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Peripheral neuropathic pain is common in patients with peripheral nerve injury and can significantly impact both their function and quality of life. There is a wide variety of non‐interventional treatment approaches, including pharmacologic therapy, physical/occupational therapy, modalities (therapeutic, mechanical, thermal, etc.), psychology, and lifestyle modification. First line pharmacologic therapy for peripheral neuropathic pain includes gabapentinoids, tricyclic antidepressants, and serotonin‐norepinephrine reuptake inhibitors. Other classes of medications, such as topical treatments, opioids, and cannabinoids, have more limited usefulness in treatment but remain part of a treatment regimen. Physical and occupational therapy, psychological interventions, and lifestyle medicine are important adjuncts in the treatment and prevention of future peripheral neuropathic pain. The strength of the evidence supporting each intervention varies, with that for pharmacologic intervention being the strongest. A combination of these options tailored to the individual needs of the patient likely will result in the best treatment outcome for peripheral neuropathic pain. [ABSTRACT FROM AUTHOR]

Peripheral nerve injuries (PNIs) are common, costly, and cause significant pain. Effective management of PNIs involves tailoring medications to the injury type as well as understanding the pharmacokinetics/pharmacodynamics to support nerve regeneration and reduce pain. Opioids act on opioid receptors to significantly reduce pain for many patients, but there are significant addiction risks and side effects. In addition, opioids may exacerbate pain sensitivity and affect nerve regeneration. Non‐steroidal anti‐inflammatory drugs or acetaminophen act on cyclooxygenase enzymes and are commonly used for nerve pain, with 34.7% of people using them for neuropathic pain. While effective for mild pain, they are often combined with opioids, gamma‐aminobutyric acid (GABA) analogs, lidocaine, or corticosteroids for more severe pain. Corticosteroids, mimicking adrenal hormones like cortisol, treat PNI‐related inflammation and pain. Their pharmacokinetics are complex, often requiring local injections in order to minimize systemic risks while effectively treating PNIs. Lidocaine, a common local anesthetic, blocks ion channels in the central nervous system (CNS) and peripheral nerves, providing strong analgesic and anti‐inflammatory effects. If used improperly, lidocaine can cause neuronal toxicity instead of anesthetic effect. GABA acts as an inhibitory neurotransmitter in the CNS and its drug analogs like pregabalin and gabapentin can alleviate neuropathic pain by binding to voltage‐gated Ca2+ channels, inhibiting neurotransmitter release. These pain medications are commonly prescribed for PNIs despite a limited guidance on their effects on nerve regeneration. This review will discuss these drug's mechanisms of action, pharmacokinetics/pharmacodynamics, and their clinical application to highlight their effect on the PNI recovery. [ABSTRACT FROM AUTHOR]

Neuropathic pain is a prevalent and debilitating chronic syndrome that is often resistant to treatment. It frequently arises as a consequence of damage to first-order nociceptive neurons in the lumbar dorsal root ganglia (DRG), with chromatolysis being the primary neuropathological response following sciatic nerve injury (SNI). Nevertheless, the function of miRNAs in modulating this chromatolytic response in the context of neuropathic pain remains unexplored. Our previous research demonstrated that the intracisternal administration of a miR-30c mimic accelerates the development of neuropathic pain, whereas the inhibition of miR-30c prevents pain onset and reverses established allodynia. In the present study, we sought to elucidate the role of miR-30c-5p in the pathogenesis of neuropathic pain, with a particular focus on its impact on DRG neurons following SNI. The organisation and ultrastructural changes in DRG neurons, particularly in the protein synthesis machinery, nucleolus, and Cajal bodies (CBs), were analysed. The results demonstrated that the administration of a miR-30c-5p mimic exacerbates chromatolytic damage and nucleolar stress and induces CB depletion in DRG neurons following SNI, whereas the administration of a miR-30c-5p inhibitor alleviates these effects. We proposed that three essential cellular responses—nucleolar stress, CB depletion, and chromatolysis—are the pathological mechanisms in stressed DRG neurons underlying neuropathic pain. Moreover, miR-30c-5p inhibition has a neuroprotective effect by reducing the stress response in DRG neurons, which supports its potential as a therapeutic target for neuropathic pain management. This study emphasises the importance of miR-30c-5p in neuropathic pain pathogenesis and supports further exploration of miRNA-based treatments. [ABSTRACT FROM AUTHOR]

Microglia take on an altered morphology during chronic opioid treatment. This morphological change is broadly used to identify the activated microglial state associated with opioid side effects, including tolerance and opioid-induced hyperalgesia (OIH). Microglia display similar morphological responses in the spinal cord after peripheral nerve injury (PNI). Consistent with this observation, functional studies have suggested that microglia activated by opioids or PNI engage common molecular mechanisms to induce hypersensitivity. In this article, we conducted deep RNA sequencing (RNA-seq) and morphological analysis of spinal cord microglia in male mice to comprehensively interrogate transcriptional states and mechanistic commonality between multiple models of OIH and PNI. After PNI, we identify an early proliferative transcriptional event across models that precedes the upregulation of histological markers of microglial activation. However, we found no proliferative transcriptional response associated with opioid-induced microglial activation, consistent with histological data, indicating that the number of microglia remains stable during morphine treatment, whereas their morphological response differs from PNI models. Collectively, these results establish the diversity of pain-associated microglial transcriptomic responses and point towards the targeting of distinct insult-specific microglial responses to treat OIH, PNI, or other central nervous system pathologies. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTo translate and culturally adapt the Brachial Assessment Tool (BrAT) into Swedish and evaluate the internal consistency, and internal content validity using Rasch analysis in patients with traumatic brachial plexus injuries (TBPI).The translation was made in accordance with international guidelines. TBPI patients were identified in clinical records. The BrAT-Swe was sent out to patients by post. Internal consistency was assessed using Cronbach alpha and content validity using Rasch analysis evaluating fit to the Rasch model, threshold response, local dependency, dimensionality, differential item functioning (DIF), and targeting.The translation of the BrAT was completed without major discrepancies. A total of 164 patients completed the BrAT-Swe. Internal consistency ranged from 0.90 to 0.98. Rasch analysis supported the content validity. All subscales demonstrated fit to the model with no local dependency, minimal disordered thresholds and no unidimensionality. Uniform DIF for item 6 by age, was identified. Minimal differences in hierarchical ordering were identified.This study presents a Swedish translation of the BrAT (BrAT-Swe) and has demonstrated that the translated BrAT-Swe is well adapted for Swedish circumstances. Analysis supports the internal content validity of the BrAT-Swe as a unidimensional targeted PROM designed to assess activity limitation after TBPI.The Swedish translation of the Brachial Assessment Tool (BrAT), the BrAT-Swe, is a valid instrument that can be used in a Swedish context.The BrAT-Swe subscales can be used independently or as a total score, similar to the original BrAT.The BrAT-Swe may be used to guide rehabilitation and for goal setting for patients with traumatic brachial plexus injury.The Swedish translation of the Brachial Assessment Tool (BrAT), the BrAT-Swe, is a valid instrument that can be used in a Swedish context.The BrAT-Swe subscales can be used independently or as a total score, similar to the original BrAT.The BrAT-Swe may be used to guide rehabilitation and for goal setting for patients with traumatic brachial plexus injury. [ABSTRACT FROM AUTHOR]

