pathways ,Fascia ,Multidisciplinary ,Proprioception ,business.industry ,S100 Proteins ,030229 sport sciences ,Anatomy ,musculoskeletal system ,Low back pain ,eye diseases ,body regions ,Mice, Inbred C57BL ,medicine.anatomical_structure ,Deep fascia ,medicine.symptom ,business ,Free nerve ending ,030217 neurology & neurosurgery ,Neuroscience - Abstract
It is recognized that different fasciae have different type of innervation, but actually nothing is known about the specific innervation of the two types of deep fascia, aponeurotic and epymisial fascia. In this work the aponeurotic thoracolumbar fascia and the epymisial gluteal fascia of seven adult C57-BL mice were analysed by Transmission Electron Microscopy and floating immunohistochemistry with the aim to study the organization of nerve fibers, the presence of nerve corpuscles and the amount of autonomic innervation. The antibodies used were Anti-S100, Anti-Tyrosine Hydroxylase and Anti-PGP, specific for the Schwann cells forming myelin, the sympathetic nerve fibers, and the peripheral nerve fibers, respectively. The results showed that the fascial tissue is pervaded by a rhomboid and dense network of nerves. The innervation was statistically significantly lower in the gluteal fascia (2.78 ± 0.6% of positive area, 140.3 ± 31.6/mm2 branching points, nerves with 3.2 ± 0.6 mm length and 4.9 ± 0.2 µm thickness) with respect to the thoracolumbar fascia (9.01 ± 0.98% of innervated area, 500.9 ± 43.1 branching points/mm2, length of 87.1 ± 1.0 mm, thickness of 5.8 ± 0.2 µm). Both fasciae revealed the same density of autonomic nerve fibers (0.08%). Lastly, corpuscles were not found in thoracolumbar fascia. Based on these results, it is suggested that the two fasciae have different roles in proprioception and pain perception: the free nerve endings inside thoracolumbar fascia may function as proprioceptors, regulating the tensions coming from associated muscles and having a role in nonspecific low back pain, whereas the epymisial fasciae works to coordinate the actions of the various motor units of the underlying muscle.
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- 2021
35. Dynamic ultrasonography for assessing the nerve-fasciae relationship in entrapment syndromes
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Carla Stecco, Carmelo Pirri, Raffaele De Caro, Levent Özçakar, and Caterina Fede
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Acoustics and Ultrasonics ,Radiological and Ultrasound Technology ,business.industry ,Nerve Compression Syndromes ,Fascia ,Anatomy ,Compression (physics) ,Entrapment ,medicine.anatomical_structure ,medicine ,Ultrasound imaging ,Humans ,Radiology, Nuclear Medicine and imaging ,Ultrasonography ,business - Published
- 2021
36. Ultrasound Imaging of Crural Fascia and Epimysial Fascia Thicknesses in Basketball Players with Previous Ankle Sprains Versus Healthy Subjects
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Caterina Fede, Carla Stecco, Antonio Stecco, Diego Guidolin, Chenglei Fan, Raffaele De Caro, and Carmelo Pirri
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0301 basic medicine ,Basketball ,Clinical Biochemistry ,Muscle-skeletal Ultrasound ,Article ,ankle sprain ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Compartment (pharmacokinetics) ,basketball sport ,fascia ,connective tissue ,lcsh:R5-920 ,030222 orthopedics ,business.industry ,Healthy subjects ,Anatomy ,Fascia ,Y-balance test ,musculoskeletal system ,body regions ,medicine.anatomical_structure ,Anterior compartment of leg ,Ultrasound imaging ,030101 anatomy & morphology ,Ankle ,lcsh:Medicine (General) ,business ,Ankle sprain - Abstract
Background: Fascial layers may play an important role in locomotor mechanics. Recent researches have revealed an association between increases of fascia thickness and reduced joint flexibility in patients with chronic pain. The purpose of this study was to measure and compare, through the use of ultrasound imaging, the thickness of the deep/crural fascia in different points of the leg as well as the epimysial fascia thickness at level 2 of anterior compartment of leg, in male basketball players with history of recurrent ankle sprain and in healthy participants. Methods: A cross-sectional study has been performed using ultrasound imaging to measure deep/crural fascia thickness of anterior, lateral and posterior compartment of the leg at different levels with a new protocol in a sample of 30 subjects, 15 basketball players and 15 healthy participants. Results: Findings of fascial thickness revealed statistically significant differences (p <, 0.01) in epimysial fascia thickness and in deep/crural fascia thickness between levels/compartments of the same group and between two groups. Moreover, Post 3 deep/crural fascia thicknesses (p <, 0.001) were decreased showing statistically significant difference for the basketball players group respect the healthy participants group. Conclusions: These findings suggested that the posterior compartment was thicker than anterior compartment, probably due to a postural reason in both groups. Moreover, they showed an increase of thickness of the epimysial fascia in basketball players with previous ankle sprains. This variability underlines the importance to assess the fasciae and to make results comparable.
