Permanent Nerve Damage Research Articles

Long-Term Treatment with Bortezomib Induces Specific Methylation Changes in Differentiated Neuronal Cells.

Simple SummaryWe exposed LUHMES cells, differentiated into mature neurons, to bortezomib (BTZ) in two treatment cycles and analyzed the methylomes of these cells after each cycle, controlling the analysis for the methylation changes potentially induced by the long-term culture. Our results show that BTZ induces methylation changes that may affect cell morphogenesis, neurogenesis, and neurotransmission. These changes are specifically enriched within transcription factor binding sites of EBF, PAX, DLX, LHX, and HNF family members, which have been shown to regulate neurogenesis and neuronal differentiation. We further show that the observed methylation changes are not present in the SH-SY5Y cells that we used to study mechanisms of development of BTZ resistance. Altogether, our results show that BTZ treatment induces very specific changes in the methylomes of neuronal cells.Bortezomib (BTZ) is proteasome inhibitor, effectively used in the treatment of multiple myeloma, but frequently discontinued due to peripheral neuropathy, which develops in patients after consecutive treatment cycles. The molecular mechanisms affected by BTZ in neuronal cells, which result in neuropathy, remain unknown. However, BTZ is unlikely to lead to permanent morphological nerve damage, because neuropathy reverses after discontinuation of treatment, and nerve cells have very limited renewal capacity. We have previously shown that BTZ induces methylation changes in SH-SY5Y cells, which take part in the development of treatment resistance. Here, we hypothesized that BTZ affects the methylomes of mature neurons, and these changes are associated with BTZ neurotoxicity. Thus, we studied methylomes of neuronal cells, differentiated from the LUHMES cell line, after cycles of treatment with BTZ. Our results show that BTZ induces specific methylation changes in mature neurons, which are not present in SH-SY5Y cells after BTZ treatment. These changes appear to affect genes involved in morphogenesis, neurogenesis, and neurotransmission. Furthermore, identified methylation changes are significantly enriched within binding sites of transcription factors previously linked to neuron physiology, including EBF, PAX, DLX, LHX, and HNF family members. Altogether, our results indicate that methylation changes are likely to be involved in BTZ neurotoxicity.

Long‐term Anesthesia in the Mexican Axolotl Salamander

Research animals are routinely anesthetized for varying durations of time and using different anesthetics. However, the anesthesia is usually limited to the duration of surgical procedures or other interventions usually lasting no more than a few hours.Establishing a long‐term anesthetic model in regenerative competent species, such as the Mexican axolotl, would allow for better estimations of physiological parameters during regeneration as the behavioral aspect is detached. As such, we aim for an anesthetic duration of 60 days, a period of time compatible with regeneration of limb amputations as well as heart and spinal cord injury. In this study, axolotls were anesthetized using propofol for increasing periods of time starting with 24 hours and gradually increasing to 7, 12 and 26 days.During this study, parameters such as oxygen consumption, echocardiography and body mass was assessed. After anesthesia, activity level, response to tactile and nociceptive stimuli, and recovery time was examined to ensure no lasting effect of long‐term anesthesia. Long‐term anesthesia was associated with a significant, but reversible, reduction in oxygen consumption (approximately 50%) and a significant increase in body mass despite fasting. Anesthetic periods exceeding 7 days in hypoosmotic medium like tap water were associated with complications including severe swelling and even death, but these complications were alleviated using isosmotic medium. Tactile and nociceptive stimulation was scored on a scale from 1 to 3 prior to anesthesia. No significant change in response was detected following anesthesia demonstrating that no permanent nerve damage had occurred. Axolotls showed a reversible decrease in activity levels following an anesthetic period with levels returning to baseline within a week of recovery.In conclusion, this study shows that axolotls can be anesthetized for extended periods of at least 26 days presenting new possibilities for future experiments in which long‐term anesthesia or immobilization is preferable. Additionally, stable long‐term anesthesia paves the way for non‐recovery experiments and more severe interventions as animals can be kept anesthetized for the duration.

