Post-surgery Day Research Articles

OS14.4.A The Neuroplastic Potential of the Human Brain before and After Glioma Surgery: Towards “Interventional Neurorehabilitation

Abstract INTRODUCTION The human brain is a highly neuroplastic ‘complex’ network: it self-organises without a hard blueprint, adapts to evolving circumstances, and can withstand insults. However, similar to other naturally occurring networks, brain networks can only endure a finite amount of damage before cognitive processes are affected. In this study, we first sought to establish the brain networks governing domain-general cognition (DGC) in healthy individuals across the lifespan. We then sought to map, track, and potentially rehabilitate networks governing DGC through connectomics and non-invasive brain stimulation (NIBS) when damaged by low-grade gliomas (LGG) and surgical oncology. METHODS Using MRI and cognitive data from n=629 individuals (aged 18–88, Female= 51%), we assessed the structural, functional, and topological relevance of the spatially-distributed multiple-demand (MD) system for DGC. Next, in n=17 patients undergoing glioma surgery, we longitudinally acquired connectomic and cognitive data at multiple time points: pre-surgery and post-surgery Day 1, Month 3, Month 12. In an independent cohort of n=34 patients, we sought to establish the safety profile for “interventional neurorehabilitation”: connectome-driven NIBS in the acute post-operative period to accelerate cognitive recovery. RESULTS In healthy individuals, the MD system across multiple scales of biological organisation was positively associated with higher-order cognition (Catell’s fluid intelligence). In our patients, pre-operative LGG infiltration into the structural MD system was negatively associated with the number of long-term cognitive deficits, suggesting a functional reorganisation. Mixed-effects modelling demonstrated the resilience of the functional MD system to infiltration and resection, while the early post-operative period was critical for effective neurorehabilitation. Graph analyses revealed increased perioperative modularity can distinguish patients with long-term cognitive improvements at one-year follow-up. Finally, NIBS within two weeks post-craniotomy had a 90% (n=31/34) recruitment rate into the trial. There were no seizures or serious complications due to NIBS in this patient population. Transient headaches and tingling were reported in a minority of patients. CONCLUSION For the first time, we elucidate long-term cognitive and network trajectories following LGG surgery while establishing a positive safety-profile for NIBS in the acute post-operative period. We argue that “mesoscale” brain mapping serves as a robust biomarker for intervention-related plasticity for future clinical trials. While we performed these experiments in the context of neurosurgery, connectomics and NIBS could be adopted across diverse neuro-oncological care pathways (i.e. chemotherapy/radiation).

A prospective study of the effect and mechanism of autologous platelet-rich plasma combined with Meek microskin grafts in repairing the wounds of limbs in severely burned patients

Objective: To observe the effect of autologous platelet-rich plasma (PRP) combined with Meek microskin grafts in repairing the wounds of limbs in severely burned patients, and to explore the mechanism. Methods: The prospective controlled research method was used. From September 2016 to January 2020, 16 patients aged 18-69 years, with extensive deep burns, including 9 males and 7 females, who met the selection criteria were admitted to the Department of Burns and Plastic Surgery of the 909th Hospital of the Joint Logistic Support Force of PLA. The bilateral limbs with similar injury in 8 patients were divided into Meek skin grafting+PRP group and Meek skin grafting alone group according to the random number table; in the other 8 patients, the limbs with severer injury were included in Meek skin grafting+PRP group, and the limbs on the other side were included in Meek skin grafting alone group. The wounds of affected limbs in the two groups were treated correspondingly. On post surgery day (PSD) 10, the survival and fusion of Meek microskin grafts were observed and the survival rate and fusion rate were calculated; the histological morphology and the angiogenesis of the basal tissue of Meek microskin graft were observed by hematoxylin-eosin staining and immunohistochemical staining, respectively, with the microvessels being counted. Data were statistically analyzed with paired sample t test. Results: On PSD 10, the wounds of affected limbs in Meek skin grafting+PRP group were dry, and most of the transplanted skin grafts were closely adhered to the basal tissue; while a small amount of exudate could be found in the wounds of affected limbs in Meek skin grafting alone group, and a small part of the transplanted microskin grafts fell off or poorly attached to the basal tissue. On PSD 10, the survival rate and the fusion rate of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group were (94±3)% and (86±4)%, which were significantly higher than (89±4)% and (79±4)% of Meek skin grafting alone group, respectively (t=3.633, 4.229, P<0.01). On PSD 10, the basal epidermis was closely connected with dermis of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group, with more inflammatory cell infiltration and active microvascular hyperplasia, while the basal epidermis was less closely connected with dermis of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting alone group, with obvious degeneration of collagen fibers under the dermis, less inflammatory cell infiltration, and slightly poor microvascular hyperplasia. On PSD 10, the distribution of microvessels in basal tissue of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group were densely clustered, while the distribution of microvessels in Meek skin grafting alone group were scattered, sparse, and dotted. On PSD 10, the number of microvessels in basal tissue of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group was 36±6 in each 400-fold visual field, which was significantly more than 29±7 of Meek skin grafting alone group (t=2.671, P<0.05). Conclusions: Autologous PRP can effectively promote the survival rate and fusion rate of Meek microskin grafts in the wounds of limbs after escharectomy in severely burned patients by promoting angiogenesis at the base of Meek microskin grafts.

