Functional Recovery Of Limb Research Articles

Comparison of Different Animal Models in Hindlimb Functional Recovery after Acute Limb Ischemia-Reperfusion Injury.

Acute limb ischemia (ALI) is a sudden lack of blood flow to a limb, primarily caused by arterial embolism and thrombosis. Various experimental animal models, including non-invasive and invasive methods, have been developed and successfully used to induce limb ischemia-reperfusion injuries (L-IRI). However, there is no consensus on the methodologies used in animal models for L-IRI, particularly regarding the assessment of functional recovery. The present study aims to compare different approaches that induce L-IRI and determine the optimal animal model to study functional limb recovery. In this study, we applied a pneumatic cuff as a non-invasive method and ligated the aorta, iliac, or femoral artery as invasive methods to induce L-IRI. We have measured grip strength, motor function, creatine kinase level, inflammatory markers such as nuclear factor NF-κB, interleukin-6 (IL-6), hypoxia markers such as hypoxia-induced factor-1α (HIF-1α), and evaluated the muscle injury with hematoxylin and eosin (H&E) staining in Sprague Dawley rats after inducing L-IRI. The pneumatic pressure cuff method significantly decreased the muscle strength of the rats, causing the loss of ability to hold the grid and inducing significant limb function impairment, while artery ligations did not. We conclude from this study that the tourniquet cuff method could be ideal for studying functional recovery after L-IRI in the rat model.

Codon-Optimized and de novo-Synthesized E-Selectin/AAV2 Dose-Response Study for Vascular Regeneration Gene Therapy.

This study focuses on dose-response investigation using a codon-optimized and de novo-synthesized E-Selectin/AAV2 (E-Sel/AAV2) vector in preparation for Investigational New Drug enabling of subsequent clinical studies. Gene therapy is a potential solution for patients suffering from chronic limb-threatening ischemia. Understanding the dose for effective gene delivery is crucial for future Investigational New Drug-enabling studies. Expression of the codon-optimized E-Selectin gene was assessed by flow cytometry following in vitro cell transfection assay and RT-qPCR for murine limbs injected in vivo with AAV-m-E-Selectin (E-Sel/AAV2). Dose-response studies involved 3 cohorts of FVB/NJ mice (n=6/group) with escalating log doses of E-Selectin/AAV2 injected intramuscularly in divided aliquots, ranging from 2 × 10 9 VG to 2 × 10 11 VG, into ischemic limbs created by left femoral artery/vein ligation/excision and administration of nitric oxide synthase inhibitor, L-NAME. Limb perfusion, extent of gangrene free limb, functional limb recovery, and therapeutic angiogenesis were assessed. Codon-optimized E-Sel/AAV2 gene therapy exhibits a superior expression level than WT E-Sel/AAV2 gene therapy both in vitro and in vivo. Mice treated with a high dose (2 × 10 11 VG) of E-Sel/AAV2 showed significantly improved perfusion indices, lower Faber scores, increased running stamina, and neovascularization compared with lower doses tested with control groups, indicating a distinct dose-dependent response. No toxicity was detected in any of the animal groups studied. E-Sel/AAV2 Vascular Regeneration Gene Therapy holds promise for enhancing the recovery of ischemic hindlimb perfusion and function, with the effective dose identified in this study as 2 × 10 11 VG aliquots injected intramuscularly.

Neural rewiring from peripheral to central

Peripheral nerve injury and reconstruction would lead to alteration of neural pathways. This is regarded as rewiring peripheral nerves, which could also be a trigger for the corresponding neural rewiring process in the brain. Brain plasticity subsequent to peripheral nerve reconstruction plays an important role in the functional recovery of limbs, which has attracted increasing concerns. The present study aimed to overview recent progress in neuroregeneration-related brain plasticity. Nerve transfer is a special technique of nerve reconstruction that usually leads to substantial peripheral neural rewiring and cortical reorganization. Nerve transfer-related shifting of motor representation was particularly discussed. We also emphasized rehabilitation strategies based on the current peripheral-central rewiring theory. Specific strategies based on neural plasticity were proposed for corresponding recovery stages.

