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Foot (Edinburgh, Scotland) Sep 2023AAFD comprises ligamentous failure and tendon overload, mainly focused on the symptomatic posterior tibial tendon and the spring ligament. Increased lateral column (LC)... (Review)
Review
AAFD comprises ligamentous failure and tendon overload, mainly focused on the symptomatic posterior tibial tendon and the spring ligament. Increased lateral column (LC) instability arising in AAFD is not defined or quantified. This study aims to quantify the increased LC motion in unilateral symptomatic planus feet, using the contralateral unaffected asymptomatic foot as an internal control. In this case matched analysis, 15 patients with unilateral stage 2 AAFD foot and an unaffected contralateral foot were included. Lateral foot translation was measured as a guide to spring ligament competency. Medial and LC dorsal sagittal instability were assessed by direct measurement of dorsal 1st and 4th/5th metatarsal head motion and further video analysis. The mean increase in dorsal LC sagittal motion (between affected vs unaffected foot) was 5.6 mm (95% CI [4.63-6.55], p < 0.001). The mean increase in the lateral translation score was 42.8 mm (95% CI [37.48-48.03], p < 0.001). The mean increase in medial column dorsal sagittal motion was 6.8 mm (95% CI [5.7-7.8], p < 0.001). Video analysis also showed a statistically significant increase in LC dorsal sagittal motion between affected and unaffected sides (p < 0.001). This is the first study that quantifies a statistically significant increased LC dorsal motion in feet with AAFD. Understanding its pathogenesis and its link to talonavicular/spring ligament laxity improves foot assessment and may allow the development of future preventative treatment strategies.
Topics: Humans; Adult; Flatfoot; Foot; Ligaments, Articular; Tendons; Tarsal Joints
PubMed: 37271102
DOI: 10.1016/j.foot.2023.102036 -
Brain, Behavior, and Immunity Jul 2023Peripheral injury during the early postnatal period alters the somatosensory system, leading to behavioural hyperalgesia upon re-injury in adulthood. Spinal microglia...
Peripheral injury during the early postnatal period alters the somatosensory system, leading to behavioural hyperalgesia upon re-injury in adulthood. Spinal microglia have been implicated as the cellular mediators of this phenomenon, but the mechanism is unclear. We hypothesised that neonatal injury (1) alters microglial phagocytosis of synapses in the dorsal horn leading to long-term structural changes in neurons, and/or (2) trains microglia, leading to a stronger microglial response after re-injury in adulthood. Using hindpaw surgical incision as a model we showed that microglial density and phagocytosis increased in the dorsal horn region innervated by the hindpaw. Dorsal horn microglia increased engulfment of synapses following injury, with a preference for those expressing the vesicular GABA transporter VGAT and primary afferent A-fibre terminals in neonates. This led to a long-term reduction of VGAT density in the dorsal horn and reduced microglial phagocytosis of VGLUT2 terminals. We also saw an increase in apoptosis following neonatal injury, which was not limited to the dorsal horn suggesting that larger circuit wide changes are happening. In adults, hindpaw incision increased microglial engulfment of predominantly VGAT synapses but did not alter the engulfment of A-fibres. This engulfment was not affected by prior neonatal injury, suggesting that microglial phagocytosis was not trained. These results highlight microglial phagocytosis in the dorsal horn as an important physiological response towards peripheral injury with potential long-term consequences and reveals differences in microglial responses between neonates and adults.
Topics: Rats; Animals; Infant, Newborn; Humans; Microglia; Rats, Sprague-Dawley; Reinjuries; Spinal Cord Dorsal Horn; Hyperalgesia; Spinal Cord; Posterior Horn Cells
PubMed: 37037363
DOI: 10.1016/j.bbi.2023.04.001 -
JBJS Essential Surgical Techniques 2023The all-dorsal scapholunate reconstruction technique is indicated for the treatment of scapholunate injuries in cases in which the carpus is reducible and there is no...
BACKGROUND
The all-dorsal scapholunate reconstruction technique is indicated for the treatment of scapholunate injuries in cases in which the carpus is reducible and there is no arthrosis present. The goal of this procedure is to reconstruct the torn dorsal portion of the scapholunate ligament in order to stabilize the scaphoid and lunate.