Rat perichondrium transplanted to articular cartilage defects forms articular-like, hyaline cartilage

Abstract Objective Perichondrium autotransplants have been used to reconstruct articular surfaces destroyed by infection or trauma. However, the role of the transplanted perichondrium in the healing of resurfaced joints has not been investigated. Design Perichondrial and periosteal tissues were harvested from rats hemizygous for a ubiquitously expressed enhanced green fluorescent protein (EGFP) transgene and transplanted into full-thickness articular cartilage defects at the trochlear groove of distal femur in wild-type littermates. As an additional control, cartilage defects were left without a transplant (no transplant control). Distal femurs were collected 3, 14, 56, 112 days after surgery. Results Tracing of transplanted cells showed that both perichondrium and periosteum transplant-derived cells made up the large majority of the cells in the regenerated joint surfaces. Perichondrium transplants contained SOX9 positive cells and with time differentiated into a hyaline cartilage that expanded and filled out the defects with Col2a1-positive and Col1a1-negative chondrocytes and a matrix rich in proteoglycans. At later timepoints the cartilaginous perichondrium transplants were actively remodeled into bone at the transplant-bone interface and at post-surgery day 112 EGFP-positive perichondrium cells at the articular surface were positive for Prg4. Periosteum transplants initially lacked SOX9 expression and despite a transient increase in SOX9 expression and chondrogenic differentiation, remained Col1a1 positive, and were continuously thinning as periosteum-derived cells were incorporated into the subchondral compartment. Conclusions Perichondrium and periosteum transplanted to articular cartilage defects did not just stimulate regeneration but were themselves transformed into cartilaginous articular surfaces. Perichondrium transplants developed into an articular-like, hyaline cartilage, whereas periosteum transplants appeared to produce a less resilient fibro-cartilage.

Intraarticular injection of MM-II, a suspension of empty large liposomes, reduces cartilage degeneration in rat osteoarthritis model

Purpose: MM-II is a suspension of large multilamellar liposomes composed of two phospholipids, dimyristoylphosphatidylcholine (DMPC) and dipalmitoylphosphatidylcholine (DPPC) which is applied via intra-articular (IA) administration. In-vivo biodistribution studies and ex-vivo wear tests have shown that MM-II liposomes are retained on the cartilage surface, providing lubrication, and leading to a reduction in wear of the cartilage. In a first-in-man study, a single injection of MM-II was demonstrated to lower pain in osteoarthritis (OA) patients for up to 3 months. Given the lubricating properties, cartilage wear reduction, and pain-lowering effect of MM-II, we hypothesized that IA administration of MM-II may also reduce OA progression. The purpose of the current study was to evaluate the effects of three consecutive IA injections of MM-II with dosing intervals of one per week, on cartilage degeneration in a rat meniscal-tear-induced model of osteoarthritis. Methods: Male Lewis rats underwent a unilateral medial meniscal tear (MMT) on study day 0. The rats (n=15 per group) were treated by the IA route on study days 7, 14, and 21 with MM-II (50μl/knee) or a vehicle control. Additional group consisted of untreated disease controls. Four weeks after surgery, joints were processed for histological analysis following staining with toluidine blue. Endpoints for evaluation of therapeutic efficacy included histopathologic examination of chondrocyte death/cartilage degeneration. General cartilage degeneration includes chondrocyte death/loss, proteoglycan (PG) loss, and collagen loss or fibrillation. Substantial Cartilage Degeneration was identified by chondrocyte and proteoglycan loss extending through greater than 50% of the cartilage thickness and was measured by ocular micrometer. Gait analysis was performed at day 24 to confirm expected animal mobility post-surgery. Results: Weekly IA treatment with MM-II (5.35 mg/knee) resulted in significant beneficial effects on cartilage damage and collagen degeneration in the rat meniscal-tear-induced model of OA as determined by evaluation of knee histopathology including significant reductions in substantial cartilage degeneration widths (38% reduction), summed cartilage degeneration scores (33%), total joint scores (25-26%), and combined severe to mild collagen degeneration widths (32%) as compared to the vehicle control. MM-II treatment also resulted in significant reductions in subchondral bone sclerosis (16%) and osteophyte scores (16%) as compared to vehicle control rats. Rats treated with MM-II had a statistically significant increase in synovial inflammation as compared to the vehicle control group with all animals showing minimal to mild synovitis. Animal body weight gain and mobility post-surgery (day 24 gait scores) in rats treated with MM-II did not differ statistically from the placebo control group. All animals survived to study termination. Conclusions: Weekly IA treatment with MM-II was shown to lower OA disease progression as manifested by significant beneficial effects on cartilage damage and collagen degeneration in the rat MMT model of OA as determined by evaluation of knee histopathology. The minimal to mild synovitis associated with the injected liposomes is consistent with the reversible synovial hyperplasia seen in the toxicity studies and is expected from IA-injected particulate agents that lodge in the synovium. The cartilage damage improvements together with the gait data indicates that MM-II treatment was overall beneficial in the rat MMT model and has the potential to be a disease modifying OA therapy in addition to its pain lowering ability.