Effects of Acupuncture in the Treatment of Dogs with Neurological Sequels of Distemper Virus

Acupuncture (AP) has been empirically used to relieve post-canine distemper virus (CDV) infection neurological signs in veterinary clinics. This clinical study aimed to investigate the effects of AP combined with electroacupuncture (EA) on neurological function in dogs infected by CDV. Twenty-four CDV-infected dogs with neurological sequelae were recruited to receive weekly AP/EA sections for 24 weeks. Neurological improvements were assessed before each AP/EA session using a modified scoring system. Data were analyzed using the McNemar test, Friedman test, Fisher's exact test, and Kaplan-Meier curves (p < 0.05). Neurological scores improved from seven to 24 weeks after AP/EA treatment compared with pretreatment scores (p < 0.001). Significant improvements were recorded over time for functional limb recovery, cranial nerve deficits, mental status (p = 0.025 - 0.014), and urinary function (p < 0.001). Myoclonus was improved and entirely reversed in 75% and 25% of the dogs, respectively. At the end of treatment, the proportion of dogs with normal proprioception, posture, hopping (p < 0.001), and superficial pain sensation responses (p = 0.004) was greater than pretreatment values. AP/EA therapy promoted significant neurological recovery in CDV-infected dogs and may be considered within the chronic phase of the disease to improve motor and sensory rehabilitation. However, these results are preliminary and must be confirmed by further investigations.

Evaluation of Application Effect of Self-Made Compression Cold Therapy in Postoperative Rehabilitation of Patients with Orthopedic Dyskinesia.

With the accelerated aging of the population, orthopedic injuries have become more collective. Among them, the incidence of ankle fractures remains high. Surgery is an effective way to treat ankle fractures by utilizing special surgical site, complex anatomical structure, and specific surgical methods. With surgical approach, it is easy for basis postoperative blood loss, pain, swelling, and other problems. After surgery, most patients suffer from symptoms of fear, increased pain sensitivity, and excessive irrational concerns about physical movement or activity. Compression cold therapy combines cold therapy with air pressure therapy to ease local exudation, constrict blood vessels, improve circulation, relieve pain, and control inflammation through the effects of low temperature and pressure. Application during the rehabilitation period can prevent joint swelling, reduce muscle soreness, and promote the functional recovery of limbs, which provides an effective guarantee for postoperative rehabilitation of patients with orthopedic dyskinesia. Based on this, it is very important to evaluate the application and effect of self-made compression cold therapy in postoperative rehabilitation of patients with orthopedic dyskinesia. This work proposes a one-dimensional deep convolutional neural network-based method; DenseNet for analyzing the rehabilitation effect of patients with orthopedic dyskinesia after ankle fracture surgery. The approach is to evaluate the rehabilitation effect of self-made compression cold therapy from the perspectives of feature reuse, attention mechanism, and feature decoupling. Experiments on the dataset show that the proposed neural network has better efficacy evaluation performance. The proposed systematic assessment based on the emerging deep learning network has great significance in healthcare domain, particularly in assessing applicability, side effects, and noninvasiveness of treatment methods.

Positive Role of Standardized Nursing Management on Limb Function after Breast Cancer Surgery

Objective: This study aims to analyze and observe the rehabilitation nursing outcome in the functional recovery of limbs after breast cancer surgery using standardized nursing management measures. Methods: A total of 100 patients underwent breast cancer surgery in our hospital were divided into two groups according to the digital method, among which the control group adopted the conventional hospital method while the nursing group implemented the standardized nursing management on the basis of the treatment of control group. The changes of clinical efficacy have been evaluated in patients between the two groups. Results: Compared with the control group, the overall response rate and satisfaction showed a rising trend in the nursing group. The scores of limb function increased obviously and the improvement was evident. The difference was significant ( P <0.05) between the two groups. Conclusion: The outcome of the standardized nursing management is good on limb function recovery after breast cancer surgery. It has actively improved the quality of life of patients and is worthy of clinical promotion.