Towards a More Realistic Appraisal of Complications Following Staged Lateral Lumbar Interbody Fusion: A Single Institution Series.

Retrospective cohort study. With steadily increasing implementation of far lateral approaches in spine surgery, surgeons can utilize the advantages of different approaches synergistically to ensure an optimal patient outcome. Our single institution study aimed to assess the complication rates of patients who underwent a lateral interbody fusion as the index procedure and additional anterior or posterior instrumentation as part of a planned staged surgical reconstruction effort. This study was approved by our institutional review board (STUDY2021000113). We included 576 patients who received a lateral lumbar interbody fusion (LLIF) as the index procedure followed by transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF) or anterior lumbar interbody fusion (ALIF) between 2016 and 2020. Primary outcomes were complications identified during the initial inpatient stay, which were categorized into approach-related and secondary complications. Secondary outcomes tracked up to 6 years post-surgery. The overall complication rate was 19.2% (10.5% approach related, 8.7% secondary complications). Significant intraoperative hemorrhage (mean 659.3mL vs 131.4mL, P < .01) was the most common approach related complication with an incidence of 4%, followed by temporary hip flexor weakness in 2.6%. A permanent (femoral) nerve damage was verified in 1 patient. The most common secondary complication was impaired wound healing in 12 patients (2.1%). We identified a 7.1% (41 of 576 patients) rate of revision surgery, on average after 372 days (±34 days). We recorded an overall complication rate of 19.2% for staged adult deformity corrective surgeries utilizing far lateral interbody fusions at several lumbar levels followed by a more comprehensive posterior surgical reconstruction.

Efficacy of Ultrasound-Guided Particulate Versus Nonparticulate Steroid Injection in Carpal Tunnel Syndrome: An Open-Label Randomized Control Trial.

IntroductionPerineural corticosteroid injection is an extensively used and accepted treatment for carpal tunnel syndrome (CTS). However, to this date, there is no guideline as to which corticosteroid has to be used as the standard treatment for CTS. Triamcinolone acetonide is a commonly used particulate steroid that can cause permanent nerve injury if it is accidentally injected into the nerve. Conversely, dexamethasone sodium phosphate is a nonparticulate steroid that would not cause permanent nerve damage following accidental injection.MethodsMild to moderate cases of CTS, confirmed by nerve conduction studies (NCS), with symptoms greater than three months were recruited. The participants received one session of ultrasound-guided perineural injection by the in-plane axial ulnar-sided approach with 4 mL of either dexamethasone (dexamethasone sodium phosphate 8 mg (2 mL) + 2 mL 0.5% bupivacaine) or triamcinolone (triamcinolone acetonide 40 mg/mL (1 mL) + 2 mL 0.5% bupivacaine + 1 mL normal saline) solution. The parameters assessed were Phalen’s test time (in seconds), visual analog scale (VAS), and Boston carpal tunnel questionnaire (BCTQ) scores at baseline and two and four months, and NCS changes in sensory nerve conduction velocity (SNCV) and distal motor latency (DML) of the median nerve at baseline and four months. Statistical analysis was conducted using the software SPSS version 26.0 (IBM Corporation, Armonk, NY, USA). Independent samples t-test was used for comparison between groups and the paired t-test for improvement within each group. P values < 0.05 were considered statistically significant.ResultsThe mean age was 42.64 ± 10.99 in the dexamethasone and 45.22 ± 10.602 in the triamcinolone group cases (P = 0.324).There were 58 females (84.06%) and 11 males (15.94%). Each of Phalen’s test time, VAS, and BCTQ scores significantly improved within both dexamethasone and triamcinolone groups at the second and fourth months after injection (P < 0.05). The NCS parameters (SNCV and DML) also significantly improved in both groups at the fourth month after the injection (P < 0.05). However, there were no significant differences in the improvement of Phalen’s test time between the two groups (P = 0.745), VAS score (P = 0.319), BCTQ score (P = 0.137), SNCV (P = 0.511), or DML (P = 0.753). Postprocedural pain lasted significantly longer in the triamcinolone group (P < 0.05). No major complications were noted in either of the two groups.ConclusionDexamethasone is as effective as triamcinolone in improving the symptoms of CTS and can be used as a safer and more effective alternative in the treatment of mild to moderate CTS cases.