Reactive Changes in Elements of Stromal-Vascular Differons of Dysferlin-Deficient Skeletal Muscles after Procaine Injection.

The study assessed reactivity of stromal-vascular skeletal muscle differons to acute chemical injury. Dysferlin-deficient Bla/J mice and the wild-type С57BL/6 mice were intramuscularly injected with 100 μl of 0.5% procaine solution. The middle segment of gastrocnemius muscle was taken on postsurgery days 2, 4, 10, and 14 for routine histological examination. To evaluate proliferation and vascularization, the paraffin sections were stained immunohistochemically with antibodies to α-smooth muscle actin and Ki-67. The connective tissue was stained according to Mallory. The study revealed diminished proliferative activity of stromal-vascular differons and decreased vascular density in muscles of Bla/J mice. Thus, mutations in the DYSF gene coding dysferlin down-regulate the reparation processes in all differons of skeletal muscle.

SkQR1 Reduces Neurologic Deficit Caused by Rat Brain Compression Ischemia.

The protective effect of antioxidant SkQR1 was examined on the model of left-sided compression ischemia in rat sensorimotor cortex. The special tests aimed to determine the neurologic deficit in the limbs and assess performance of the forelimbs showed that a 2.5-min ischemia produced no disturbance in the limb functions on postsurgery days 1, 3, and 7. Elevation of compression time resulted in neurologic deficit in animals, and its severity depended on this time. A single intravenous injection of SkQR1 (250 nmol/kg body weight) performed 30 min after ischemia significantly reduced the degree of neurologic deficit. In vitro model of ischemia in surviving rat hippocampal slices showed that a 15-min-long ischemia significantly inhibited the population excitatory postsynaptic potentials, which did not restore during reperfusion. Preincubation of the slices with SkQR1 did not significantly affect recovery of these potentials.

Bovine tunica albuginea conserved in honey as xenograft for cystoplasty in rats

ABSTRACT: Urinary bladder damages leading to few viable bladder tissue available might demand a challenging reconstructive surgery. In this context, biomaterials are valid alternatives for bladder reconstruction. This study evaluated the bovine tunica albuginea fragment as graft material for cystoplasty in rats and honey-preserved implant viability.Thirty Wistar rats were assigned to two groups: (1) a test group (T) with a circular 1.0-cm-diameterbovine tunica albuginea graft application in the apex region by a continuous absorbable (Polyglactin 910 5-0) suture with stitching of all bladder layers and (2) a simulation group (S) in which animals underwent only partial cystectomy. In addition, each of these groups was further divided into three subgroups according to euthanasia period on post-surgery day 7, 15 and 30.Two animals had self-limiting hematuria at postsurgical period. At necropsy, frequent crystals and adhesion to the peritoneum were observed. At the histopathological evaluation, animals from the T group euthanized by 15th postoperative day had layers disorganization and initial muscle development, while T group rats euthanized by 30th postoperative day showed complete urothelization. Urothelization pattern was similar in both groups. Moreover, the muscular layer formation was present in both groups, but more evident in S group animals. Nevertheless, inflammatory infiltrate and neovascularization were remarkably more intense in T group rats.It might be concluded that bovine tunica albuginea graft was successful in repairing rats’ bladder, being a good biomaterial option in reconstructive urinary vesicle surgery.