Nerve gaps repaired with acellular nerve allografts recellularized with Schwann-like cells: Preclinical trial

Acellular nerve allografts (ANA) recellularized with mesenchymal stem cells (MSC) or Schwann cells (SC) are, at present, a therapeutic option for peripheral nerve injuries (PNI). This study aimed to evaluate the regenerative and functional capacity of a recellularized allograft (RA) compared with autograft nerve reconstruction in PNI. Fourteen ovines were randomly included in two groups (n=7). A peroneal nerve gap 30 mm in length was excised, and nerve repair was performed by the transplantation of either an autograft or a recellularized allograft with SC-like cells. Evaluations included a histomorphological analysis of the ANA, MSC pre differentiated into SC-like cells, at one year follow-up functional limb recovery (support and gait), and nerve regeneration using neurophysiological tests and histomorphometric analysis. All evaluations were compared with the contralateral hindlimb as the control. The nerve allograft was successfully decellularized and more than 70% of MSC were pre differentiated into SC-like cells. Functional assessment in both treated groups improved similarly over time (p <0.05). Neurophysiological results (latency, amplitude, and conduction velocity) also improved in both treated groups at twelve months. Histological results demonstrated a less organized arrangement of nerve fibers (p <0.05) with an active remyelination process (p <0.05) in both treated groups compared with controls at twelve months. ANA recellularized with SC-like cells proved to be a successful treatment for nerve gaps. Motor recovery and nerve regeneration were satisfactorily achieved in both graft groups compared with their contralateral nontreated nerves. This approach could be useful for the clinical therapy of PNI.

Effect of Self-Controlled Exercise on Antioxidant Activity of Red Blood Cells and Functional Recovery of Limbs in Patients with Breast Cancer after Rehabilitation.

Background:We aimed to investigate the effect of self-controlled exercise on the antioxidant activity of red blood cells and the recovery of limb function in patients with breast cancer after rehabilitation.Methods:Overall 130 breast cancer patients admitted to the First Affiliated Hospital of Zhengzhou University, China from Feb 2018 to Jan 2019 were divided into intervention group and control group. The control group received perioperative care and chemotherapy, the intervention group implemented a self-controlled exercise program. Indexes were compared between the two groups before intervention, 3 months and 6 months after intervention.Results:The activity of erythrocyte superoxide dismutase (SOD) in the intervention group was significantly increased in the first 3 months (P=0.030), and decreased from 3rd to 6th month (P=0.033). The glutathione peroxidase (GSH-Px) activity in the intervention group increased through the whole intervention period. The plasma malondialdehyde (MDA) in the intervention group was significantly decreased (P=0.029, 0.012). After intervention for 3 months and 6 months, the 6MND distances in the intervention group were significantly longer (P=0.001, 0.045). The average exercise time in the intervention group were significantly increased (P=0.004, 0.000).Conclusion:Self-controlled exercise can effectively improve the antioxidant ability of red blood cells in patients with breast cancer, improve the mobility of shoulder joints of the affected side and increase their exercise capacity, with good sustainability. It has positive effect on postoperative rehabilitation, could be used in long-term regular clinical work.

Salviae miltiorrhizae radix and puerariae lobatae radix herbal formula improves circulation, vascularization and gait function in a peripheral arterial disease rat model

Ethnopharmacological relevanceDG is a herbal formula, containing the root of Salvia miltiorrhiza Bunge (Danshen) and the root of Pueraria lobate (Willd.) Ohwi (Gegen), has a history of usage in China for cardiovascular protection and anti-atherosclerosis. Aim of the studyThe present study aims to determine the beneficial effect of DG on the hind-limb ischemia rat model which mimics peripheral arterial disease (PAD) and its vasodilative effect on isolated femoral artery. Materials and methodsThe vasodilatory effects were assessed by contractile responses to DG in the isolated femoral artery and its underlying mechanisms were evaluated by the involvement of endothelium, potassium channel and calcium channel. For hind-limb ischemia study, treatment outcomes were assessed by evaluating hind-limb blood flow, functional limb recovery, muscle histology and angiogenesis. ResultsOur results demonstrated positive dose-dependent vasodilatory response to DG via an endothelium-independent mechanism that involved inwardly rectifying K+ channels and Ca2+ channels. We also demonstrated significant improvement in blood perfusion and micro-vessel density in the ischemic limb and positive effects in functional limb recovery. ConclusionIn conclusion, our study supported the potential use of DG as a novel treatment for symptomatic PAD.