Pengaruh Metode Mc Kenzie Exercise dan Core Stability Exercise terhadap Penurunan Nyeri pada Penderita Hernia Nucleus Pulposus

Hernia Nucleus Pulposus (HNP) is one of the causes of lower back pain due to heavy mechanical loads for a long time. HNP if not treated immediately it can cause fluid buildup and swelling that can cause permanent nerve damage. This study is a quantitative study with a quasi-experimental pre-test-post-test design with a control group divided into 3 groups. The sampling technique was using probability sampling method as many as 30 respondents who visited Grandmed Lubuk Pakam Hospital. The results of the statistical test showed that there was an effect of McKenzie and Core Stability Exercise on reducing pain in patients with HNP with a p value of 0.020 &lt;0.05.

Management of Missile Injuries of the Knee

Background and Objectives: Iraq continues to be a troublesome area, missile injuries around the large joints of the extremity remains to be a challenging injury to the under resourced and poorly equipped unsafe hospitals. The aim of this study is to report our experience in the management of such injuries. patients and methods: Thirteen patients (14 knees) with grade III Gustillo open fractures of the knee caused by war injury including bullets, shells of blast and missiles were treated by wound debridement, washout, repair of arterial injury after external or internal fixation of the fracture. Five patients (38%) required Dacron arterial graft for associated vascular injury, there was a case of permanent nerve damage (7%). Results: The outcome was satisfactory in 6 patients (46%), fair in five (38%) and poor in the remaining (16%). One limb remained was ischemic; one case of infection required amputation. These patients underwent wound debridement, skeletal fixation and vascular and or plastic reconstruction. Conclusion: There is high association of open war injuries of the knee with neurovascular injuries. Awareness of the associated vascular injury and team approach, is vital in the management of these injuries. Skeletal stabilization using any method deem to be appropriate is associated with good outcome provided appropriate early wound debridement is performed.

Neutrophil NETworking in ENL: Potential as a Putative Biomarker: Future Insights.

Erythema nodosum leprosum (ENL), also known as type 2 reaction (T2R) is an immune complex mediated (type III hypersensitivity) reactional state encountered in patients with borderline lepromatous and lepromatous leprosy (BL and LL) either before, during, or after the institution of anti-leprosy treatment (ALT). The consequences of ENL may be serious, leading to permanent nerve damage and deformities, constituting a major cause of leprosy-related morbidity. The incidence of ENL is increasing with the increasing number of multibacillary cases. Although the diagnosis of ENL is not difficult to make for physicians involved in the care of leprosy patients, its management continues to be a most challenging aspect of the leprosy eradication program: the chronic and recurrent painful skin lesions, neuritis, and organ involvement necessitates prolonged treatment with prednisolone, thalidomide, and anti-inflammatory and immunosuppressive drugs, which further adds to the existing morbidity. In addition, the use of immunosuppressants like methotrexate, azathioprine, cyclosporine, or biologics carries a risk of reactivation of persisters (Mycobacterium leprae), apart from their own end-organ toxicities. Most ENL therapeutic guidelines are primarily designed for acute episodes and there is scarcity of literature on management of patients with chronic and recurrent ENL. It is difficult to predict which patients will develop chronic or recurrent ENL and plan the treatment accordingly. We need simple point-of-care or ELISA-based tests from blood or skin biopsy samples, which can help us in identifying patients who are likely to require prolonged treatment and also inform us about the prognosis of reactions so that appropriate therapy may be started and continued for better ENL control in such patients. There is a significant unmet need for research for better understanding the immunopathogenesis of, and biomarkers for, ENL to improve clinical stratification and therapeutics. In this review we will discuss the potential of neutrophils (polymorphonuclear granulocytes) as putative diagnostic and prognostic biomarkers by virtue of their universal abundance in human blood, functional versatility, phenotypic heterogeneity, metabolic plasticity, differential hierarchical cytoplasmic granule mobilization, and their ability to form NETs (neutrophil extracellular traps). We will touch upon the various aspects of neutrophil biology relevant to ENL pathophysiology in a step-wise manner. We also hypothesize about an element of metabolic reprogramming of neutrophils by M. leprae that could be investigated and exploited for biomarker discovery. In the end, a potential role for neutrophil derived exosomes as a novel biomarker for ENL will also be explored.