Biomechanical Interfaces of Corticotomies on Periodontal Tissue Remodeling during Orthodontic Tooth Movement

Corticotomy is an effective approach in accelerating orthodontic tooth movement (OTM) in clinical treatment. Corticotomy causes regional acceleratory phenomenon (RAP) in the alveolar bone of surgical sites. However, the molecular mechanism of RAP after corticotomy remains unclear. Herein, we established a mouse model to study the biomechanical interfaces of corticotomy-assisted OTM and to investigate the histological responses and underlying cellular mechanism. A total of 144 male C57BL/6 mice were randomly assigned into four groups: corticotomy alone (Corti), sham operation (Sham), corticotomy with tooth movement (Corti + TM), and sham operation with tooth movement (Sham + TM). Nickel–titanium orthodontic springs were applied to trigger tooth movement. Mice were sacrificed on Post-Surgery Day (PSD) 3, 7, 14, 21, and 28 for radiographic, histological, immunohistochemical, and molecular biological analyses. The results reveal that corticotomy significantly promoted alveolar bone turnover and periodontal tissue remodeling. During orthodontic tooth movement, corticotomy significantly promoted osteogenic and proliferative activity, accelerated tooth movement, and eliminated root resorption by upregulating Wnt signal pathway.

Thymus algeriensis and Thymus fontanesii exert neuroprotective effect against chronic constriction injury-induced neuropathic pain in rats

We have previously demonstrated that the Thymus algeriensis and Thymus fontanesii extracts have powerful anti-inflammatory, antipyretic, and analgesic effects against acute pain models. We profiled their chemical composition and found many phenolic acids, flavonoids, and phenolic diterpenes. In this work, we investigated their antioxidant properties on HaCaT cells exposed to UVA-induced oxidative stress and examined their effects against chronic neuropathic pain and the underlying mechanisms. Through a rat chronic constriction injury (CCI) model, we induced chronic neuropathic pain by placing 4 loose ligatures around the right sciatic nerve for 14 days. Thermal and mechanical hyperalgesia in addition to cold and dynamic allodynia were tested on the day before surgery and on the 7th and 14th post-surgery days. Key markers of the nitrosative and oxidative stresses, in addition to markers of inflammation, were measured at day 14 post surgery. Histopathological examination and immunostaining of both synaptophysin and caspase-3 of sciatic nerve and brain stem were also performed. Results of this study showed that T. algeriensis extract suppresses UVA oxidative stress in HaCaT cells via activation of the Nrf-2 pathway. Both extracts attenuated hyperalgesia and allodynia at 7- and 14-days post-surgery with more prominent effects at day 14 of surgery. Their protective effects against neuropathic pain were mediated by inhibiting NOX-1, iNOS, by increasing the enzyme activity of catalase, and inhibition of inflammatory mediators, NF-κB, TNF-α, lipoxygenase, COX-2 enzymes, and PGE2. Furthermore, they improved deleterious structural changes of the brainstem and sciatic nerve. They also attenuated the increased caspase-3 and synaptophysin. The data indicate that both extracts have neuroprotective effects against chronic constriction injury-induced neuropathic pain. The observed protective effects are partially mediated through attenuation of oxidative and nitrosative stress and suppression of both neuroinflammation and neuronal apoptosis, suggesting substantial activities of both extracts in amelioration of painful peripheral neuropathy.

Anestesi untuk Kraniotomi Evakuasi Perdarahan Intraserebral pada Pasien Cedera Otak Traumatik dengan Tetralogy of Fallot

Congenital heart disease (CHD) is one of the leading congenital disease with the incidence of 8 patients of 1000 livebirth. Around 85% of patients with CHD is expected to reach adult age in United States of America. Management of traumatic brain injury in patients with CHD requires combination of fine understanding on pathophysiology of CHD and neuroanesthesia technique. A male patient, 17 years of age had a motor vehicle accident and was diagnosed with moderate traumatic brain injury, intracerebral hemorrhage, epidural hemorrhage and cerebral edema with Tetralogy of Fallot, underwent an emergency craniotomy for ICH evacuation. Surgery was done under general anesthesia and lasted for approximately 3 hours. Challenges during anesthesia and surgery include maintaining optimal oxygen delivery, avoiding increase in oxygen demand and preventing catecholamine release which may trigger hypercyanotic tet spell. Patient was observed and ventilator supported in Intensive Observation Ward and was extubated at the same post surgery day. Patient was then observed in the Ward and sent home on the 14th day after the incident.