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- 2021
37. Fascial or muscle stretching? A narrative review
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Carmelo Pirri, Can A. Yucesoy, Caterina Fede, Carla Stecco, Antonio Stecco, and Raffaele De Caro
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musculoskeletal diseases ,medicine.medical_specialty ,Computer science ,Biomechanics ,Exercise ,Fascia ,Injury and prevention ,Musculoskeletal ,Stretching ,Passive stretching ,lcsh:Technology ,Static stretching ,lcsh:Chemistry ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,medicine ,General Materials Science ,Instrumentation ,lcsh:QH301-705.5 ,Fluid Flow and Transfer Processes ,lcsh:T ,Process Chemistry and Technology ,General Engineering ,030229 sport sciences ,musculoskeletal system ,lcsh:QC1-999 ,Computer Science Applications ,Tendon ,body regions ,medicine.anatomical_structure ,lcsh:Biology (General) ,lcsh:QD1-999 ,lcsh:TA1-2040 ,Narrative review ,Deep fascia ,Muscle stretching ,Range of motion ,lcsh:Engineering (General). Civil engineering (General) ,030217 neurology & neurosurgery ,lcsh:Physics - Abstract
Stretching exercises are integral part of the rehabilitation and sport. Despite this, the mechanism behind its proposed effect remains ambiguous. It is assumed that flexibility increases, e.g., action on muscle and tendon, respectively, but this is not always present in the stretching protocol of the exercises used. Recently, the fasciae have increased popularity and seems that they can have a role to define the flexibility and the perception of the limitation of the maximal range of motion (ROM). Deep fascia is also considered a key element to transmit load in parallel bypassing the joints, transmitting around 30% of the force generated during a muscular contraction. So, it seems impossible dividing the action of the muscles from the fasciae, but they have to be considered as a “myofascial unit”. The purpose of this manuscript is to evaluate the mechanical behavior of muscles, tendons, and fasciae to better understand how they can interact during passive stretching. Stress-strain values of muscle, tendon and fascia demonstrate that during passive stretching, the fascia is the first tissue that limit the elongation, suggesting that fascial tissue is probably the major target of static stretching. A better understanding of myofascial force transmission, and the study of the biomechanical behavior of fasciae, with also the thixotropic effect, can help to design a correct plan of stretching.
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- 2021
38. A Closer Look at the Cellular and Molecular Components of the Deep/Muscular Fasciae
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Chenglei Fan, Diego Guidolin, Lucia Petrelli, Raffaele De Caro, Caterina Fede, Carmelo Pirri, and Carla Stecco
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0301 basic medicine ,Computer science ,extracellular matrix ,Connective tissue ,Review ,nerve ,Cells ,Extracellular matrix ,Fascia ,Nerve ,Mechanotransduction, Cellular ,Catalysis ,Inorganic Chemistry ,lcsh:Chemistry ,03 medical and health sciences ,Nerve Fibers ,0302 clinical medicine ,medicine ,Animals ,Humans ,Telocytes ,Hyaluronic Acid ,Physical and Theoretical Chemistry ,Muscle, Skeletal ,Myofibroblasts ,Molecular Biology ,lcsh:QH301-705.5 ,Spectroscopy ,fascia ,Viscosity ,Organic Chemistry ,General Medicine ,Fibroblasts ,Computer Science Applications ,body regions ,030104 developmental biology ,medicine.anatomical_structure ,lcsh:Biology (General) ,lcsh:QD1-999 ,Treatment strategy ,cells ,Collagen ,Neuroscience ,030217 neurology & neurosurgery - Abstract
The fascia can be defined as a dynamic highly complex connective tissue network composed of different types of cells embedded in the extracellular matrix and nervous fibers: each component plays a specific role in the fascial system changing and responding to stimuli in different ways. This review intends to discuss the various components of the fascia and their specific roles; this will be carried out in the effort to shed light on the mechanisms by which they affect the entire network and all body systems. A clear understanding of fascial anatomy from a microscopic viewpoint can further elucidate its physiological and pathological characteristics and facilitate the identification of appropriate treatment strategies.