An Update on Peroneal Nerve Entrapment and Neuropathy.

Peroneal neuropathy is the most common compressive neuropathy of the lower extremity. It should be included in the differential diagnosis for patients presenting with foot drop, the pain of the lower extremity, or numbness of the lower extremity. Symptoms of peroneal neuropathy may occur due to compression of the common peroneal nerve (CPN), superficial peroneal nerve (SPN), or deep peroneal nerve (DPN), each with different clinical presentations. The CPN is most commonly compressed by the bony prominence of the fibula, the SPN most commonly entrapped as it exits the lateral compartment of the leg, and the DPN as it crosses underneath the extensor retinaculum. Accurate and timely diagnosis of any peroneal neuropathy is important to avoid progression of nerve injury and permanent nerve damage. The diagnosis is often made with physical exam findings of decreased strength, altered sensation, and gait abnormalities. Motor nerve conduction studies, electromyography studies, and diagnostic nerve blocks can also assist in diagnosis and prognosis. First-line treatments include removing anything that may be causing external compression, providing stability to unstable joints, and reducing inflammation. Although many peroneal nerve entrapments will resolve with observation and activity modification, surgical treatment is often required when entrapment is refractory to these conservative management strategies. Recently, additional options including microsurgical decompression and percutaneous peripheral nerve stimulation have been reported; however, large studies reporting outcomes are lacking.

Complications and Effects of Dorsal Root Ganglion Stimulation in the Treatment of Chronic Neuropathic Pain: A Nationwide Cohort Study in Denmark

ObjectivesDorsal root ganglion (DRG) stimulation is a novel treatment of chronic neuropathic pain and has been shown to be efficacious across several case reports and randomized trials. However, long-term follow-up is limited, as are reports of complication rates. This study presents efficacy and complications for patients treated with DRG stimulation. Materials and MethodsWe performed an observational, multicenter cohort study of all patients in Denmark implanted with FDA-approved DRG stimulation systems to treat chronic, neuropathic pain between 2014 and 2018. Follow-up period was one to three years. ResultsForty-three patients underwent trial DRG stimulation; 33 were subsequently fully implanted. Pain location: 58% lower extremity; 21% upper extremity; 21% thoracic/abdominal. At the end of the observation period, 58% of fully implanted patients were still implanted; 42% had fully functional systems.In these patients, average Numerical Rating Scale (NRS)-score of pain was reduced from 6.8 to 3.5 (p = 0.00049) and worst NRS-score was reduced from 8.6 to 6.0 (p = 0.0039) at 12 months follow-up. Pain Catastrophizing Score was reduced from 32 to 15 (p = 0.0039).Thirteen patients experienced complications related to defect leads (39% of implanted systems). In four patients (12%), lead removal left fragments in the root canal due to lead fracture, and three patients suffered permanent nerve damage during attempts to replace broken leads. ConclusionsThis study suggests a significant, clinically relevant effect of DRG stimulation on neuropathic pain, but also demonstrates substantial problems with maintenance and revision of currently available systems. Consequently, treatment with equipment marketed specifically for DRG stimulation is currently paused in Denmark.