Design and clinical application of specialized protective cap for patients with alopecia after autologous hair transplantation

Objective: To investigate the design of specialized protective cap for patients with alopecia after autologous hair transplantation and its application value in nursing care after autologous hair transplantation. Methods: The author designed a kind of specialized protective cap for patients with alopecia after autologous hair transplantation with elastic gauze, fiber, silica gel, and other materials. It was divided into two parts, the front piece was mainly used to protect the hair receiving site, and the back piece was mainly used for pressure hemostasis at the hair donor site. From February 2017 to January 2019, 81 patients with alopecia and had autologous hair transplantation in the First Affiliated Hospital of Air Force Military Medical University, who met the inclusion criteria, were enrolled in this prospective controlled study. According to the tail number of admission number of each patient, 43 patients with odd numbers were recruited in protective cap group (38 males and 5 females, aged 23 to 52 years) and 38 patients with even numbers were recruited in convention group (34 males and 4 females, aged 22 to 55 years). After hair transplantation surgery, patients in the two groups received routine postoperative education. Patients in the conventional group were treated with conventional dressing after surgery. On this basis, patients in protective cap group wore the specialized protective caps for at least 1 week continuously except for necessary dressing change, wound clean, and dressing remove. The follow-ups was performed by responsible doctors and nurses at clinic. The postoperative hemorrhage at the hair donor site on post surgery day (PSD) 3 and swelling of scalp at the surgical site on PSD 7, the folliculitis at the hair receiving site and survival condition of transplanted hair follicle at the receiving site, and satisfaction score within 3 months after surgery were observed and recorded. Data were statistically analyzed with two independent sample t test, chi-square test, and Fisher's exact probability test. Results: (1) On PSD 3, one patient in protective cap group had hemorrhage at the hair donor site, which was significantly less than 8 patients in convention group (P<0.05). (2) On PSD 7, 4 patients in protective cap group had swelling of scalp at the surgical site, which was significantly less than 11 patients in convention group (χ(2)=5.160, P<0.05). (3) Within 3 months after surgery, 0 patient in protective cap group had folliculitis at the hair receiving site, which was less than 3 patients in convention group. (4) In 3 months after surgery, the survival number of hair follicle in each 100 transplanted hair follicles at the hair receiving site of patients in protective cap group was 94.9±2.8, which was significantly more than 91.1±4.7 in convention group (t=4.354, P<0.01). (5) The patients' satisfaction score in protective cap group was (14.2±2.6) points, which was significantly higher than (12.1±3.0) points in convention group (t=3.338, P<0.01). Conclusions: After autologous hair transplantation, the specialized protective cap can reduce postoperative hemorrhage at the hair donor site, swelling of scalp at the surgical site, as well as improve the survival rate of transplanted hair follicles at the hair receiving site and score of patient satisfaction.

Influence of Xuebijing injection and its component paeoniflorin on immune function and survival rate of septic rats

Influence of Xuebijing injection and its component paeoniflorin on immune function and survival rate of septic rats

Postconditioning With Red-Blue Light Therapy Improves Survival of Random Skin Flaps in a Rat Model.

Random skin flap ischemic necrosis is a serious challenge in reconstructive surgery. Photobiomodulation is a noninvasive effective technique to improve microcirculation and neovascularization. Photobiomodulation with red or blue light has been separately proven to partially prevent skin flap necrosis, but the synergistic effect of red and blue light not been elucidated. Our experiment evaluated the impact of postconditioning with red-blue light therapy on the viability of random flaps. Thirty Sprague-Dawley male rats (male, 12 weeks) with a cranially based random pattern skin flap (3 × 8 cm) were divided into 3 groups: control group, red light group, and red-blue light group. On postoperative day 7, flap survival was observed and recorded using transparent graph paper, flaps were obtained and stained with hematoxylin and eosin, and microvessel density was measured. Micro-computed tomography was used to measure vascular volume and vascular length. On days 0, 3, and 7 after surgery, blood flow was measured by laser Doppler. To investigate the underlying mechanisms, the amount of nitric oxide (NO) metabolites in the flap tissue was assessed on days 3, 5, and 7 after surgery. The mean percentage of skin flap survival was 59 ± 10% for the control group, 69 ± 7% for the red light group, and 79 ± 9% for the red-blue light group (P < 0.01). The microvessel density was 12.3 ± 1.2/mm2 for the control group, 31.3 ± 1.3/mm2 for the red light group, and 36.5 ± 1.4/mm2 for the red-blue light group (P < 0.01). Both vascular volume and total length in the red-blue light group showed significantly increased compared with the red light and control group (P < 0.01). Blood flow in the red-blue light treated flap showed significantly increased at postsurgery days 3 and 7 compared with the red light and control group (P < 0.01). The level of the NO metabolites was significantly increased in flap tissues belonging to the red-blue light group compared with the other 2 groups (P < 0.01). This study showed that postconditioning with red-blue light therapy can enhance the survival of random skin flap by improving angiogenesis and NO releasing.