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- 2021
39. Fascial Innervation: A Systematic Review of the Literature
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Vidina Suarez-Rodriguez, Caterina Fede, Carmelo Pirri, Lucia Petrelli, Juan Francisco Loro-Ferrer, David Rodriguez-Ruiz, Raffaele De Caro, and Carla Stecco
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Sensory Receptor Cells ,Musculoskeletal Physiological Phenomena ,Organic Chemistry ,Pain ,General Medicine ,innervation ,Catalysis ,Rats ,Computer Science Applications ,Inorganic Chemistry ,fascia ,nociceptor ,pain ,Mice ,Animals ,Horses ,Fascia ,Physical and Theoretical Chemistry ,Mechanoreceptors ,Molecular Biology ,Spectroscopy - Abstract
Currently, myofascial pain has become one of the main problems in healthcare systems. Research into its causes and the structures related to it may help to improve its management. Until some years ago, all the studies were focused on muscle alterations, as trigger points, but recently, fasciae are starting to be considered a new, possible source of pain. This systematic review has been conducted for the purpose of analyze the current evidence of the muscular/deep fasciae innervation from a histological and/or immunohistochemical point of view. A literature search published between 2000 and 2021 was made in PubMed and Google Scholar. Search terms included a combination of fascia, innervation, immunohistochemical, and different immunohistochemical markers. Of the 23 total studies included in the review, five studies were performed in rats, four in mice, two in horses, ten in humans, and two in both humans and rats. There were a great variety of immunohistochemical markers used to detect the innervation of the fasciae; the most used were Protein Gene Marker 9.5 (used in twelve studies), Calcitonin Gene-Related Peptide (ten studies), S100 (ten studies), substance P (seven studies), and tyrosine hydroxylase (six studies). Various areas have been studied, with the thoracolumbar fascia being the most observed. Besides, the papers highlighted diversity in the density and type of innervation in the various fasciae, going from free nerve endings to Pacini and Ruffini corpuscles. Finally, it has been observed that the innervation is increased in the pathological fasciae. From this review, it is evident that fasciae are well innerved, their innervation have a particular distribution and precise localization and is composed especially by proprioceptors and nociceptors, the latter being more numerous in pathological situations. This could contribute to a better comprehension and management of pain.
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- 2022
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40. Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae
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Veronica Macchi, Raffaele De Caro, Nathaly Gaudreault, Chenglei Fan, Diego Guidolin, Carla Stecco, Andrea Porzionato, Caterina Fede, Carmelo Pirri, and Serena Ragazzo
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Adult ,Medicine (General) ,Article ,03 medical and health sciences ,0302 clinical medicine ,abdominal muscles ,R5-920 ,Abdominal muscles ,Pregnancy ,Surveys and Questionnaires ,medicine ,Humans ,caesarean section ,vaginal delivery ,fascia ,pain ,ultrasound ,Ultrasonography ,Loose connective tissue ,Labor, Obstetric ,Cesarean Section ,Vaginal delivery ,business.industry ,Pelvic pain ,Ultrasound ,Caesarean section ,Fascia ,Pain ,General Medicine ,Rectus sheath ,Anatomy ,Middle Aged ,body regions ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Linea alba (abdomen) ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background and objectives: Possible disorders after delivery may interfere with the quality of life. The aim of this study was to ascertain whether abdominal muscles and fasciae differ in women depending on whether they experienced transverse cesarean section (CS) or vaginal delivery (VA) in comparison with healthy nulliparous (NU). Materials and methods: The thicknesses of abdominal muscles and fasciae were evaluated by ultrasound in 13 CS, 10 VA, and 13 NU women (we examined rectus abdominis (RA), external oblique (EO), internal oblique (IO), transversus abdominis (TrA), total abdominal muscles (TAM = EO + IO + TrA), inter-rectus distance (IRD), thickness of linea alba (TLA), rectus sheath (RS), which includes anterior fascia of RS and posterior fascia of RS (P-RS), loose connective tissue between sublayers of P-RS (LCT), abdominal perimuscular fasciae (APF), which includes anterior fascia of EO, fasciae between EO, IO, and TrA, and posterior fascia of TrA). Data on pain intensity, duration, and location were collected. Results: Compared with NU women, CS women had wider IRD (p = 0.004), thinner left RA (p = 0.020), thicker right RS (p = 0.035) and APF (left: p = 0.001, right: p = 0.001), and IO dissymmetry (p = 0.009). VA women had thinner RA (left: p = 0.008, right: p = 0.043) and left TAM (p = 0.024), mainly due to left IO (p = 0.027) and RA dissymmetry (p = 0.035). However, CS women had thicker LCT (left: p = 0.036, right: p <, 0.001), APF (left: p = 0.014, right: p = 0.007), and right IO (p = 0.028) than VA women. There were significant correlations between pain duration and the affected fasciae/muscles in CS women. Conclusions: CS women showed significant alterations in both abdominal fasciae and muscle thicknesses, whereas VA women showed alterations mainly in muscles. Thinner RA and/or dissymmetric IO, wider IRD, and thicker LCT and APF after CS may cause muscle deficits and alteration of fascial gliding, which may induce scar, abdominal, low back, and/or pelvic pain.