Combined cervicosternotomy and cervicotomy for true retrosternal goiters: a surgical cohort study

ObjectiveIntrathoracic goiters are a heterogeneous group characterized by limited or extensive substernal extension. Whereas the former can be treated through cervicotomy, the latter sometimes requires a cervicosternotomy. Whether cervicosternotomy leads to more morbidity remains unclear.This study aimed to compare intra- and postoperative morbidity in patients treated by cervicotomy or cervicosternotomy for intrathoracic goiters and standard thyroidectomy.MethodsIn a prospectively gathered cohort undergoing thyroid surgery (2010–2019) intra- and postoperative morbidity of cervicotomy (N = 80) and cervicosternotomy (N = 15) for intrathoracic goiters was compared to each other and to a ‘standard’ thyroidectomy (N = 1500).ResultsAn intrathoracic extension prior to surgery was found in 95 (6%) of all thyroidectomies. Eighty patients (84%) were operated by cervicotomy and 15 (16%) by cervicosternotomy. The risk of temporary recurrent laryngeal nerve palsy was much higher in the cervicosternotomy group (21%) compared to cervicotomy (4%) and standard thyroidectomy (3%). The risk of temporary hypocalcemia after cervicotomy (28%) was comparable to a standard thyroidectomy (32%) but higher after cervicosternotomy (20%). No cases of permanent hypocalcemia or laryngeal nerve palsy were observed in both groups with substernal extension. The need for surgical reintervention was significantly higher in the cervicotomy group (6%) compared to cervicosternotomy (0%) and standard thyroidectomy (3%).ConclusionIn patients undergoing thyroid surgery for an intrathoracic goiter, cervicosternotomy was associated with more temporary laryngeal nerve palsy, but none of the interventions resulted in higher risks of permanent nerve damage, permanent hypocalcemia, or reintervention for bleeding. Reintervention was even more common after cervicotomy compared to cervicosternotomy.Level of evidenceIV

NEUROLOGICAL IMPROVEMENT AFTER SURGICAL TREATMENT OF INTRADURAL SCHWANNOMA T9-10 WITH PARAPLEGIA INFERIOR — A CASE REPORT

Schwannoma is a peripheral nerve sheath tumor, a benign tumor that grows slowly from neural fairy cells in the nerve sheath. These tumors can cause neurological deficits because of their intradural location and suppress the spinal cord so it needs to be decompressed to prevent permanent nerve damage. We reported one case of intradural thoracal schwannoma with a neurologic deficit of paraplegia inferior. We have performed a laminectomy — posterior durotomy and tumor excision with a posterior approach without intraoperative monitoring. The result is a return of motoric and sensory improvement. The patient was satisfied with the result.

Median nerve swelling is an independent risk factor of carpal tunnel syndrome in chronic hemodialysis patients

Carpal tunnel syndrome (CTS) has a wide variety of underlying causes and occurs in association with dialysis. Early diagnosis is essential to prevent permanent nerve damage and functional sequelae. We evaluated the association between CTS and cross-sectional area (CSA) of the median nerve in chronic hemodialysis (HD) patients. Patients with end-stage renal disease (ESRD) on maintenance HD via arteriovenous fistula were enrolled. We divided forty-three patients into two groups; patients diagnosed with CTS (n=19) and patients without CTS (n=24). The median nerve CSA was measured at the wrist (CSA-W) and forearm (CSA-F) by ultrasonography. Median nerve swelling was assessed by the wrist-to-forearm ratio (WFR). There were no significant differences in the underlying causes of CKD and adequacy of dialysis between the two groups (P = NS). The patients with CTS showed significantly higher WFR than the patients without CTS (P = 0.001). Univariate Cox regression analysis revealed that WFR > 1.25 (odds ratio, 6.30; 95% confidence interval, 1.44 to 27.45; P = 0.014) was associated with CTS in HD patients. The factors traditionally associated with CTS such as age, sex, diabetes, vintage of HD, β2-MG, intact PTH and Kt/V were not associated with CTS. After adjustment for age and sex, we found a strong correlation between CTS and the WFR > 1.25 (odds ratio, 10.8; 95% confidence interval, 1.85 to 62.4; P = 0.008). High WFR was associated with the development of CTS, and median nerve swelling was an independent risk factor of CTS in chronic HD patients. (Pusan National University Yangsan Hospital Review Board IRB No. 05-2015-137). This article is protected by copyright. All rights reserved.