A subpopulation of astrocytes on the brain's surface, known as subpial astrocytes, constitutes the "glia limitans superficialis" (GLS), which is an interface between the brain parenchyma and the cerebrospinal fluid (CSF) in the subpial space. Changes in connexin-43 (Cx43) and aquaporin-4 (AQP4) proteins in subpial astrocytes were examined in the medial prefrontal cortex at postoperative day 1, 3, 7, 14, and 21 after sham operation and sciatic nerve compression (SNC). In addition, we tested the altered uptake of TRITC-conjugated 3 kDa dextran by reactive subpial astrocytes. Cellular immunofluorescence (IF) detection and image analysis were used to examine changes in Cx43 and AQP4 protein levels, as well as TRITC-conjugated 3 kDa dextran, in subpial astrocytes. The intensity of Cx43-IF was significantly increased, but AQP4-IF decreased in subpial astrocytes of sham- and SNC-operated rats during all survival periods compared to naïve controls. Similarly, the uptake of 3 kDa dextran in the GLS was reduced following both sham and SNC operations. The results suggest that both sciatic nerve injury and peripheral tissue injury alone can induce changes in subpial astrocytes related to the spread of their reactivity across the cortical surface mediated by increased amounts of gap junctions. At the same time, water transport and solute uptake were impaired in subpial astrocytes. [ABSTRACT FROM AUTHOR]

Peripheral nerve lesions of the upper extremity are common and are associated with devastating limitations for the patient. Rapid and accurate diagnosis of the lesion by electroneurography, neurosonography, or even MR neurography is important for treatment planning. There are different therapeutic approaches, which may show individual differences depending on the injured nerve. If a primary nerve repair is not possible, several strategies exist to bridge the gap. These may include autologous nerve grafts, bioartificial nerve conduits, or acellular nerve allografts. Tendon and nerve transfers are also of major importance in the treatment of nerve lesions in particular with long regeneration distances. As a secondary reconstruction, in addition to tendon transfers, there is also the option for free functional muscle transfer. In amputations, the prevention of neuroma is of great importance, for which different strategies exist, such as target muscle reinnervation, regenerative peripheral nerve interface, or neurotized flaps. In this article, we give an overview of the latest methods for the therapy of peripheral nerve lesions. [ABSTRACT FROM AUTHOR]

Purpose: Although sciatic nerve (SN) injury is relatively rare, it is a devastating complication after primary and revision total hip arthroplasty (THA). Therefore, precise localization of the SN is essential for arthroplasty surgeons. Methods: We dissected 50 hemipelves from formalin-fixed cadavers. The course and location of the sciatic nerve were investigated in relation to different approaches for THA with the help of anatomical landmarks like the greater trochanter (GT), the iliac tubercle, the ischial tuberosity (IschT), the infrapiriform foramen, and the suprapiriform foramen. Results: We found and exposed the sciatic nerve in all 50 specimens with no sex-specific differences. No SN was encountered up to 22 mm posterior from the GT. The zone affording the highest probability of finding the nerve was posterior to the GT between 32 and 55 mm in 39 (78%) cases, thus defining a danger zone for different approaches for the THA. Conclusion: Special care should be taken with posterior and deep instrument placement between the GT and IschT during THA. Moreover, manipulations in the proximal third of the posterior approach reaching deep and posteriorly should be performed with the utmost care. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the therapeutic effect of repeated injections of mesenchymal stem cell (MSC)-derived exosomes on the erectile dysfunction (ED) of bilateral cavernous nerve injury (BCNI) rat model and to identify potential target genes of these injections. Materials and Methods: MSC-derived exosomes were isolated using an aqueous two-phase system. Rats were randomly assigned into four groups: Normal, BCNI, exosome once, and exosome-repeat groups. After four weeks, we measured the intracavernosal pressure (ICP)/mean arterial pressure (MAP) ratio to evaluate erectile function and examined cavernous nerve tissues for histological and molecular analyses. RNA sequencing in penile tissues was used to determine differentially expressed genes and was verified by quantitative polymerase chain reaction. Human umbilical vein endothelial cells (HUVECs) were used for in vitro studies to analyze biological roles. Results: The ICP/MAP ratios in the exosome-once and exosome-repeat groups were significantly increased compared to those in the BCNI group. Interestingly, the ICP/MAP ratio showed a greater increase in the exosome-repeat group, which also showed significantly increased smooth muscle/collagen ratio, α-smooth muscle actin and neuronal nitric oxide synthase expression, and cyclic guanosine monophosphate level compared to the BCNI and exosome-once groups. Three genes were significantly differentially expressed in the exosome group, among which Ras homolog family member B promoted cell proliferation and angiogenesis of HUVECs. Conclusions: Repeated injections of MSC-derived exosomes can be effective in the treatment of rat models with ED induced by cavernous nerve injury. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate whether there is a difference in hand bone mineral density (BMD) between patients with traumatic hand injuries and healthy volunteers during the immobilization process, as well as to examine the change in BMD during follow‑up and the effect of denervation on BMD. In addition, we aimed to compare the BMD in the dominant and nondominant hands. Methods: The study involved patients aged 18–55 years who had undergone surgery for hand tendon injuries (TIs), with or without accompanying nerve injury, and subsequently sought rehabilitation at our outpatient clinic. The study groups were comprised patients with TI, those with tendon and nerve injury (TNI), and healthy volunteers. Results: The study examined 24 patients with TI, 23 with TNI, and 31 healthy volunteers. In the healthy control group, the BMD of the dominant hand was significantly higher than that of the nondominant hand (P < 0.001). At 4 weeks, there was no significant decrease in BMD observed in the TI and TNI groups compared to controls (P > 0.05). However, at the 4th month, both groups showed a significant decrease in BMD, with the TNI group exhibiting higher changes (P < 0.05). Injuries to the dominant hand did not result in significant changes in BMD at 4 weeks and 4 months (P > 0.05). However, a significant decrease in BMD was observed in injuries to the nondominant hand compared to controls at 4 months (P < 0.05). Notably, nondominant hand TNI patients experienced a significant reduction in BMD during the 4th month compared to the 4th week (P < 0.05). In addition, a significant correlation (r = 0.567) was found between grip strength and BMD value in the 4th month of patients with hand injuries. Conclusion: In patients with traumatic hand injuries, nondominant hand injury and/or nerve injury may lead to a decrease in BMD in addition to immobilization. [ABSTRACT FROM AUTHOR]

Opposition is an essential function of the human thumb to enable fine pinch and grip strength. Loss of opposition can be caused by both congenital and acquired pathology resulting in significant disability. This systematic review aims to compare the different techniques available to restore opposition. A systematic review of opponensplasty techniques was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines using PubMed, Embase, Medline, and Web of Science. Studies published in English before April 2021 and that reported on original outcomes of opponensplasty techniques used in the context of neurologic dysfunction were eligible for inclusion. A total of 641 articles were included, of which 42 texts were eligible for inclusion with a total cohort of 873 patients. The most commonly used transfers were palmaris longus (PL), extensor indicis proprius (EIP), and flexor digitorum superficialis (FDS). These transfers all demonstrated an improvement in range of motion, pinch strength, and Kapandji scores. Complication rates of 19% and 12% were reported with FDS and EIP transfers, respectively, predominantly related to donor site morbidity. A complication rate of 6% was observed with PL transfers, which was most commonly related to bowstringing. Heterogeneity of outcomes precluded a direct statistical comparison. There is significant heterogeneity in the literature reporting on opponensplasty techniques. There is limited capacity of direct comparison; however, FDS and EIP appear to demonstrate better functional outcomes, at the cost of higher complication rates. Each technique has specific complications and advantages and importance in patient counseling and discussion. Further prospective comparative studies are warranted. [ABSTRACT FROM AUTHOR]