Nanoscaled Bionic Periosteum Orchestrating the Osteogenic Microenvironment for Sequential Bone Regeneration.

Periosteum orchestrates bone repair. Previously developed artificial periosteum was mainly focusing on materials modification to simply enhance bone formation, but few were attempting to make the artificial periosteum fit different bone repair stages. Here, we constructed a functionalized periosteum, which was composed of an electrospun scaffold grafted with leptin receptor antibody (LepR-a) and BMP2-loaded hollow MnO2 (h-MnO2) nanoparticles through a polydopamine (PDA)-assisted technique. The bionic periosteum showed suitable mechanical properties and favorable biocompatibility. It effectively recruited skeletal stem cells (SSCs) through antigen-antibody interactions, as in in vitro cell adhesion tests, we observed that more SSCs attached to the LepR-a-grafted periosteum compared to the control group. In vivo, the LepR-a-grafted periosteum covered on the cranial defect in Prx1-Cre/ERT2, -EGFP mice recruited more Prx1-EGFP cells to the fracture site compared to control groups at post-surgery day 3, 7, and 14. Co-staining with Sp7 indicated that most of the recruited Prx1-EGFP cells underwent osteogenic lineage commitment. Sustained BMP2 release from h-MnO2 promoted osteogenesis by accelerating the osteogenic differentiation of recruited SSCs, as demonstrated by alkaline phosphatase (ALP) and alizarin red staining (ARS) in vitro and microcomputed tomography (micro-CT) in vivo. Interestingly, we also observed the growth of osteogenic coupled capillaries (CD31hiEmcnhi) in the bone repair site, which might be induced by increased platelet-derived growth factor-BB (PDGF-BB) in the regenerative microenvironment subsequent to SSCs' differentiation. Taken together, the findings from this study indicate that the multifunctionalized periosteum efficiently recruited and motivated the SSCs in vivo and orchestrated the osteogenic microenvironment for bone repair in a sequence manner. Thus, the construction of the bionic periosteum to couple with natural bone regeneration stages has been demonstrated to be effective in facilitating bone healing.

Aerobic Recovery Of A 65-year Old Following Radical Prostatectomy

Following radical prostatectomy, patients are generally advised to engage in no strenuous exercise for 4-6 weeks. Beyond that time range, the rapidity with which a patient may return to high-level aerobic activity is not known. PURPOSE: To examine the recovery following radical prostatectomy (RP) of an endurance-trained 65-year old man with localized prostate cancer and single-vessel heart disease. METHODS: A maximal incremental exercise test and a one-hour steady-state test were performed just prior to and three months following robotic RP to determine maximal oxygen consumption (VO2max) and other cardiorespiratory variables. The patient recorded his training as he prepared for an endurance event that was to occur three months after RP, the Norwegian Foot March (NFM), a 30-km road march carrying 11.4 kg. RESULTS: In the month prior to RP, the patient performed 2-3 hours of vigorous-intensity aerobic exercise per week, fast walking carrying an 11.4-kg pack, with the longest individual session being a 16-km road march. Just prior to surgery, VO2max was 36.7 mL.min-1.kg-1, heart rate during 30 min at 7.2 km.hr-1 and 0% grade was 77% of heart rate reserve (HRR), and during 30 min at 5.3 km.hr-1 and 10% grade was 92% HRR. On post-surgery day 44, he did a 19-km road march carrying 11.4 kg, exceeding the training level of the month pre-surgery. Three months post-surgery, VO2max was 42.7 mL.min-1.kg-1, and heart rates during the flat and uphill 30-min sessions at the same absolute-intensity as pre-surgery were 70% and 83% HRR, respectively. He completed the NFM 93 days post-surgery in 4:24:37, with an average heart rate of 72% HRR. CONCLUSIONS: This case study demonstrates that an aerobically trained prostate cancer patient can return to high-level aerobic training in as little as seven weeks post-radical prostatectomy, and even exceed pre-surgery fitness. This finding has implications for prognosis given the beneficial effect of vigorous-intensity exercise on prostate cancer progression.