- Published
- 2020
41. Sensitivity of the Fasciae to the Endocannabinoid System: Production of Hyaluronan-Rich Vesicles and Potential Peripheral Effects of Cannabinoids in Fascial Tissue
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Raffaele De Caro, Chenglei Fan, Carmelo Pirri, Diego Guidolin, Lucia Petrelli, Carla Stecco, and Caterina Fede
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Male ,peripheral effect ,Extracellular matrix ,lcsh:Chemistry ,Fibrosis ,Cannabinoid receptor type 2 ,pain ,Hyaluronic Acid ,agonist ,lcsh:QH301-705.5 ,Spectroscopy ,vesicles ,Chemistry ,Vesicle ,General Medicine ,Fascia ,Endocannabinoid system ,Immunohistochemistry ,Computer Science Applications ,Cell biology ,medicine.anatomical_structure ,Female ,Immunocytochemistry ,Catalysis ,Article ,Inorganic Chemistry ,hyaluronan ,medicine ,Extracellular ,Humans ,Physical and Theoretical Chemistry ,Molecular Biology ,fascia ,Aged ,Dose-Response Relationship, Drug ,Cannabinoids ,Organic Chemistry ,Cytoplasmic Vesicles ,fibrosis ,antagonist ,endocannabinoid ,Fibroblasts ,medicine.disease ,body regions ,inflammation ,lcsh:Biology (General) ,lcsh:QD1-999 ,Biomarkers ,Endocannabinoids - Abstract
The demonstrated expression of endocannabinoid receptors in myofascial tissue suggested the role of fascia as a source and modulator of pain. Fibroblasts can modulate the production of the various components of the extracellular matrix, according to type of stimuli: physical, mechanical, hormonal, and pharmacological. In this work, fascial fibroblasts were isolated from small samples of human fascia lata of the thigh, collected from three volunteer patients (two men, one woman) during orthopedic surgery. This text demonstrates for the first time that the agonist of cannabinoid receptor 2, HU-308, can lead to in vitro production of hyaluronan-rich vesicles only 3&ndash, 4 h after treatment, being rapidly released into the extracellular environment. We demonstrated that these vesicles are rich in hyaluronan after Alcian blue and Toluidine blue stainings, immunocytochemistry, and transmission electron microscopy. In addition, incubation with the antagonist AM630 blocked vesicles production by cells, confirming that release of hyaluronan is a cannabinoid-mediated effect. These results may show how fascial cells respond to the endocannabinoid system by regulating and remodeling the formation of the extracellular matrix. This is a first step in our understanding of how therapeutic applications of cannabinoids to treat pain may also have a peripheral effect, altering the biosynthesis of the extracellular matrix in fasciae and, consequently, remodeling the tissue and its properties.