Background: The scratch-collapse test (SCT) is a provocative maneuver used to diagnose compressive neuropathies. Despite multiple studies supporting its use, the SCT remains a controversial point in the literature in regard to its exact clinical application. We performed a systematic review and statistical analysis to provide statistical data on SCT outcomes and elucidate its role in diagnosing compressive conditions. Methods: We performed a systematic review of the literature according to Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. We extracted data of patients with outcomes on the SCT (yes/no) and on an accepted gold standard examination (electrodiagnostic studies). These data were analyzed using a statistical software program to generate the sensitivity and specificity values of the pooled data, as well as kappa agreement statistics. Results: For patients with carpal tunnel, cubital tunnel, peroneal, and pronator compressive neuropathies, the overall sensitivity of the SCT was 38%, and the specificity was 94%, with the kappa statistic approximately 0.4. Sensitivity and specificity values were higher for cubital tunnel syndrome and peroneal compression syndrome but lower for carpal tunnel syndrome. Pronator syndrome was also examined, but the data were inadequate for analysis. Conclusions: The SCT is a useful adjunct in the armament of diagnostic tools for the hand surgeon. Given its low sensitivity and high specificity, SCT should be used as a confirmatory test, rather than as a diagnostic screening test. More analyses are needed to identify subtler applications. [ABSTRACT FROM AUTHOR]

Background: Nerve transfers represent a new paradigm in the treatment of nerve injuries. Their current level of adoption among surgeons is unknown. This study evaluates the incidence of nerve transfers on case logs of board-eligible plastic surgeons over the past 14 years and surveys practicing nerve surgeons regarding their use of this technique. Methods: We queried the American Board of Plastic Surgery case log database for all nerve reconstruction Current Procedural Terminology codes from 2008 to 2021 and assessed trends and relationships between geographic region, examination year, and nerve transfer use. We surveyed nerve surgery professional societies to assess trends in practice, compared with a 2017 survey. Results: A total of 1959 nerve reconstruction cases were logged by 738 candidates from 2008 to 2021. Twelve percent of cases included nerve transfers. The proportion of nerve transfer codes (Z = −11.57; P <.0001) and the proportion of candidates performing nerve transfers (Z = −9.21, P <.0001) increased over the study period. Nerve transfers were associated with geographic region (χ2 = 25.826, P =.0002), with most cases performed in the Midwest (26.4%). A higher proportion of practicing nerve surgeons reported performing nerve transfers in this survey than in our 2017 survey (χ2 = 16.7, P <.001). Conclusions: There has been an increase in nerve transfers logged in the past 14 years by board-eligible plastic surgeons, as well as increased use among currently practicing nerve surgeons. Although nerve transfer use is increasing among both plastic and orthopedic surgeons, a greater proportion of nerve reconstructions include nerve transfers in the plastic surgery cohort. [ABSTRACT FROM AUTHOR]

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Local anesthetics, such as ropivacaine (Ropi), are toxic to nerve cells. We aimed to explore the role of forkhead box O3 (FOXO3) in Ropi-induced nerve injury to provide a theoretical basis for reducing the anesthetic neurotoxicity. SK-N-SH cells were cultured and treated with different concentrations of Ropi. Cell viability, apoptosis, cytotoxicity (LDH/ROS/SOD), and levels of FOXO3, miR-126-5p, and tumor necrosis factor receptor–associated factor 6 (TRAF6) were detected. The enrichment of FOXO3 on the miR-126-5p promoter was analyzed. The binding relationships among FOXO3, miR-126-5p promoter sequence, and TRAF6 3′UTR sequence were verified. Combined experiments detected the regulatory role of FOXO3/miR-126-5p/TRAF6 in Ropi-induced nerve injury. FOXO3 was upregulated in Ropi-induced nerve cell damage. Inhibition of FOXO3 ameliorated Ropi-induced decreased cell viability, and increased apoptosis and cytotoxicity. FOXO3 bound to the miR-126-5p promoter and inhibited its expression, thereby counteracting miR-126-5p-induced repression. miR-126-5p inhibition and TRAF6 overexpression partially reversed the alleviative effect of FOXO3 inhibition on Ropi-induced nerve cell damage. In conclusion, FOXO3 aggravated the neurotoxicity of Ropi through miR-126-5p downregulation and TRAF6 upregulation, suggesting that FOXO3 inhibitor could be an adjuvant agent for local anesthetics, to alleviate local anesthetics-induced neurotoxicity. [ABSTRACT FROM AUTHOR]

The potassium–chloride cotransporter KCC2 is the main extruder of Cl- in neurons. It plays a fundamental role in the activity of the inhibitory neurotransmitters (GABA and glycine) since low levels of KCC2 promote intracellular Cl- accumulation, leading to the depolarizing activity of GABA and glycine. The downregulation of this cotransporter occurs in neurological disorders characterized by hyperexcitability, such as epilepsy, neuropathic pain, and spasticity. KCC2 is also downregulated after axotomy. If muscle reinnervation is allowed, the KCC2 levels recover in motoneurons. Therefore, we argued that target-derived neurotrophic factors might be involved in the regulation of KCC2 expression. For this purpose, we performed the axotomy of extraocular motoneurons via the monocular enucleation of adult rats, and a pellet containing either VEGF or BDNF was chronically implanted in the orbit. Double confocal immunofluorescence of choline acetyl-transferase (ChAT) and KCC2 was carried out in the brainstem sections. Axotomy led to a KCC2 decrease in the neuropil and somata of extraocular motoneurons, peaking at 15 days post-lesion, with the exception of the abducens motoneuron somata. VEGF administration prevented the axotomy-induced KCC2 downregulation. By contrast, BDNF either maintained or reduced the KCC2 levels following axotomy, suggesting that BDNF is involved in the axotomy-induced KCC2 downregulation in extraocular motoneurons. The finding that VEGF prevents KCC2 decrease opens up new possibilities for the treatment of neurological disorders coursing with neuronal hyperactivity due to KCC2 downregulation. [ABSTRACT FROM AUTHOR]

BACKGROUND: It has been shown that neural stem cells can differentiate into neurons, astrocytes, and oligodendrocytes. Mesenchymal stem cells-derived extracellular vesicles have also been shown to cross the blood-brain barrier to reach sites of central nervous injury and promote neural repair. However, it is not clear whether neuron-derived extracellular vesicles promote the differentiation of neural stem cells in a direction that is beneficial for neurogenesis. OBJECTIVE: To investigate whether neuron-derived extracellular vesicles facilitate neural stem cell differentiation towards neurogenesis. METHODS: Neurons and neural stem cells were extracted from neonatal SD rat cerebral cortex by trypsin digestion. Cell supernatants of neurons were collected. Neuron-derived extracellular vesicles were extracted. Neural stem cells cultured for 10 days were co-cultured with neuron-derived extracellular vesicles or PBS for 7 days. Immunoblotting, immunofluorescence, and RT-qPCR were used to detect proteins specifically expressed by neurons, neural stem cells, oligodendrocytes, and astrocytes. RESULTS AND CONCLUSION: The neural stem cells co-cultured with neuron-derived extracellular vesicles showed high expression of neuron-specific proteins and oligodendrocyte-specific proteins including β3-tubulin, neurofilament 200 and myelin basic protein, and low expression of astrocyte-specific protein glial fibrillary acidic protein. These results suggest that neuron-derived extracellular vesicles can promote the differentiation of neural stem cells into neurons and oligodendrocytes and prevent the differentiation of neural stem cells into astrocytes. [ABSTRACT FROM AUTHOR]