Degenerative Cervical Myelopathy: Insights into Its Pathobiology and Molecular Mechanisms.

Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy (CSM), is the most common and serious neurological disorder in the elderly population caused by chronic progressive compression or irritation of the spinal cord in the neck. The clinical features of DCM include localised neck pain and functional impairment of motor function in the arms, fingers and hands. If left untreated, this can lead to significant and permanent nerve damage including paralysis and death. Despite recent advancements in understanding the DCM pathology, prognosis remains poor and little is known about the molecular mechanisms underlying its pathogenesis. Moreover, there is scant evidence for the best treatment suitable for DCM patients. Decompressive surgery remains the most effective long-term treatment for this pathology, although the decision of when to perform such a procedure remains challenging. Given the fact that the aged population in the world is continuously increasing, DCM is posing a formidable challenge that needs urgent attention. Here, in this comprehensive review, we discuss the current knowledge of DCM pathology, including epidemiology, diagnosis, natural history, pathophysiology, risk factors, molecular features and treatment options. In addition to describing different scoring and classification systems used by clinicians in diagnosing DCM, we also highlight how advanced imaging techniques are being used to study the disease process. Last but not the least, we discuss several molecular underpinnings of DCM aetiology, including the cells involved and the pathways and molecules that are hallmarks of this disease.

Cardio-vocal Syndrome as a Complication Patient with Severe Mitral Regurgitation and Moderate Aortic Regurgitation with Pulmonary Hypertension

ABSTRACT Hoarseness due to paralysis of vocal cord, as in Cardio-vocal syndrome, is caused by mechanical affection of left recurrent laryngeal nerve from enlarged cardiovascular structures. Mitral valve prolapse is rarely found to cause this syndrome. Case report presenting a 47 years old male visited the outpatient department with a clinical history of dyspnea and hoarseness since a year ago. Physical examination revealed late systolic murmur in apex and low-grade diastolic murmur in right second intercostal space. Echocardiography confirmed severe mitral regurgitation due to flail anterior mitral valve leaflet with severe left atrium dilatation (9.0 cm) and moderate aortic regurgitation due to mal-coaptation of aortic valves. Laryngoscopy revealed an immobile left vocal cord. He underwent successful double valve replacement after three months follow up the patient showed improvement of hoarseness. The incidence of Cardio-vocal syndrome in mitral valve disease varies from 0.6% to 5%. In cases diagnosed with thoracic disease, paralysis of the left vocal cord was reported 1.75 times more frequent than the right side. The aim of this case report is we have to aware that Cardio-vocal syndrome is a rare cause of vocal cord paralysis and should be considered as a differential diagnosis of hoarseness, particularly if the patient has a cardiac history. Comprehensive evaluation and prompt treatment may allow reversal of the damage to left recurrent laryngeal nerve. Permanent nerve damage can occur due to late diagnosis. Keywords : Cardio-vocal syndrome, Mitral regurgitation, Aortic RegurgitationCorrespondence : adityobasworo@gmail.com

Thoracic vertebrae spinal brucellosis with formation of epidural abscess

Introduction:China is the largest developing country in the world, and the probability of Brucellosis is high in some areas. The incidence of spondylitis in brucellosis is 2% Mel 53%, and the most common site is the lumbar vertebrae. However, spinal cord compression caused by thoracic vertebrae brucellosis accompanied by epidural abscess is very rare. Methodology: We report a case a 59-year-old female with Brucella antibody test and serum agglutination test (SAT) for Brucella revealed brucella infection. Thoracic vertebrae magnetic resonance imaging (MRI) and computed tomography (CT) scan suggested T6, T7 vertebral destruction and at the same time, it is accompanied by spinal cord compression caused by epidural abscess. Based on preoperative clinical symptoms and auxiliary examination, Thoracic vertebrae spinal brucellosis with formation of epidural abscess suspected. Results: The preoperative symptoms of the patient decreased significantly after surgery. The patient Follow-up for 6 months showed that the pain was relieved, the nerve function recovered obviously, and the patients could walk independently. Conclusion: The formation of epidural abscess is a serious complication of spinal brucellosis, which can lead to permanent nerve damage. We have to make an early diagnosis, and when infection cannot be relieved by conservative treatment, or when neurological dysfunction continues to progress, priority should be given to surgical treatment.