Effect of Early and Intensive Rehabilitation after Ischemic Stroke on Functional Recovery of the Lower Limbs: A Pilot, Randomized Trial

Objective: We aimed to develop an early and intense lower extremity training technique using a recumbent cycle ergometer system in patients with acute ischemic stroke. Methods: This was a pilot, prospective, randomized, controlled study with 2 parallel groups followed for 3 months with blinded assessment of outcomes. Thirty-one eligible patients were randomized to experimental and control groups. To strengthen the motion of the lower extremities within 48 hours after stroke, the control and experimental groups received conventional treatment and additional interventions under a therapist's guidance combined with conventional treatment, respectively. The primary outcome measure was the change in lower extremity motor control from admission to 4 weeks, assessed by the Fugl-Meyer Assessment. Secondary outcomes were the number of days to walking 50 m and the change in the Berg Balance Scale score and Barthel index. The modified Rankin Score was used to assess the overall function and prognosis at 3 months. Results: Fugl-Meyer Assessment and Berg Balance Scale scores and Barthel index increased over time in the experimental group, as did the Berg Balance Scale score and Barthel index in the control group (P < .001). However, Fugl-Meyer Assessment scores in the control group were similar over time (F = 2.303, P = 1.119). Fugl-Meyer Assessment scores in the experimental group were higher than those in the control group after 2 and 4 weeks (P = .084 and .037, respectively). Compared with the control group at 2 weeks or at discharge, the percentage of patients who returned to unassisted walking in the experimental group showed an increasing trend (56.3% versus 26.67%, P = .095), but there was no significant difference between the 2 groups after 3 months (P = .598). The modified Rankin Score at 3 months showed no significant difference between the 2 groups (P > .05). Conclusions: Our early and intense lower extremity training technique involving a leg cycle ergometer system contributes to the recovery of lower extremity function in patients with acute ischemic stroke. This finding will provide a basis for future investigations on the applicability of the intervention in early lower extremity and walking rehabilitation among individuals with neurological disorder.

Characteristics of Upper Extremity Recovery in Acute Flaccid Myelitis: A Case Series.

Clinical characteristics and timing associated with nonsurgical recovery of upper extremity function in acute flaccid myelitis are unknown. A single-institution retrospective case series was analyzed to describe clinical features of acute flaccid myelitis diagnosed between October of 2013 and December of 2016. Patients were consecutively sampled children with a diagnosis of acute flaccid myelitis who were referred to a hand surgeon. Patient factors and initial severity of paralysis were compared with upper extremity muscle strength outcomes using the Medical Research Council scale every 3 months up to 18 months after onset. Twenty-two patients with acute flaccid myelitis (aged 2 to 16 years) were studied. Proximal upper extremity musculature was more frequently and severely affected, with 56 percent of patients affected bilaterally. Functional recovery of all muscle groups (≥M3) in an individual limb was observed in 43 percent of upper extremities within 3 months. Additional complete limb recovery to greater than or equal to M3 after 3 months was rarely observed. Extraplexal paralysis, including spinal accessory (72 percent), glossopharyngeal/hypoglossal (28 percent), lower extremity (28 percent), facial (22 percent), and phrenic nerves (17 percent), was correlated with greater severity of upper extremity paralysis and decreased spontaneous recovery. There was no correlation between severity of paralysis or recovery and patient characteristics, including age, sex, comorbidities, prodromal symptoms, or time to paralysis. Spontaneous functional limb recovery, if present, occurred early, within 3 months of the onset of paralysis. The authors recommend that patients without signs of early recovery warrant consideration for early surgical intervention and referral to a hand surgeon or other specialist in peripheral nerve injury. Risk, III.

Comparison of four different internal fixation methods in the treatment of distal clavicle fractures