Multiple studies have shown that astrocytes in the medullary dorsal horn (MDH) play an important role in the development of pathologic pain. However, little is known about the structural reorganization of the peripheral astrocytic processes (PAP), the main functional part of the astrocyte, in MDH in neuropathic state. For this, we investigated the structural relationship between PAP and their adjacent presynaptic axon terminals and postsynaptic dendrites in the superficial laminae of the MDH using electron microscopical immunohistochemistry for ezrin, a marker for PAP, and quantitative analysis in a rat model of neuropathic pain following chronic constriction injury of the infraorbital nerve (CCI-ION). We found that, compared to controls, in rats with CCI-ION, (1) the number, % area, surface density, and volume fraction of ezrin-positive (+) PAP, as well as the fraction of synaptic edge apposed by ezrin + PAP and the degree of its coverage of presynaptic axon terminals and postsynaptic dendrites increased significantly, (2) these effects were abolished by administration of the mGluR5 antagonist 2-methyl-6-(phenylethynyl) pyridine (MPEP). These findings indicate that PAP undergoes structural reorganization around the central synapses of sensory afferents following nerve injury, suggest that it may be mediated by mGluR5, and may represent the structural basis for enhancing astrocyte-neuron interaction in neuropathic pain. [ABSTRACT FROM AUTHOR]

Background: Peroneus longus (PL) graft harvest has gained popularity in recent years for a variety of ligament surgeries. One of the common apprehensions regarding its more widespread usage has been the risk of injury to the common peroneal nerve or the sural nerve during graft harvest. The purpose of the current study is to assess the rate of injury to the peroneal and sural nerve following PL harvest using our technique in a large cohort of patients. Materials and Methods: A prospective cohort of 600 consecutive patients undergoing PLG harvest over a period from January 2022 to December 2022 at a single tertiary referral centre were included for analysis. Patients had baseline screening of nerve function prior to surgery and were regularly followed up at 3 weeks, 6 weeks, 3 months and 6 months post-harvest. Grouped variables for the sural and peroneal nerve were completed and analysis was carried out using Cochrane's Q test and McNemar's test. Results: We found that only 0.01% of patients had any nerve complications at 6 months follow-up, and three times more patients had sural nerve complaints than peroneal nerve complaints at the end of the 6 months follow-up. Conclusion: Peroneus longus harvest is a safe and reproducible technique with low complication rate. The rate of nerve complications post-harvest is grossly overestimated in the literature secondary to low-powered and low evidence studies. We believe that using our safe surgical technique for PL harvest with respect to surface landmarks allows for PL harvest with a low nerve complication rate. [ABSTRACT FROM AUTHOR]

Background. Dupuytren's disease (DD) is a chronic and progressive fibroproliferative disease consisting of the progressive pathological fibrosis of the palmar fascia leading to permanent flexion and deficit of extension, with marked deformity and severe disability. Among treatment options, conservative and infiltrative therapies, physiotherapy, or surgery, with less invasive surgical options, are reported. The therapeutic planning, shared with the patient, must consider the severity of the disease, surgical risks, the functional, aesthetic, and occupational consequences, and the risk of recurrence. Case report. We describe a complicated clinical case that led her to a claim for compensation under presumed medical professional liability profiles. A female patient, 32-years-old, suffering from early symptomatic DD in the left non-dominant hand, underwent to palmar fasciotomy complicated by severe paraesthesia. In the re-surgery, vascular and nerve injury was found, leading to permanent disabling sequelae. Discussion. The early stage of DD, although symptomatic, without previous medical or infiltrative therapy, in a young subject with insulindependent diabetes and a high risk of recurrence contraindicated the surgical approach, especially palmar fasciotomy, according to the best evidence. The vascular-nervous lesion in the hand palm indicated a censurable surgical execution technique. The technical consultation ascertained the causal relationship between impairments and surgical malpractice, followed by compensation. Conclusion. The analysis of this case highlights the value of informed clinical practice to provide optimal care and mitigate the risks associated with the management of DD. The choice of possible treatment options must be tailored to the patient in accordance with the best evidence. Clin Ter 2024; 175 (5):333-336 doi: 10.7417/ CT.2024.5138 [ABSTRACT FROM AUTHOR]

Background: This study seeks to examine the reliability, quality, and content of YouTube videos on cubital tunnel syndrome, on which there is presently a paucity of information. Methods: The top 50 unique YouTube videos by relevance resulting from the Boolean search term "cubital tunnel + cubital tunnel syndrome" were identified, with video properties for analysis including source, upload date, duration, views, and comments. Content was assessed using the Journal of American Medical Association (JAMA) criteria, the Global Quality Score (GQS), and a "Cubital Tunnel–Specific Score" (CTSS). Results: The average video saw 72 108 ± 199 362 views, with videos produced by allied (nonphysician) health professionals demonstrating the highest mean views (111 789 ± 294 471 views). Videos demonstrated low mean JAMA scores (2.4/4 ± 0.7), GQS (2.8/5 ± 1.3), and CTSS (7.5/21 ± 4.3), with academic and nonacademic physician videos demonstrating significantly greater mean GQS and CTSS scores when compared with videos by allied health professionals. Positive independent predictors for GQS included academic sources (β = 1.871), nonacademic physician sources (β = 1.651), and video duration (β = 0.102), which were likewise positive predictors for CTSS (β = 4.553, 4.639, 0.374). Content relating to surgical techniques or approaches for cubital tunnel decompression had the greatest CTSS scores (11.2 [4.2]). Conclusions: YouTube is a source of highly accessible information on cubital tunnel syndrome, although the average video presents generally poor and inadequate information. Directing patients toward higher quality video resources can be a meaningful component of patient education. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess success rates and to report complications of coronectomy of mandibular third molars (M3M), including intra-operative failure, pain, infection, dry socket, inferior dental alveolar (IAN) and lingual nerve (LN) injuries and re-operation rates. Methods: Retrospective analysis of 167 coronectomies completed between January 2017 to December 2022 was undertaken. Results: The success of coronectomy was 93%. Intra-operative failure was reported to be 3.6% (n = 8). Complications accounted for pain (15%, n = 24), infection (9%, n = 15) and dry socket (3.6%, n = 6). Three patients required removal of M3M root at 3 months (n = 2) and 24 months (n = 1), accounting for 1.8% re-operation rate. A total of number of patients who suffered a nerve injury was 12; three of these were permanent (LN – 1.2%, n = 2; IAN – 0.6%, n = 1), nine were temporary (IAN – 1.2%; n = 2, LN – 2.4%; n = 4; site not specified – 1.8%, n = 3). No patients with intra-operative failure and re-operation suffered IAN or LN injury post-operatively. Conclusion: Coronectomy offers a successful strategy for management of high risk M3M. The treatment outcomes can be improved with careful case selection and adjusting surgical technique, including assessment of root morphology, incomplete crown sectioning technique and avoidance of lingual retraction. Reporting of coronectomy success as a factor of surgical outcome, presence or absence of permanent IAN injury, persistent symptoms or any other long-standing complications (such as LN injury), and the need for re-operation accounting for root migration status may be a useful tool to measure coronectomy outcomes. [ABSTRACT FROM AUTHOR]