A Case of Uncomplicated Childbirth Causing Permanent Nerve Damage

Lower extremity nerve damage (LEND) from childbirth is considered rare, affecting less than 1% of all births, but it can be severely debilitating. The resulting disability can be permanent. LEND is underreported, underrecognized, and undertreated. Many women suffer this injury and are discharged without a diagnosis, prognosis, consults, or treatment plans. This case study describes how a healthy intensive care unit nurse had an uncomplicated pregnancy and birth with her second child and experienced permanent nerve damage. The case study will use the story of the nurse’s experience during birth and on the postpartum unit to share best practices to prevent LEND and to provide hospital care for these patients. Information on the patient's recovery and physical therapy treatment are provided. By using specific positioning techniques during labor, labor and delivery nurses can reduce the likelihood of LEND. If nerve damage does occur, postpartum nurses can assist in prompt recognition and initiate appropriate treatment that can accelerate physical and emotional recovery.

Cryotherapy for the prevention of chemotherapy-induced peripheral neuropathy: A systematic review.

Chemotherapy induced peripheral neuropathy (CIPN) is an adverse effect of certain chemotherapy agents that can result in dose reductions, permanent nerve damage, and chronic pain. Although pharmacological agents have been studied in this setting, there is no standard of care for the prevention of CIPN. Thus, the objective of this systematic review is to assess the efficacy and safety of cryotherapy for the prevention of CIPN. PubMed (1946 to February 2020) and Embase (1947 to February 2020) were utilized to conduct a literature search using the following search terms: antineoplastic agent(s), taxoid(s), or chemotherapy and neuralgia, peripheral nervous system diseases, peripheral neuropathy, or paclitaxel-induced peripheral neuropathy and cryotherapy, cryotherapy device, hypothermia, low temperature procedures, or ice. A total of 11 studies were included in the final assessment. Results of this systematic review indicate that the efficacy of cryotherapy in preventing CIPN is conflicting. This may be due to studies utilizing differing cryotherapy administration methods, study design, and including only a small number of patients. All included studies utilized cryotherapy with taxane-based chemotherapy treatments and cooling gloves and socks was the most common method of administration. Overall, cryotherapy was well-tolerated and no serious adverse effects were noted. Due to the absence of serious adverse effects, cryotherapy is a reasonable option to consider to prevent CIPN in patients receiving taxane-based chemotherapy. However, additional research is needed, including larger, better designed studies, to fully delineate the role of cryotherapy for CIPN.

Internal Neurolysis of the Common Peroneal Nerve With Lower Extremity Flexion Increases Likelihood for Direct End-End Nerve Repairs.

IntroductionAn understanding of common peroneal neuropathy is essential to improving current surgical techniques and overcoming limitations of permanent common peroneal nerve (CPN) damage, which negatively impacts quality of life. This study focuses on quantifying additional nerve length after CPN internal neurolysis with varying degrees of lower extremity flexion, in order to improve end-end nerve repairs in the setting of injury with a significant gap.Materials and methodsFull and partial neurolysis dissections were performed on salt- and formaldehyde-perfused cadavers. For accurate measurement of additional length obtained, all dissections were palpated at the fibular head and CPNs transected proximally at the distal fascial border. We chose this site to measure the nerve length obtained because it is the common site for CPN injury and the most clinically applicable. The amount of nerve length gained from neurolysis alone was measured at the location of the common peroneal nerve passing deep to peroneus longus before and after being transected. Nerve length after neurolysis was measured in cm at 10° increments, using a protractor starting at 90° and ending at 0°.ResultsBoth formaldehyde- and salt-perfused cadavers have a significant difference in nerve length obtained after neurolysis at each angle of measurement. This is seen for both dissection groups with p-values <0.05.ConclusionsIn this study, we found a direct statistically significant relationship between extent of neurolysis and increased angle of measurement, to amount of addition nerve length obtained in both neurolysis groups despite fixation type.