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- 2020
42. An anatomical comparison of the fasciae of the thigh: A macroscopic, microscopic and ultrasound imaging study
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Chenglei Fan, Diego Guidolin, Lucia Petrelli, Caterina Fede, Raffaele De Caro, Carla Stecco, and Carmelo Pirri
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Adult ,Male ,musculoskeletal diseases ,0301 basic medicine ,Histology ,Thigh ,Iliotibial tract ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Cadaver ,Fascia lata ,medicine ,Humans ,Molecular Biology ,Ecology, Evolution, Behavior and Systematics ,Aged ,Ultrasonography ,superficial fascia ,business.industry ,Ultrasound ,imaging ,Cell Biology ,Fascia ,Anatomy ,Middle Aged ,musculoskeletal system ,Original Papers ,thickness ,musculo-skeletal ultrasound ,body regions ,030104 developmental biology ,medicine.anatomical_structure ,fascia lata ,Female ,Deep fascia ,business ,030217 neurology & neurosurgery ,Developmental Biology ,Subcutaneous tissue - Abstract
Although the number of Ultrasound (US) imaging studies investigating the fascial layers are becoming more numerous, the majority tend to use different reference points and terminology to describe their findings. The current work set out to compare macroscopic and microscopic data of specimens of the fascial layers of the thigh with US imaging findings. Specimens of the different fascial layers of various regions of the thigh were collected for macroscopic and histological analyses from three fresh cadavers and compared with in vivo US images of the thighs of 20 healthy volunteers. The specimens showed that the subcutaneous tissue of the thigh is made up of three layers: a superficial adipose layer, a membranous layer/superficial fascia, and a deep adipose layer. The deep fascia is composed of an aponeurotic fascia, which envelops all the thigh muscles and is laterally reinforced by the iliotibial tract and an epimysial fascia, which is specific for each muscle. The morphometric measurements of the thickness of the superficial fascia were different (anterior: 153.2 ± 39.3 µm; medial: 128.4 ± 24.7 µm; lateral: 154 ± 28.9 µm; and posterior: 148.8 ± 33.2 µm) as were those of the deep fascia (anterior: 556.8 ± 176.2 µm; medial: 820.4 ± 201 µm; lateral: 1112 ± 237.9 µm; and posterior: 730.4 ± 186.5 µm). The US scans showed a clear picture of the superficial adipose tissue, the superficial fascia, and the deep adipose tissue, as well as the deep fasciae. The epimysial and aponeurotic fasciae of only some topographic areas could be independently identified. The US imaging findings confirmed that the superficial and deep fascia have different thicknesses, and they showed that the US measurements were always larger with respect to those produced by histological analysis (p
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- 2020
43. Quantitative evaluation of the echo intensity of paraneural area and myofascial structure around median nerve in carpal tunnel syndrome
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Carla Stecco, Caterina Fede, Diego Guidolin, Raffaele De Caro, Carlo Biz, Veronica Macchi, Chenglei Fan, and Carmelo Pirri
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Clinical Biochemistry ,Abnormal pressure ,Median nerve ,Carpal tunnel syndrome ,Echo intensity ,Myofascial structure ,Paraneural area ,Ultrasound ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Carpal tunnel ,lcsh:R5-920 ,business.industry ,Significant difference ,medicine.disease ,Control subjects ,nervous system diseases ,medicine.anatomical_structure ,business ,Nuclear medicine ,lcsh:Medicine (General) ,030217 neurology & neurosurgery - Abstract
The aim of this study was to investigate whether the echo intensity (EI) of the paraneural area (PA), the median nerve (MN) at the carpal tunnel, the EI of the myofascial structure (MS) around MN, the &lsquo, PA and MN&rsquo, at the mid-forearm, and the MN transversal displacement at both sites differs between persons with carpal tunnel syndrome (CTS) and control subjects. Methods: In total, 16 CTS patients and 16 controls, age- and gender-matched, were recruited. Cross-sectional ultrasound images of MN were obtained to evaluate the EI of the PA, the MN at carpal tunnel, the EI of MS, and the &lsquo, at the mid-forearm in a natural position, then images were taken after a whole-hand grasp movement, to evaluate MN transversal displacement. Inter-rater and intra-rater reliability in control, and differences in the EI and MN displacement between CTS and control, were analyzed. In addition, the correlations between ultrasound parameters and MN displacement were evaluated. Results: The quantitative EI of PA, MN, EI of MS, &lsquo, had high inter-rater and intra-rater reliability in the control. The EI of PA, MS and &lsquo, were significantly higher in CTS subjects (p <, 0.01), whilst there was no significant difference in the EI of MN at the carpal tunnel. MN displacement was significantly decreased both at the carpal tunnel and the mid-forearm in CTS subjects (p <, 0.01). In addition, there were negative correlations among the EI of PA (rs = &minus, 0.484, p = 0.004), EI of MS (rs = &minus, 0.479, p = 0.002), EI of &lsquo, (rs = &minus, 0.605, p <, 0.001) and MN transversal displacement. Conclusions: The higher EI of PA and MS around MN in CTS may indicate greater fibrosis along the course of MN, reducing fascial adaptability, influencing the synergy and coordination of the MS, and increasing the shear stress between MS and MN, and it may further increase the abnormal pressure on the MN not only at the carpal tunnel, but also at the mid-forearm. These results may partly explain the role of PA and MS in CTS pathogenesis.