Nuclear erythroid 2-related factor 2 (Nrf2) and its downstream effector heme oxygenase 1 (HO-1) are commonly activated in response to cellular stresses. The elevated expression of HO-1 has been associated with markedly accelerated peripheral nerve regeneration. This study aimed to evaluate the impact of a naturally occurring dietary Nrf2/HO-1 activator—sulforaphane (SFN)—on regeneration in a murine sciatic nerve crush model. The beneficial safety profile of SFN has been thoroughly investigated and confirmed several times. Here, SFN was administered daily, starting immediately after C57BL/6 mice were subjected to sciatic nerve crush injury. Injured sciatic nerves were excised at various time points post injury for molecular, immunohistochemical and morphometric analyses. Moreover, functional assessment was performed by grip strength analysis and electrophysiology. Following SFN treatment, the early response to injury includes a modulation of autophagic pathways and marked upregulation of Nrf2/HO-1 expression. This enhancement of HO-1 expression was maintained throughout the regeneration phase and accompanied by a significant increase in repair Schwann cells. In these cells, elevated proliferation rates were observed. Significant improvements in grip strength test performance, nerve conduction velocity and remyelination were also noted following SFN treatment. Collectively, SFN modulates cytoprotective and autophagic pathways in the injured nerve, increasing the number of repair Schwann cells and contributing to effective nerve regeneration. Given the availability of SFN as a nutritional supplement, this compound might constitute a novel regenerative approach with broad patient accessibility and further studies on this topic are warranted. [ABSTRACT FROM AUTHOR]

Abstract Background We aimed to investigate the compression and ischemic effects of two different tourniquet pressures on tissues during surgery show a clinical difference. Methods Patients aged 18–65 years who underwent foot and ankle surgery and applied a tourniquet in a single center between September 2022 and November 2023 were included in this prospective randomized study. Accordingly, tourniquet pressures were applied as limb occlusion pressure (LOP) + 50 mmHg in group 1 (12 patients) and LOP + 100 mmHg in group 2 (12 patients). The time point at which the femoral nerve motor evoked potential (MEP) decreased by 50%, the time point at which the MEP decreased by 100% for all nerves (femoral, tibial, and deep peroneal), and the time point at which all responses returned after the tourniquet was deflated were identified as the time points for analysis. Results There were no differences in demographic data (age, body mass index, and sex) between the two groups. The mean tourniquet pressure was 191 ± 16 mmHg in Group 1 and 247 ± 21 mmHg in Group 2 (p

Purpose: A systematic review to identify treatment approaches for the management of pain following peripheral nerve injury. Methods: A published literature search was performed for the concepts of peripheral nerve injury and pain management with related synonyms. The strategies were created using a combination of controlled vocabulary terms and keywords and were executed in Embase.com, Ovid-Medline All, and Scopus from database inception. Database searches were completed on August 22, 2023. Results: The initial search resulted in a total of 1,793 citations. In total, 724 duplicates were removed, leaving 1,069 unique citations remaining for analysis. This review excluded all papers that were not specific to pain following peripheral nerve injury. Case and cohort studies (n < 5) were also excluded. Thirty-two articles on pain management strategies after peripheral nerve injury remained, with years of publication ranging from 1981 to 2023. An additional four articles were identified by manual search. Of the 36 articles reviewed, 15 articles reported on the approach to the treatment of pain after a peripheral nerve injury, and the other 22 articles consisted of cohort and case series studies. Conclusions: There is a lack of literature describing efficacy of various treatment strategies for pain following peripheral nerve injuries. Few studies provide clear, stepwise clinical guidance for practicing physicians and other health care providers on the treatment of these complicated patients.

Tissue-engineered nerve guidance conduits (NGCs) are an area of research interest and investment. Currently, two separate three-dimensional, filled NGCs have Food and Drug Administration approval in the management of nerve gaps up to 3 cm in length, with more on the horizon. Future NGC options will leverage increasingly intricate designs to mimic the natural biology and architecture of native nerve tissue. To enhance the development of next-generation NGCs, experimental protocols and models should be standardized. For the NGCs currently on the market, more clinical data and randomized comparative studies are needed.

Abstract A patient in her 60s with spinal cord injury developed pruriginous lesion only in a nerve‐noninjured area, although erythema resulting from scratching was also prominent in a nerve‐injured lesion. The area of protein gene product 9.5 (PGP9.5)‐positive nerve fibres within the nerve‐injured lesion was significantly reduced compared with the nerve‐noninjured area. This case suggests an essential role for PGP 9.5‐positive nerve fibres in the development of chronic pruritus.

Axonal regeneration following surgical nerve repair is slow and often incomplete, resulting in poor functional recovery which sometimes contributes to lifelong disability. Currently, there are no FDA-approved therapies available to promote nerve regeneration. Tacrolimus accelerates axonal regeneration, but systemic side effects presently outweigh its potential benefits for peripheral nerve surgery. The authors describe herein a biodegradable polyurethane-based drug delivery system for the sustained local release of tacrolimus at the nerve repair site, with suitable properties for scalable production and clinical application, aiming to promote nerve regeneration and functional recovery with minimal systemic drug exposure. Tacrolimus is encapsulated into co-axially electrospun polycarbonate-urethane nanofibers to generate an implantable nerve wrap that releases therapeutic doses of bioactive tacrolimus over 31 days. Size and drug loading are adjustable for applications in small and large caliber nerves, and the wrap degrades within 120 days into biocompatible byproducts. Tacrolimus released from the nerve wrap promotes axon elongation in vitro and accelerates nerve regeneration and functional recovery in preclinical nerve repair models while off-target systemic drug exposure is reduced by 80% compared with systemic delivery. Given its surgical suitability and preclinical efficacy and safety, this system may provide a readily translatable approach to support axonal regeneration and recovery in patients undergoing nerve surgery.

Platelet-rich plasma (PRP) has the capability of assisting in the recovery of damaged tissues by releasing a variety of biologically active factors to initiate a hemostatic cascade reaction and promote the synthesis of new connective tissue and revascularization. It is now widely used for tissue engineering repair. In addition, PRP has demonstrated nerve repair and pain relief, and has been studied and applied to the facial nerve, median nerve, sciatic nerve, and central nerve.These suggest that PRP injection therapy has a positive effect on nerve repair. This indicates that PRP has high clinical value and potential application in nerve repair. It is worthwhile for scientists and medical workers to further explore and study PRP to expand its application in nerve repair, and to provide a more reliable scientific basis for the opening of a new approach to nerve repair.