NNC55-0396 Reduces SH-SY5Y Cell Damage Induced by Bupivacaine Hydrochloride

Background Local anesthetic neurotoxicity is a common complication in clinical anesthesia, which can cause permanent nerve damage in severe cases. The T-type calcium channel is an important channel for regulating the excitability of neurons. Normally, extracellular calcium ions enter the cell through the T-type calcium channel to change the excitability of neurons. When the intracellular calcium is overloaded, it can cause cell damage. Aims To investigated the roles of T-type calcium channel in the SH-SY5Y cells injury induced by the bupivacaine. Methods The SH-SY5Y cell culture model was used to observe the effect of T-type calcium channel blocker NNC55-0396 on the neurotoxicity of bupivacaine hydrochloride by MTT methold,flow cytometry, Western blotting and other methods. Results The results show that NNC55-0396 can block the T-type calcium channel of SH-SY5Y cells, improve the decrease of cell viability caused by bupivacaine hydrochloride, reduce the level of intracellular calcium ion, reduce the expression of Cleavedcaspase-3, and reduce cell apoptosis. Conclusion The above results indicate that the T-type calcium channel is involved in the SH-SY5Y cell damage caused by bupivacaine hydrochloride, and blocking the T-type calcium channel can reduce the neurotoxicity of bupivacaine hydrochloride.

Clinical features and surgical outcomes of type A intramural hematoma.

BackgroundData on the clinical features and surgical outcomes of type A intramural hematoma (IMH) in Chinese patients are very limited. We aimed to present the surgical experiences on type A IMH in our center, and report early and late outcomes.MethodsFrom February 2012 to April 2018, 106 consecutive patients underwent open surgery for type A IMH at our hospital. We adopted emergent operation for patients with cardiac tamponade or other severe complications, and recommended initial medical treatment followed by elective surgery for stable patients. The composite endpoints included operative mortality, permanent nerve damage (stroke, paraplegia), and new-onset renal failure necessitating hemodialysis. Risk factors for operative mortality and the composite endpoints were identified using univariable and multivariable logistic regression model analysis. The survival and freedom from aortic events were analyzed using a Kaplan-Meier surviving curve and a log-rank test.ResultsExcept 1 patient receiving emergent surgery (within 24 hours from onset) because of cardiac tamponade and cerebral malperfusion, all patients received initial medical treatment and delayed surgery. Two patient developed pericardial tamponade while waiting for surgery, and then received emergent surgery. Preoperative conversion to aortic dissection (AD) was noted in no patient. The operative techniques included ascending aorta replacement in 9 patients, hemiarch replacement in 18 patients, total arch replacement (TAR) with frozen elephant trunk (FET) in 45 patient and hybrid aortic arch repair in 34 patients. The mean cardiopulmonary bypass (CPB) time and cross-clamp time were 138.7±41.6 and 79.3±27.8 min, respectively. The operative mortality was 1.9% (2/106). And the composite endpoints occurred in 7 patients. Multivariable logistic regression analysis showed CPB time ≥200 min and chronic kidney disease were risk factors for the composite endpoints. The follow-up data were available in 97 survivors, with the mean follow-up time of 30.8±16.2 months. Three patients died and 5 patients developed aortic events during the follow-up. The overall survival at 1-, 3- and 5-year were 97.0%, 95.3%, and 79.4%, respectively. And freedom from aortic events at 1-, 3- and 5-year were 97.7%, 95.3% and 89.4%, respectively.ConclusionsOur strategy had got low mortality and excellent mid-term survival in patients with type A IMH. Therefore, our strategy was suitable for the surgical repair of type A IMH in Chinese population.