This study compared the clinical efficacy of four internal fixation methods in the treatment of distal clavicle fractures, in an effort to guide appropriate selection and application in the clinic. Eighty-four patients with distal clavicle-comminuted fractures were treated with a distal clavicle anatomic plate (group A), clavicular hook plate (group B), double-plate vertical fixation (group C), or T-shaped steel plate internal fixation (group D). The Constant-Murley scoring system was used to evaluate the shoulder joint function. The fracture healing time, VAS, and postoperative complications were compared and analyzed among the four groups. According to the Constant-Murley evaluation standard, the excellent and good rates of the four groups were 94.4, 73.1, 95 and 80% in groups A-D, respectively. The excellent and good rates of Constant-Murley evaluation standard in groups A and C were significantly better than those in groups B and D (P<0.05). VAS in the distal clavicle anatomic plate group (group A), double-plate vertical fixation group (group C), and T-shaped steel plate internal fixation group (group D) were significantly better than the clavicular hook plate group (group B) (P<0.05). The incidence of postoperative complications in the clavicular hook plate group (group B) was 15.4% and in the T-shaped steel plate internal fixation group (group D) was 15%, which were significantly higher than those of the distal clavicle anatomic plate group (group A) and double-plate vertical internal fixation group (group C) (P<0.05). The treatment of distal clavicle fractures using either one of the four internal fixation techniques can obtain better clinical results. The distal clavicle anatomic plate and double-plate vertical internal fixation techniques are associated with a decreased incidence of shoulder pain, an increase in the range of motion of the shoulder, and a reduction in complications, and thus, are preferable for the early functional recovery of limbs.

Traumatic brachial plexus injury: a study of 510 surgical cases from multicenter services in Guangxi, China.

Traumatic brachial plexus injuries are severe lesions, and the incidence of these injuries has been increasing in recent years. The clinical data of 510 operated patients with brachial plexus injury recruited from 74 hospitals in Guangxi from 2004 to 2016 were retrospectively studied. Our study included 447 males and 63 females, with an average age of 29.04years. Traffic accidents were the most common cause of injury (64.71%), especially motorcycle accidents. Closed injuries accounted for 88.24% of cases, and 83.53% of patients had associated injuries, the most common of which were fractures (76.27%). The preoperative predictive value of root injury of MRI and CT was 74.71% and 71.28%, respectively. 44.71% of patients underwent an initial operation within 6months after the trauma. Regarding the surgery, neurolysis alone, brachial plexus reconstruction, and free functioning gracilis graft accounted for 16.67%, 75.50%, and 4.51%, respectively. A total of 415 patients were followed up with an average time of 47.95 (25-68) months, and anxiety or depression were found among 81.20% of them. Two hundred seventy-six patients suffered from nerve pain, with mild pain present in 67.03% of patients. Additionally, 347 patients were followed up for more than 3years, 76.81% of patients with C5-C6 injury recovery to useful function, and the procedure of neurolysis alone demonstrated the best efficacy (79.45%). Brachial plexus injury is still a challenging trauma for surgeons, and traffic accidents are the dominant cause. Timely and effective surgery is important for functional limb recovery.

Melatonin protects mesenchymal stem cells from autophagy-mediated death under ischaemic ER-stress conditions by increasing prion protein expression.

ObjectThe purpose of this study was to explore whether melatonin could protect mesenchymal stem cells (MSCs) against ischaemic injury, by inhibiting endoplasmic reticulum (ER) stress and autophagy both in vivo and in vitro.Materials and MethodsTo confirm the protective effect of melatonin against ER stress in MSCs, markers of cell viability, apoptosis and autophagy were analysed. To further investigate the regenerative effect of melatonin‐treated MSCs in ischaemic tissues, a murine hindlimb ischaemic model was established.ResultsUnder oxidative stress conditions, treatment with melatonin suppressed the activation of ER stress–associated proteins and autophagy‐associated proteins acting through upregulation of cellular prion protein (PrPC) expression. Consequently, inhibition of apoptotic cell death occurred. Melatonin also promoted the activation of MnSOD and catalase activities in MSCs. In a murine hindlimb ischaemia model, melatonin‐treated MSCs also enhanced the functional limb recovery as well as neovascularization. These beneficial effects of melatonin were all blocked by knock‐down of PrPC expression.ConclusionMelatonin protects against ER stress/autophagy‐induced apoptotic cell death by augmenting PrPC expression. Thus, melatonin‐treated MSCs could be a potential cell‐based therapeutic agent for ER stress–induced ischaemic diseases, and melatonin‐induced PrPC might be a key molecule in ameliorating ER stress and autophagy.