BACKGROUND: At present, there are some limitations in evaluating the severity of acute spinal cord injury, and a rapid and accurate evaluation method is urgently needed. OBJECTIVE: To analyze the correlation between the expression levels of serum oxidative stress and nerve injury indexes and the severity of the disease in patients with acute spinal cord injury. METHODS: A total of 65 patients were included in the study from August 2020 to May 2022, including 32 patients in the experimental group (acute spinal cord injury) and 33 patients in the control group (simple spinal fracture). American Spinal Injury Association (ASIA) Impairment Scale and neurological function score were evaluated within 8 hours of admission. Meanwhile, serum levels of superoxide dismutase, malondialdehyde, glutathione, nitric oxide, glial fibrillary acidic protein and neuron-specific enolase were detected and compared between the two groups. The correlation between the expression levels of the above serological indicators in serum and ASIA impairment grade and AISA neural function score was analyzed. RESULTS AND CONCLUSION: The average serum levels of superoxide dismutase and glutathione in the experimental group were significantly lower than those of the control group (P < 0.001), while the average serum levels of malondialdehyde, nitric oxide, glial fibrillary acidic protein and neuron-specific enolase in the experimental group were higher than those of the control group (P < 0.01). The serum levels of superoxide dismutase and glutathione in the experimental group were positively correlated with the damage grade of AISA (r=0.862 4, 0.849 3, P < 0.01), while the serum levels of malondialdehyde, nitric oxide, glial fibrillary acidic protein and neuron-specific enolase were negatively correlated with the damage grade of AISA (r=-0.866 1, -0.638 1, -0.746 6, P < 0.001), and the serum level of nitric oxide was not significantly correlated with the damage grade of AISA (r=-0.177 5, P > 0.05). The serum level of glutathione in the experimental group was positively correlated with AISA sensory function scores (r=0.569 9, P < 0.001), while the serum levels of malondialdehyde, glial fibrillary acidic protein and neuron-specific enolase were negatively correlated with AISA sensory function scores (r=-0.574 1, -0.099 2, -0.708 6, P < 0.05), and the serum levels of superoxide dismutase and nitric oxide were not significantly correlated with AISA sensory function scores (r=0.230 8, -0.376 2, P > 0.05). The serum levels of superoxide dismutase and glutathione in the experimental group were positively correlated with ASIA motor function scores (r=0.380, 0.524 7, P < 0.05); the serum levels of malondialdehyde, glial fibrillary acidic protein and neuron-specific enolase were negatively correlated with AISA motor function scores (r=-0.577 9, -0.452 2, -0.662 8, P < 0.05); and the level of nitric oxide had no significant correlation with AISA motor function scores (r=-0.049 7, P > 0.05).To conclude, the serum levels of superoxide dismutase, malondialdehyde, glutathione, nitric oxide, glial fibrillary acidic protein and neuron-specific enolase in serum of patients with acute spinal cord injury are significantly correlated with ASIA impairment grade and ASIA neural function score, which could be used as biomarkers for early clinical assessment of disease severity. [ABSTRACT FROM AUTHOR]

Plexus injury results in lifelong suffering from flaccid paralysis, sensory loss, and intractable pain. For this clinical problem, regenerative medicine concepts set high expectations. However, it is largely unknown how dorsal root ganglia (DRG) are affected by accidental deafferentation. Here, we phenotyped DRG of a clinically and MRI-characterised cohort of 13 patients with plexus injury. Avulsed DRG were collected during reconstructive nerve surgery. For control, we used DRG from forensic autopsy. The cellular composition of the DRG was analysed in histopathological slices with multicolour high-resolution immunohistochemistry, tile microscopy, and deep-learning-based bioimage analysis. We then sequenced the bulk RNA of corresponding DRG slices. In about half of the patients we found loss of the typical DRG units consisting of neurones and satellite glial cells. The DRG cells were replaced by mesodermal/connective tissue. In the remaining patients, the cellular units were well preserved. Preoperative plexus MRI neurography was not able to distinguish the two types. Patients with 'neuronal preservation' had less maximum pain than patients with 'neuronal loss'. Arm function improved after nerve reconstruction, but severe pain persisted. Transcriptome analysis of preserved DRGs revealed expression of subtype-specific sensory neurone marker genes, but downregulation of neuronal attributes. Furthermore, they showed signs of ongoing inflammation and connective tissue remodelling. Patients with plexus injury separate into two groups with either neuronal preservation or neuronal loss. The former could benefit from anti-inflammatory therapy. For the latter, studies should explore mechanisms of neuronal loss especially for regenerative approaches. DRKS00017266. [ABSTRACT FROM AUTHOR]

Background The normal ability to distinguish two points from one is known as the two-point discriminative (2PD) sense. This forms an extremely important assessment in patient with injuries to the nerves distributed to the upper extremity.

Purpose: The aim of this study was to investigate whether there is a difference in hand bone mineral density (BMD) between patients with traumatic hand injuries and healthy volunteers during the immobilization process, as well as to examine the change in BMD during follow-up and the effect of denervation on BMD. In addition, we aimed to compare the BMD in the dominant and nondominant hands. Methods: The study involved patients aged 18–55 years who had undergone surgery for hand tendon injuries (TIs), with or without accompanying nerve injury, and subsequently sought rehabilitation at our outpatient clinic. The study groups were comprised patients with TI, those with tendon and nerve injury (TNI), and healthy volunteers. Results: The study examined 24 patients with TI, 23 with TNI, and 31 healthy volunteers. In the healthy control group, the BMD of the dominant hand was significantly higher than that of the nondominant hand (P < 0.001). At 4 weeks, there was no significant decrease in BMD observed in the TI and TNI groups compared to controls (P > 0.05). However, at the 4th month, both groups showed a significant decrease in BMD, with the TNI group exhibiting higher changes (P < 0.05). Injuries to the dominant hand did not result in significant changes in BMD at 4 weeks and 4 months (P > 0.05). However, a significant decrease in BMD was observed in injuries to the nondominant hand compared to controls at 4 months (P < 0.05). Notably, nondominant hand TNI patients experienced a significant reduction in BMD during the 4th month compared to the 4th week (P < 0.05). In addition, a significant correlation (r = 0.567) was found between grip strength and BMD value in the 4th month of patients with hand injuries. Conclusion: In patients with traumatic hand injuries, nondominant hand injury and/or nerve injury may lead to a decrease in BMD in addition to immobilization.

Introduction Progress in shoulder surgery is associated with improved operating rooms equipment, advanced surgical products and minimally invasive techniques. There are rare injuries to nerves and vessels being intersected or pulled into the sutures. However, marginal tears, compression and nerve entrapment of trunks during access retraction, catheterization, inadequate correct of the patient on the operating table and errors in rehabilitation can be common. The purpose was to identify factors predisposing to peripheral nerve injury to the upper limb during shoulder surgery and offer prevention options. Material and methods Major studies in the field of shoulder anatomy and surgery published between 1984 and 2023 were reviewed to identify anatomical, biomechanical and perioperative factors leading to peripheral nerve injuries. The original literature search was conducted on key resources including GoogleScholar, PubMed, ScienceDirect, RSCI, Scopus. Four approaches were used for structuring and informative presentation of the data to include types of the peripheral nerve injury in the upper limb. Results and discussion Factors predisposing to the peripheral nerve injury in the upper limb during shoulder surgery were identified in the review. Prevention measures include the patient positioned on the operating table with adequate fixation of the head and torso, regardless of the chosen position; traction of the involved upper limb with a load of not greater than 9 kg using a specialized clamp; preoperative marks of the surgical field and staining of bone landmarks; the arthroscopic ports 1–2 cm to be shifted more distally minimizing the fluid flow into the joint during a long operation. Postoperative consultation with rehabilitation specialists is essential to develop an early activation program and assess the risks of neurological disorders. Conclusion The shoulder anatomy and the localization of unsafe zones of the shoulder, the risks associated with a particular manipulation were explored for effective preoperative planning and prevention of neurological complications in the treatment of surgical pathology of the shoulder joint.