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- 2020
44. Fascia and soft tissues innervation in the human hip and their possible role in post-surgical pain
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Carmelo Pirri, Chenglei Fan, Carla Stecco, Lucia Petrelli, Andrea Porzionato, Carlo Biz, Raffaele De Caro, and Caterina Fede
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musculoskeletal diseases ,Male ,medicine.medical_treatment ,proprioception ,0206 medical engineering ,02 engineering and technology ,03 medical and health sciences ,0302 clinical medicine ,Cadaver ,arthroplasty ,fascia ,hip joint ,innervation ,pain ,soft tissue ,Hip replacement ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,030203 arthritis & rheumatology ,Aged, 80 and over ,Pain, Postoperative ,Hip ,business.industry ,Soft tissue ,Fascia ,Anatomy ,020601 biomedical engineering ,Arthroplasty ,Tendon ,medicine.anatomical_structure ,Ligament ,Female ,Deep fascia ,Schwann Cells ,business - Abstract
Persistent symptoms, most commonly pain, may remain after otherwise successful hip replacement surgery. Innervation of fascia and soft tissues has become increasingly important in etiopathogenesis of pain, but the relative importance of the various anatomical structures in the hip region is still not known. Innervation of skin, superficial adipose tissue, superficial fascia, deep adipose tissue, deep fascia, muscles, capsule, capsule ligament, ligamentum teres, and tendon in the human hip from 11 patients and 2 cadavers were quantified by staining with anti-S100 antibody for myelin-forming Schwann cells, to obtain the percentage of antibody positivity, density and mean diameter of the nerve fibers. The skin was the most highly innervated (0.73% ± 0.37% of positive area in patients; 0.80% ± 0.28% in cadavers); the tendon was the least innervated (0.07% ± 0.01% in patients, 0.07% ± 0.007% in cadavers). The muscles (vasto-lateral and gluteus medius) were the second most innervated structure according the percentage (0.31% ± 0.13% in living humans, 0.30% ± 0.07% in cadavers), but with only a few nerves, with large diameters (mean diameter 36.4 ± 13.4 µm). Instead, the superficial fasciae showed 0.22% ± 0.06% and 0.26% ± 0.05% of positive areas in living humans and cadavers, respectively. Fasciae were invaded by networks of small nerve fibers, revealing a possible role in pain. The superficial fascia was the second most highly innervated tissue after the skin, with a density of 33.0 ± 2.5/cm2 , and a mean nerve sizes of 19.1 ± 7.2 µm. Lastly, the capsule turned out to be poorly innervated (0.09%), showing that its removal does not necessarily lead to painful consequences. Statement of clinical significance: Deeper knowledge about the innervation of the soft tissue in the human hip joint will enhance study and understanding of the best surgical procedures to follow during hip arthroplasty to reduce post-operative pain.
- Published
- 2020
45. Variations in contents of hyaluronan in the peritumoral micro-environment of human chondrosarcoma
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Andrea Angelini, Assunta Pozzuoli, Carla Stecco, Chenglei Fan, Pietro Ruggieri, Caterina Fede, Elisa Belluzzi, and Raffaele De Caro
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0301 basic medicine ,Pathology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Connective tissue ,medicine.disease ,Extracellular matrix ,Radiation therapy ,03 medical and health sciences ,chemistry.chemical_compound ,030104 developmental biology ,0302 clinical medicine ,medicine.anatomical_structure ,chemistry ,Stroma ,Tumor progression ,030220 oncology & carcinogenesis ,Hyaluronic acid ,medicine ,Orthopedics and Sports Medicine ,Clinical significance ,Chondrosarcoma ,business - Abstract
A concept consolidated in recent years is that tumor growth depends to a great extent on the micro-environment surrounding the tumor, which has a fundamental role in tumor progression and in determining the effectiveness of therapies. Our analysis focuses on chondrosarcoma, the second primary malignant bone tumor, resistant to both chemotherapeutic and radiation therapy. We quantified hyaluronan, one of the main components of the extracellular matrix, with the aim of comparing its amount in the connective tissue surrounding the tumor with intra-tumoral tissue and healthy fascia of the same anatomic district, viewed as a health control. We demonstrate that hyaluronan increased significantly in the peritumoral stroma compared with the healthy fascia, which showed an average amount according to the physical characteristics of body districts by a mean value of 26.9 μg/g. In the peritumoral stroma, the mean hyaluronan content reached 132.6 μg/g (mean value of 63.2 μg/g). The p-value was less than 0.01, showing a highly significant statistical difference. Surprisingly, no significant differences were detected as a function of age, gender, or tumor grade. The levels of hyaluronan were comparable in peritumoral and tumor tissues, although there were differences depending on the state of necrosis. In addition, data on the expression of hyaluronic acid synthetase showed a decrease of about 50% in peritumoral and tumor tissues, indicating alterations in hyaluronan turnover and synthesis. This work demonstrates a variation in hyaluronan contents around the chondrosarcoma, likely correlated with the aggressiveness and resistance to chemotherapy of this tumors. Statement of Clinical Significance: Deeper knowledge about the composition of the peritumoral stroma, rich in extracellular matrix, will enhance better study and understanding of the metastatic potential of tumors and their prognostic indices. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:503-509, 2019.