Early Exercise after Intracerebral Hemorrhage Inhibits Inflammation and Promotes Neuroprotection in the Sensorimotor Cortex in Rats

The present study examined the effect of early exercise on brain damage and recovery of motor function following intracerebral hemorrhage (ICH) in rats. Subjects were randomly assigned to no training after ICH (ICH), no training after sham surgery (SHAM), early treadmill exercise after ICH (ICH + ET), and late treadmill exercise after ICH (ICH + LT) groups. The ICH + ET and ICH + LT groups were trained for seven consecutive days starting on day 2 and day 9 after surgery, respectively. At post surgery day 16, the brain was surgically excised, and lesion volume, cortical thickness, neuronal number, dendritic length, and dendritic complexity were analyzed. Expression levels of IL-1b, TGF-b1, and IGF-1 mRNAs in ipsilateral sensorimotor cortex were measured by RT-PCR. The recovery of motor function in the ICH + ET group was the most accelerated. Cortical thickness and neuronal number were significantly higher in the ICH + ET group than the ICH and ICH + LT groups. The length and complexity of dendrites were also significantly greater in the ICH + ET group compared with the ICH and ICH + LT groups. Expression of IL-1b mRNA was significantly lower in the ICH + ET group than that in the ICH group. Collectively, these results suggest that early treadmill exercise after ICH promotes recovery of sensorimotor function by preventing neuronal death and ensuing cortical atrophy and by preserving dendritic structure compared with late treadmill exercise and no exercise. Early exercise may prevent neurodegeneration and functional loss by inhibiting neuroinflammation.

Factors influencing performances and indicating risk of falls using the true Timed Up and Go test time of patients with hip fracture upon acute hospital discharge.

To examine the influence and risk of falls of individual factors on timed up and go test (TUG) times using standardized instructions in patients with hip fracture upon discharge from an acute orthopaedic hip fracture unit. Following instructions, the TUG was performed three times with a rollator (standardized aid), as fast as safely possible. Up to a 1-min rest was given after the first and second TUG trial. Multivariable linear regression analysis was used to investigate the factors influencing TUG-times and corresponding logistic analysis was used to investigate factors indicating risk of falls, using a cut-off of 24 s for TUG. A total of 181 patients (122 women), 60 years or older, with a mean (SD) age of 78.1 (9.1) years were studied. The fastest of three TUG trials performed within a mean of 10.0 (5.2) post-surgery days and used in analyses reached a mean of 25.6 (11.0) s. Multivariable regression analysis showed that greater age (B = 0.24; 2.4s more per decade older), a low pre-fracture function level (New Mobility Score <7 points, B = 6.4s more than high level), having a trochanteric fracture (B = 6.2 s, vs. cervical), and the post-surgery day of testing (B = 0.42, 4.2s per 10 days later) were independently associated with using more time for performing the TUG. Correspondingly, the same four factors indicated an increased risk of falls in the logistic analysis. The linear model explained 28% of the variance on TUG, while the accuracy of the logistic model to predict patients having TUG≥24 s was 69%. The age, pre-fracture function, fracture type and post-surgery day of TUG testing were identified as strong factors influencing TUG performances and TUG-times indicating risk of falls in patients with hip fracture. We suggest that these factors be considered when interpreting TUG test results and in further rehabilitation and fall prevention efforts.