Ibdanelo Cortez,1,&ast; Caitlyn M Gaffney,1,&ast; Riddhi Vichare,2 Caitlin V Crelli,2 Lu Liu,2 Eric Lee,1 Jules Edralin,1 James M Nichols,1 Hoang Vu Pham,1 Syed Mehdi,1 Jelena M Janjic,2 Andrew J Shepherd1 1Laboratories of Neuroimmunology, Department of Symptom Research, the University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA; 2School of Pharmacy, Duquesne University, Pittsburgh, PA, 15282, USA&ast;These authors contributed equally to this workCorrespondence: Jelena M Janjic, School of Pharmacy, Duquesne University, 600 Forbes Ave., Pittsburgh, PA, 15282, USA, Email janjicj@duq.edu Andrew J Shepherd, Laboratories of Neuroimmunology, Department of Symptom Research, the University of Texas MD Anderson Cancer Center, Unit 1055, 6565 MD Anderson Boulevard, Houston, TX, 77030, USA, Tel +1 713 745-7959, Fax +1 832 750-5153, Email ajshepherd@mdanderson.orgAbstract: Soft tissue injuries often involve muscle and peripheral nerves and are qualitatively distinct from single-tissue injuries. Prior research suggests that damaged innervation compromises wound healing. To test this in a traumatic injury context, we developed a novel mouse model of nerve and lower limb polytrauma, which features greater pain hypersensitivity and more sustained macrophage infiltration than either injury in isolation. We also show that macrophages are crucial mediators of pain hypersensitivity in this model by delivering macrophage-targeted nanoemulsions laden with the cyclooxygenase-2 (COX-2) inhibitor celecoxib. This treatment was more effective in males than females, and more effective when delivered 3 days post-injury than 7 days post-injury. The COX-2 inhibiting nanoemulsion drove widespread anti-inflammatory changes in cytokine expression in polytrauma-affected peripheral nerves. Our data shed new light on the modulation of inflammation by injured nerve input and demonstrate macrophage-targeted nanoimmunomodulation can produce rapid and sustained pain relief following complex injuries. Keywords: nerve injury, muscle contusion, inflammation, celecoxib, nanoemulsion, COX-2

Purpose: The purpose of this study was to assess ulnar and median nerve injury after reverse total shoulder arthroplasty (RSA) by measuring the sensory nerve conduction velocity (SCV). The secondary objective was to evaluate the impact of lateralization and/or distalization on SCV changes. Methods: Twenty consecutive cases were prospectively included and retrospectively reviewed. SCV of the ulnar and median nerves as well as humeral lateralization/distalization quantified by plain radiography were evaluated pre-operatively and at 1 week post-operatively. Changes in SCV were tested using the paired t-test, and correlations between humeral lateralization/distalization and SCV changes were tested using Kendall's rank correlation coefficient and maximal information coefficient (MIC). Results: The SCV of the ulnar nerve was delayed from 55.4 ​m/s pre-operatively to 53.0 ​m/s post-operatively (p ​= ​0.021), whereas there was no significant change in the median nerve (p ​= ​0.17). There was a weak to moderate correlation between ulnar nerve SCV delay and lateralization (τ ​= ​−0.38; p ​= ​0.021; MIC ​= ​0.70) but no significant correlation with distalization (p ​= ​0.65; MIC ​= ​0.56). Conclusions: Following RSA, a small but significant delay in SCV of the ulnar nerve was observed. A negative correlation was found between lateralization and SCV delay of the ulnar nerve.

Objective: To investigate the regulatory effect of Fas-L on the repair and regeneration of peripheral extension injury in rats. Methods: This study aimed to explore the effects of Fas-L on apoptosis and axonal regeneration of dorsal root ganglion (DRG) cells in rat peripheral nerve repair and regeneration by using several relevant experimental techniques from the injured nerve animal model, cell biology, and molecular biology. Results: The expression level of Fas-L in DRG tissues was significantly down-regulated after sciatic nerve injury. Interference with Fas-L can significantly promote the regeneration of DRG neuronal axons and inhibit apoptosis, while the overexpression of Fas-L is contrary to it. Moreover, Fas-L may play a role in the regulation of DRG function and the repair and regeneration of peripheral nerves in Sprague Dawley (SD) rats by affecting several signaling pathways, such as p-AKT/AKT, β-catenin, and NF-κB. Conclusion: Fas-L may have a certain effect on the repair and regeneration of peripheral nerve injury in SD rats, which may provide an experimental basis and a new theoretical basis for the functional reconstruction of peripheral nerves. Significance statement: The expression level of Fas-L in DRG tissues was significantly down-regulated after sciatic nerve injury. Fas-L can significantly promote the regeneration of DRG neuronal axons and inhibit apoptosis. Fas-L may play a role in the regulation of DRG function and the repair and regeneration of peripheral nerves in SD rats by affecting several signaling pathways, such as p-AKT/AKT, β-catenin, and NF-κB. Fas-L may have a certain effect on the repair and regeneration of peripheral nerve injury in SD rats, which may provide an experimental basis and a new theoretical basis for the functional reconstruction of peripheral nerves.

• The therapeutic effects of different types of cell transplantation (Neural stem cells, Schwann cells, olfactory ensheathing cells and mesenchymal stem cells) in the application of NPP were discussed comprehensively. • The application value of cell transplantation in NPP clinical trial was discussed. • The problems and challenges of cell transplantation in the treatment of NPP were discussed. Nerve injury can not only lead to sensory and motor dysfunction, but also be complicated with neuropathic pain (NPP), which brings great psychosomatic injury to patients. At present, there is no effective treatment for NPP. Based on the functional characteristics of cell transplantation in nerve regeneration and injury repair, cell therapy has been used in the exploratory treatment of NPP and has become a promising treatment of NPP. In this article, we discuss the current mainstream cell types for the treatment of NPP, including Schwann cells, olfactory ensheathing cells, neural stem cells and mesenchymal stem cells in the treatment of NPP. These bioactive cells transplanted into the host have pharmacological properties of decreasing pain threshold and relieving NPP by exerting nutritional support, neuroprotection, immune regulation, promoting axonal regeneration, and remyelination. Cell transplantation can also change the microenvironment around the nerve injury, which is conducive to the survival of neurons. It can effectively relieve pain by repairing the injured nerve and rebuilding the nerve function. At present, some preclinical and clinical studies have shown that some encouraging results have been achieved in NPP treatment based on cell transplantation. Therefore, we discussed the feasible strategy of cell transplantation as a treatment of NPP and the problems and challenges that need to be solved in the current application of cell transplantation in NPP therapy. [ABSTRACT FROM AUTHOR]

Palmitoylethanolamide (PEA) is a highly lipophilic molecule with low solubility, making absorption difficult. Recent techniques like micronisation, ultra-micronisation and combining PEA with solvents have improved their bioavailability and stability. Our study analysed particle size differences and absorption kinetics using specific solvents (PEAΩ and PEA DynoΩ) over time (0.5 h–6 h) in a dose-dependent manner (200 mg–1800 mg). The results showed that PEAΩ and PEA DynoΩ achieved 82–63% absorption at 3 h, compared to 30–60% for micronised, ultra-micronised PEA and a commercial product, highlighting the optimal dose range of 300 mg–600 mg. In addition, a 3D model of the peripheral nerve was utilised to explain the efficacy after gut passage and support the most effective dose (300 mg or 600 mg) achieved at the gut level. PEAΩ and PEA DynoΩ, which are associated with better intestinal bioavailability compared to PEA-micronised, PEA ultra-micronised and a commercial product, have allowed not only a reduction in the inflammatory context but also an improvement of peripheral nerve well-being by increasing specific markers like MPZ (26–36% vs. 8–15%), p75 (25–32% vs. 13–16%) and NRG1 (22–29.5% vs. 11–14%). These results highlight the potential of advanced PEA formulations to overcome solubility challenges and maintain in vitro efficacy, modulating peripheral nerve well-being. [ABSTRACT FROM AUTHOR]