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- 2018
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46. Anatomical and functional relationships between external abdominal oblique muscle and posterior layer of thoracolumbar fascia
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Chenglei Fan, Raffaele De Caro, Nathaly Gaudreault, Andrea Porzionato, Caterina Fede, Veronica Macchi, and Carla Stecco
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0301 basic medicine ,Histology ,business.industry ,Oblique case ,Thoracolumbar fascia ,General Medicine ,Anatomy ,Rectus sheath ,Fascia ,Trunk ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,medicine.anatomical_structure ,Cadaver ,Medicine ,Aponeurosis ,030101 anatomy & morphology ,business ,030217 neurology & neurosurgery - Abstract
The abdominal muscles are important for the stability of the lumbar region through the thoracolumbar fascia (TLF). However, there is not full agreement regarding the posterior transversal continuity of the external abdominal oblique muscle (EO) with the TLF. To clarify this point, 10 cadavers and computed tomography (CT) images from 27 subjects were used to evaluate the transversal continuity of the TLF with the abdominal muscles. The width of the fascial continuity of the EO with the posterior layer of TLF along the posterior border of the EO was also measured (40.70 ±3.92 mm). The epimysial fascia of the EO was in direct continuity with the posterior layer of TLF in eight cadavers and 23 CT images, whereas in two cadavers and four CT images, the epimysial fascia of the EO first fused with the fascia covering the latissimus dorsi, and then, both fasciae were in continuity with the posterior layer of TLF. Therefore, the transversal fascial continuity of the EO could explain the transmission of tension from the EO to the posterior layer of TLF and its importance in maintaining the stability of the lumbar spine through a hydraulic effect. Regarding fascial continuity in the trunk, and taking the EO into consideration, the TLF is formed by the fascia of all the abdominal muscles as the rectus sheath. In this manner, myofascial continuity between the TLF and the abdominal muscles is achieved through the aponeurosis and fascia, which ensures synchronization between the erector spinae and the rectus abdominis. Clin. Anat. 31:1092-1098, 2018. © 2018 Wiley Periodicals, Inc.
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- 2018
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47. Morphometric and dynamic measurements of muscular fascia in healthy individuals using ultrasound imaging: a summary of the discrepancies and gaps in the current literature
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Carla Stecco, Chenglei Fan, Caterina Fede, Veronica Macchi, Raffaele De Caro, and Nathaly Gaudreault
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musculoskeletal diseases ,medicine.medical_specialty ,Physical examination ,Strain ,Pathology and Forensic Medicine ,Iliotibial tract ,Fascia ,Motion ,Thickness ,Ultrasound imaging ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Reference Values ,Fascia lata ,Fascia Lata ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Muscle, Skeletal ,Ultrasonography ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Muscular fascia ,musculoskeletal system ,eye diseases ,body regions ,Critical appraisal ,medicine.anatomical_structure ,Data extraction ,Surgery ,Plantar fascia ,Anatomy ,business ,030217 neurology & neurosurgery ,Fascia (architecture) - Abstract
The objectives of this work was to conduct a comprehensive state-of-the art review of the current literature to identify any gaps or discrepancies and summarize the main challenges for obtaining a homogeneous evaluation of muscular fascia in healthy individuals. An electronic document search using key words and MeSH terms was performed with various databases. Two independent investigators were tasked with the screening of articles and data extraction. A critical appraisal of what is known was then conducted. The literature search identified 65 articles related to healthy facia in the various databases consulted and 20 articles were kept for the review. The thickest portion of the fascia lata (the iliotibial tract) and the plantar fascia are the most often studied muscular fasciae whereas there is paucity of studies on fascia related to other muscles in the body. US imaging is suitable to complement physical examination and for evaluating treatment outcomes. However, the small number of studies and the heterogeneity of the methods did not allow us to establish normal reference values for muscular fascia thickness and to provide strong recommendations about measurement protocols.