Research on clinical nursing path in application of VSD technology in patients in hand and foot surgery

Objective To explore the effects of clinical nursing path implement in patients with VSD technology applications.Methods We selected 82 patients with hand-foot skin defect who were treated by VSD technology applications in 2011 as the control group,and they were given routine nursing care for postoperative.Then selected 90 patients with hand-foot skin defect who were treated by VSD technology applications in 2012 as the experimental group,they were implemented with clinical nursing pathway for postoperative.We observed and compared functional exercise adherence,health education awareness rate,satisfaction and average length of stay in patients of two groups after nursing care.Results The average length of stay (16.5 days)in experimental group was apparently less than that in control group (19.5 days); the functional exercise adherence was 97.7 ％in experimental group,apparently higher than that in control group (89％); the health education awareness rate 96.8 ％ was apparently higher than that in control group (87.5 ％); the satisfaction 99.1％ in experimental group was apparently higher than that in control group (90％),there was obviously statistical significant difference between both groups (P ＜ 0.05).Conclusion Carrying out clinical nursing pathway for the patients with handfoot skin defect who were treated by VSD technology applications could improve patients' satisfaction and health education awareness rate,improve work efficiency and quality of nursing care,furthermore,shorten hospital stays,reduce hospital costs,and promote functional recovery of limb for patients. Key words: Clinical nursing pathway; VSD technology; Quality of nursing

Fulminant Aeromonas hydrophila infection during acute lymphoblastic leukemia treatment

Aeromonas hydrophila septicemia has a fulminant course and it has been usually reported in immunocompromised hosts and rarely among children with leukemia. High morbidity and mortality is associated with A hydrophila infections. We describe the case of a child with acute lymphoblastic leukemia who presented with septicemia due to A hydrophila. The patient presented with fever and skin discoloration during a febrile neutropenia episode, which rapidly evolved into bacteremia and extensive thigh suppuration, fasciitis, and myonecrosis. Apart from antibiotic treatment, surgical debridement to relieve compartment pressure and prevent further lower extremity compromise was promptly performed. Despite long delays in chemotherapy and an extensive tissue gap, primary closure of the involved area was possible with full cosmetic and functional limb recovery, and the patient has remained in clinical remission for more than 7 years.

Repair of nerve defect with acellular nerve graft supplemented by bone marrow stromal cells in mice

The acellular nerve graft that can provide internal structure and extracellular matrix components of the nerve is an alternative for repair of peripheral nerve defects. However, results of the acellular nerve grafting for nerve repair still remain inconsistent. This study aimed to investigate if supplementing bone marrow mesenchymal stromal cells (MSCs) could improve the results of nerve repair with the acellular nerve graft in a 10-mm sciatic nerve defect model in mice. Eighteen mice were divided into three groups (n = 6 for each group) for nerve repairs with the nerve autograft, the acellular nerve graft, and the acellular nerve graft by supplemented with MSCs (5 × 10(5)) fibrin glue around the graft. The mouse static sciatic index was evaluated by walking-track testing every 2 weeks. The weight preservation of the triceps surae muscles and histomorphometric assessment of triceps surae muscles and repaired nerves were examined at week 8. The results showed that the nerve repair by the nerve autografting obtained the best functional recovery of limb. The nerve repair with the acellular nerve graft supplemented with MSCs achieved better functional recovery and higher axon number than that with the acellular nerve graft alone at week 8 postoperatively. The results indicated that supplementing MSCs might help to improve nerve regeneration and functional recovery in repair of the nerve defect with the acellular nerve graft.

Observation and nursing for children with cerebral palsy by cerebrovascular function treatment

Objective To investigate the curative effect and nursing of children with cerebral palsy treated by cerebrovascular function treatment(CVFT).Methods Children with cerebral palsy(56 cases)were divided into the therapy group and the control group.They all received rehabilitation training and medication.The therapy group were treated with CVFT based upon routine treatmenL Results The effective rate in the thempy group was 96.5% and was 77.8% in the control group.There were statistical difference between the two groups(P＜0.05).Conclusions CVFY can improve the cerebral circulation,advance the blood-supply and oxygen-supply of injured cerebral tissue,alleviate the putrescence of cerebral tissue,accelerate the functional recovery of limbs of children with cerebral palsy,shorten the course of disease and improve the quality of children's life. Key words: Children with cerebral palsy; Cerebrovascular function treatment; Effect observation; Nursing