Nerve injury can lead to defects in related motor functions. It is critical to achieve long‐term and convenient real‐time evaluation of motor function recovery status during nerve injury repair. In this study, an implantable PLLA/BTO piezoelectric sensor (PBPS) with good biodegradability and biocompatibility for real time evaluation of the motor function recovery after nerve injury is developed. PLLA fibers doped with BTO are employed as piezoelectric material in PBPS, which can convert the biomechanical signals generated by motion into electrical signals. PBPS can be implant simultaneously with commonly used tissue scaffolds for treatment in the rats with sciatic nerve injury. The linearity of the pressure and the output voltage of PBPS is ≈0.9445. For the evaluation effectiveness, as the treatment process progresses, the signals generated by PBPS exhibited good consistency with EMG signals, indicating effectively evaluation of the motor function. Moreover, the integration of PBPS and wireless module can break the limitations of time and space for sensing and realize wireless evaluation of motor function in rat. The implantable sensor based on PBPS may bring new ideas for the development of implantable bioelectronics. [ABSTRACT FROM AUTHOR]

Background The normal ability to distinguish two points from one is known as the two-point discriminative (2PD) sense. This forms an extremely important assessment in patient with injuries to the nerves distributed to the upper extremity. Objective The aim of this study was to estimate the normal reference values of static 2PD in healthy adults and children. Materials and Methods A total of 624 normal adults comprising 380 men and 244 women were recruited randomly for the study at three different centers. Additionally, 172 healthy children, comprising 110 boys and 62 girls, were studied. Eight sensory areas in the palmar surface of the hand were delineated. The ability to distinguish the static 2PD was estimated in millimeters by using disk discriminator. The results were tabulated and statistically analyzed. Results The mean static 2PD in the adult population ranged from 2.78 to 3.5 mm in the fingertips and 5.39 to 7.13 mm in the mid-palm. There was a statistically significant difference between men and women in zones 6, 7, and 8. In children, the observed 2PD values were 2.15 to 3.63 mm in the fingertips and 4.10 to 5.77 mm in the palm. Children have a significantly better 2PD sense when compared with adults. Conclusion The normal value of static 2PD in the palmar surface of the hand among the Indian pediatric and adult populations was established in the study. [ABSTRACT FROM AUTHOR]

In the Old Testament book of Genesis, Chapter 32, Jacob wrestled with an angel. After that encounter, Jacobs limped. Through careful understanding of the original meaning of the words in Verses 25, 31, and 32 of Genesis 32, we seek to learn what type of injury the angel might have inflicted on Jacob. At the time Genesis was written, the difference between tendon and nerve was not understood. While wrestling, when the angel's hand grabbed Jacob, it was most likely Jacob's hip that was affected, not his thigh. Most likely, there was a posterior dislocation of the "socket" (hip joint), and the "sinew" that was damaged was the sciatic nerve. Today, this biblical description is manifested by the sciatic nerve being removed for beef to be considered Kosher. In Genesis Chapter 32, Jacob wrestled with an angel, after which Jacob limped. Most likely, Jacob had a posterior hip dislocation with a sciatic nerve stretch injury. Today, this Biblical description is manifested by the sciatic nerve being removed for beef to be considered Kosher. [ABSTRACT FROM AUTHOR]

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Background: As TMJ surgery incisions have evolved, there has been a decrease in facial deformity and adequate surgical access. Even though the traditional preauricular and endaural incisions offer great exposure, they heal with a noticeable scar; in contrast, the Inviscision becomes invisible. Aim: To compare and evaluate both the approaches for TMJ surgeries in terms of surgical exposure, VII nerve injury and postoperative aesthetics. Methods: 60 TMJ surgery cases were randomly divided into two groups: Group A-30 Inviscision and Group B-30 Endaural incision and assessed for the amount of time from the incision to the exposure, ample access for surgery and postoperative nerve injury, scarring, cartilage injury/necrosis and ear deformity. All the patients were followed up for an average of six months. Results: Surgical exposure time was average 12 and 10 min via Inviscision and endaural incision, respectively. In Inviscision, scar becomes invisible after 40 days and in endaural incision, scar becomes a thin but visible line after 35 days. No cases of hypertrophic scar, keloid formation, cartilage injury/necrosis/ear deformity in either group. Transient temporal branch of VII nerve weakness seen in 33% of Inviscision and 40% of endaural cases which improved after average 3 and 3.4 months, respectively. Likert's patient satisfaction score was average 4 and 2, and POSAS score for scarring was 1.5 and 3, in Inviscision and endaural incision, respectively. Conclusion: Inviscision gives adequate exposure, avoids all related anatomic structures, other than causing transient retraction neuropraxia, along with outstanding aesthetic outcomes by hiding the scar in the anatomical folds of the ear auricle. Although, endaural incision provides better surgical time management and equivalent surgical exposure, Inviscision proves to be a better alternative for TMJ surgeries through all other parameters. [ABSTRACT FROM AUTHOR]

Laryngeal electromyography (LEMG) is a technique used to characterize neuropathic injuries to the recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN). The RLN and SLN innervate the laryngeal muscles to produce vocal fold (VF) motion and elongation, respectively. VF motion deficiencies can affect voice, swallowing, and breathing, which can greatly affect a patient's quality of life. Neuropathy‐related VF motion deficiencies most often result from surgical interventions to the skull base, neck, or chest likely due to the circuitous route of the RLN. LEMG is ideally conducted by an electromyographer and an otolaryngologist using a team‐approach. LEMG is a powerful diagnostic tool to better characterize the extent of neuropathic injury and thus clarify the prognosis for VF motion recovery. This updated review discusses current techniques to improve the positive and negative predictive values of LEMG using laryngeal synkinesis and quantitative LEMG. Synkinesis can be diagnosed by comparing motor unit potential amplitude during vocalization and sniff maneuvers when recording within adductor muscles. Quantitative turns analysis can measure motor unit recruitment to avoid subjective descriptions of reduced depolarization during vocalization, and normal values are >400 turns/s. By integrating qualitative, quantitative, and synkinetic data, a robust prognosis can help clinicians determine if VF weakness will recover. Based on LEMG interpretation, patient‐centered treatment can be developed to include watchful waiting, temporary VF augmentation, or definitive medialization procedures and laryngeal reinnervation. [ABSTRACT FROM AUTHOR]

Case: We present a case of type II (intraosseous) entrapment of the median nerve in a patient who was diagnosed based on clinical examination and magnetic resonance imaging and who was treated with medial epicondyle osteotomy, neurolysis, and transposition of the nerve to its anatomical position within a month of injury. Our patient made a complete motor and sensory recovery at 5 months with complete functionality and grip strength. Conclusion: Median nerve entrapment after posterolateral elbow dislocation is a rare complication with roughly 40 cases reported in the literature. This case illustrates the importance of prompt diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Heterotopic ossification (HO) is a pathological process characterized by the aberrant formation of bone in muscles and soft tissues. It is commonly triggered by traumatic brain injury, spinal cord injury, and burns. Despite a wide range of evidence underscoring the significance of neurogenic signals in proper bone remodeling, a clear understanding of HO induced by nerve injury remains rudimentary. Recent studies suggest that injury to the nervous system can activate various signaling pathways, such as TGF-β, leading to neurogenic HO through the release of neurotrophins. These pathophysiological changes lay a robust groundwork for the prevention and treatment of HO. In this review, we collected evidence to elucidate the mechanisms underlying the pathogenesis of HO related to nerve injury, aiming to enhance our understanding of how neurological repair processes can culminate in HO. [ABSTRACT FROM AUTHOR]