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- 2018
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48. The fasciacytes: A new cell devoted to fascial gliding regulation
- Author
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Robert S. Stern, Veronica Macchi, Carla Stecco, Caterina Fede, Lucia Petrelli, Andrea Porzionato, Raffaele De Caro, and Carlo Biz
- Subjects
0301 basic medicine ,Loose connective tissue ,Cell type ,Histology ,business.industry ,General Medicine ,Fascia ,Hyaluronan Synthase 2 ,Cell biology ,body regions ,Extracellular matrix ,03 medical and health sciences ,chemistry.chemical_compound ,030104 developmental biology ,medicine.anatomical_structure ,chemistry ,Hyaluronic acid ,medicine ,Deep fascia ,Anatomy ,Fibroblast ,business - Abstract
Hyaluronan occurs between deep fascia and muscle, facilitating gliding between these two structures, and also within the loose connective tissue of the fascia, guaranteeing the smooth sliding of adjacent fibrous fascial layers. It also promotes the functions of the deep fascia. In this study a new class of cells in fasciae is identified, which we have termed fasciacytes, devoted to producing the hyaluronan-rich extracellular matrix. Synthesis of the hyaluronan-rich matrix by these new cells was demonstrated by Alcian Blue staining, anti-HABP (hyaluronic acid binding protein) immunohistochemistry, and transmission electron microscopy. Expression of HAS2 (hyaluronan synthase 2) mRNA by these cells was detected and quantified using real time RT-PCR. This new cell type has some features similar to fibroblasts: they are positive for the fibroblast marker vimentin and negative for CD68, a marker for the monocyte-macrophage lineage. However, they have morphological features distinct from classical fibroblasts and they express the marker for chondroid metaplasia, S-100A4. The authors suggest that these cells represent a new cell type devoted to the production of hyaluronan. Since hyaluronan is essential for fascial gliding, regulation of these cells could affect the functions of fasciae so they could be implicated in myofascial pain. Clin. Anat. 31:667-676, 2018. © 2018 Wiley Periodicals, Inc.
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- 2018
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49. Dermatome and fasciatome
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Caterina Fede, Chenglei Fan, Raffaele De Caro, Calogero Foti, Carla Stecco, Luigi Stecco, Federico Giordani, and Carmelo Pirri
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Histology ,Nerve root ,proprioception ,Superficial fascia ,nerve ,dermatome ,medicine ,Humans ,pain ,Muscle, Skeletal ,fascia ,Irradiating pain ,Skin ,Proprioception ,business.industry ,Fascia ,Pain ,General Medicine ,Anatomy ,Skeletal ,Settore MED/34 - Medicina Fisica e Riabilitativa ,medicine.anatomical_structure ,Dermatome ,Spinal nerve ,Muscle ,Deep fascia ,business - Abstract
Increased knowledge of the rich innervation of the deep fascia and its anatomical organization indicates the need to reevaluate maps of the dermatome according to the new findings. The authors present a distinction between dermatome and fasciatome, basing their approach to the literature on nerve root stimulation and comparing dermatomeric and myomeric maps. The former represents the portion of tissue composed of skin, hypodermis, and superficial fascia supplied by all the cutaneous branches of an individual spinal nerve; the latter includes the portion of deep fascia supplied by the same nerve root and organized according to force lines to emphasize the main directions of movement. The dermatome is important for esteroception, whereas the fasciatome is important for proprioception. If they are altered, the dermatome shows clearly localized pain and the fasciatome irradiating pain according to the organization of the fascial anatomy. Clin. Anat. 32:896-902, 2019. © 2019 Wiley Periodicals, Inc.
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- 2019
50. Ultrasound imaging of a scar on the knee: Sonopalpation for fascia and subcutaneous tissues
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Levent Özçakar, Caterina Fede, Carla Stecco, Antonio Stecco, Raffaele De Caro, and Carmelo Pirri
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0301 basic medicine ,medicine.medical_specialty ,lcsh:Medicine ,knee ,scar ,Article ,lcsh:QM1-695 ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Effective treatment ,Orthopedics and Sports Medicine ,pain ,Ultrasonography ,fascia ,Molecular Biology ,business.industry ,Ultrasound ,lcsh:R ,Cell Biology ,Fascia ,lcsh:Human anatomy ,medicine.anatomical_structure ,Ultrasound imaging ,030101 anatomy & morphology ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Persistent scar pain associated with healed surgical incisions after a trauma is a common and potentially debilitating type of fascial pain. At present, there is no universally effective treatment for persistent surgical or post-trauma scar pain. Herein we describe the successful objective diagnosis of debilitating scar pain by Ultrasound (US) imaging. The sonopalpation of the fasciae and subcutaneous tissues seems to be relevant to diagnose the real cause of the pain and why not to monitor the treatment.
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- 2019
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