Contribution of CD137-CD137L pathway in sciatic nerve crush-induced behavioral hypersensitivity and functional reduction

Abstract The T cell costimulatory molecule CD137L is involved in the development of neuropathic pain following peripheral nerve injury. Previously, our work has shown that absence or neutralization of CD137L reduces hypersensitivity, sensory and functional impairment following a sciatic nerve crush (SNC). CD137L activation utilizes both a CD137-dependent and a CD137-independent pathway. To further determine the contribution of these pathways, we examined pain-like and functional recovery-related behavioral responses following intrathecal injection (IT) of a CD137 neutralizing antibody (αCD137; daily days 3–10) after SNC in male and female B6 mice. Mice were randomly assigned to 1 of 4 groups: PBS, 0.5μg isotype control, 0.1 or 0.5μg of αCD137, and then were evaluated for sensitivity (von Frey, Hargreaves, &amp; cold plantar test), sensory (pin prick assay) and motor (hind limb grip strength, toe spread reflex and toe spacing score) functions before surgery and on post-surgery days 1–77. On post-SNC day 1, all groups showed changes in sensitivity and decreased sensory and motor functions. αCD137 treatment did not alter mechanical, heat or hypersensitivity compared to PBS- or isotype-treated controls. αCD137-treated groups showed faster sensory (pin prick score) and motor functional recovery (toe spread reflex, toe spacing), as well as slightly greater improvement in grip strength test compared to controls. Together, our results indicate partial involvement of the CD137-dependent pathway in SNC-induced sensory and motor function changes following peripheral nerve injury. (Supported by NIH/NINDS R01NS098426 (Cao))

SUN-014 IMPACT OF AKI ON OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING

Acute kidney injury (AKI) post-coronary artery bypass graft (CABG) is common, but outcomes are not well described. We aimed to investigate the true incidence and risk factors of AKI post Cardiopulmonary bypass (CPB) CABG; in a large inner-city, multi-ethnic, population. Data were analysed in 2413 patients undergoing first time CPB CABG in a large tertiary care, UK hospital. Creatinine measurements were obtained from hospital records, pre-surgery and post-surgery days 1,2,3 and 4. AKI was defined as a rise of serum creatinine 26.4 µmol/L or 50% or 1.5-fold from baseline creatinine. All statistics were done using SPSS 17 and p value<0.05 was considered significant. Baseline patient characteristics (table 1) were: age 67(13) years [median (IQR)], 19% women, 27% diabetics, 68% hypertensives, 59% smokers, BMI 27(6) kg/m2 and heart failure 24%. The incidence of AKI was 23%. Twenty-three percent patients who developed AKI, were older, with higher proportion of blacks, diabetics, hypertensives, higher CCS score (Canadian Cardiovascular Society grading of angina) and higher NYHA class compared to non-AKI patients (table 2). Incidence of AKI was associated with increased length of ICU stay (1[IQR2] vs 1[IQR0] days; p <0.000), length of length of hospital stay (8[IQR5] vs 6[IQR3] days; p<0.000) and increased in-hospital mortality (4.4% vs 0.5%; p<0.000) (table 3). AKI post CABG surgery was common, associated with increased ICU and hospital length of stay, which likely to be associated with increased cost of management; and approximately nine-fold increase in mortality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Euthyroid sick syndrome in hip fractures: Valuation of vitamin D and parathyroid hormone axis

IntroductionFemur fracture is an acute event with a high incidence and mortality worldwide. Euthyroid sick syndrome (ESS) is a disease characterized by an alteration of fT3 in the absence of a primary thyroid pathology. The aim of the study is evaluating the association between femur fracture and ESS and post-operative fluctuations of the parathyroid hormone (PTH) and vitamin D and their physio-pathological implications. Materials and MethodsAll patients older than 65 years, admitted in our emergency care unit with a diagnosis of proximal femur fracture were recruited. Exclusion criteria were acute cardio-pulmonary events, neoplastic diseases, any thyroid or endocrine pathology and use of drugs with thyroidal interactions. All patients underwent surgery within 48 h from the injury. The outcome of the study is the presence of ESS, moreover, post-operative fluctuations of the PTH and vitamin D are also evaluated. Result45 patients (13 men and 32 females) were enrolled. 20 patients had a normal thyroidal function, while 23 had a diagnosis of ESS. Mean age was 81.9. BMI was lower in the ESS group than the controls (25,3 vs 22,7; p < 0.02). In the ESS group a significantly higher decrease in Vitamin D levels was observed, compared to controls (3.96 ng/ml, p<0.001). Values of PTH were significantly different between the two groups, with a level 44.29 pg/ml lower among the ESS group compared to controls (p = 0.002). In the ESS group a significant decrease of serum calcium on the first post-surgery day was observed, compared to controls (8,7 vs 8,3; p < 0,01). There were no differences in the CCI, serum electrolytes and other variables collected between the two groups. ConclusionPart of the geriatric population suffering from fractures of the proximal femur are affected by ESS. This population displays anomalies of the Vitamin d-PTH axis and a lower BMI.