DESCRIPTION
A standard dorsal approach to the wrist, extending from the third metacarpal distally to the distal radioulnar joint, is utilized. The extensor pollicis longus is transposed and retracted radially, and the second and fourth extensor compartments are retracted ulnarly. A Berger ligament-sparing capsulotomy is utilized to visualize the carpus. Volarly, an extended open carpal tunnel release is also utilized to relieve any median nerve compression and to aid in reduction. The contents of the carpal tunnel can be retracted radially, allowing for visualization of the carpal bones. Joystick pins are placed in order to reduce the scaphoid and lunate. Reduction is held provisionally by clamping the pins until 4 pins can be placed across the carpal bones. For scapholunate reconstruction, 3 holes are made: in the lunate, proximal scaphoid, and distal scaphoid. Suture tape is then utilized to hold the scaphoid and lunate in their proper position. The dorsal wrist capsule and extensor retinaculum are repaired during closure. The pins are cut near the skin and are removed in 8 to 12 weeks.
ALTERNATIVES
Several other methods of scapholunate reconstruction have been described, including capsulodesis, tenodesis, and bone-tissue-bone repairs. Additionally, in patients who are poor candidates for scapholunate reconstruction, wrist-salvage procedures can be utilized as the primary treatment.
RATIONALE
Scapholunate reconstruction has the advantage of preserving the native physiologic motion of the wrist, in contrast to the many different wrist-salvage procedures that include arthrodesis or arthroplasty. Avoiding arthrodesis is specifically advantageous in patients who have not yet developed arthrosis of the wrist bones.
EXPECTED OUTCOMES
Outcomes of scapholunate reconstruction vary widely; however, there is a nearly universal decrease in range of motion and strength of the wrist. Wrist range of motion is typically 55% to 75% of the contralateral side, and grip strength is typically approximately 65% of the contralateral side. In a prior study, 50% to 60% of patients whose work involved physical labor were able to return to their same level of full-time work. Disabilities of the Arm, Shoulder and Hand scores average between 24 and 30. Specific patients at risk for inferior outcomes are those with delayed surgical treatment, poor carpal alignment following reduction, or open injuries.
IMPORTANT TIPS
Patients are counseled preoperatively regarding the likelihood of permanent wrist stiffness and the possibility of scapholunate diastasis even in the setting of technically successful repair.Traction and dorsally directed pressure on the lunate through an extended carpal tunnel incision can aid in reduction of the lunate.The joystick pin position in the dorsal scaphoid is angulated from distal to proximal and that in the lunate is angulated from proximal to distal in order to help correct flexion of the scaphoid and extension of the lunate by clamping together the Kirschner wires. Modifying the distance of the clamp from the carpus can allow precision in the degree of scapholunate angle fixation.Intercarpal Kirschner wire fixation of the scapholunate, lunotriquetral, and midcarpal joints (scaphocapitate and triquetrohamate) is best performed with 0.062-in (1.6-mm) Kirschner wires. The insertion angle is best visualized when the Kirschner wire is introduced from inside the incision through the skin, "inside out," in order to best envision the trajectory on the dorsal carpus and define the starting point on the bone. The Kirschner wire is then advanced through the carpus from outside-in at a slightly more volarly translated (but not angulated) position. The Kirschner wires are then cut beneath the skin at a depth that will allow them to be retrieved but will not cause them to become exposed once swelling decreases.The wrist is generally immobilized until the pins are removed at 3 months postoperatively.
ACRONYMS AND ABBREVIATIONS
ROM = range of motionK-wire = Kirschner wireDASH = Disabilities of the Arm, Shoulder and HandDISI = dorsal intercarpal ligament instability.
PubMed: 38357468
DOI: 10.2106/JBJS.ST.23.00031 -
The Journal of Comparative Neurology Dec 2023Accurate anatomical characterizations are necessary to investigate neural circuitry on a fine scale, but for the rodent claustrum complex (CLCX), this has yet to be...
Accurate anatomical characterizations are necessary to investigate neural circuitry on a fine scale, but for the rodent claustrum complex (CLCX), this has yet to be fully accomplished. The CLCX is generally considered to comprise two major subdivisions, the claustrum (CL) and the dorsal endopiriform nucleus (DEn), but regional boundaries to these areas are debated. To address this, we conducted a multifaceted analysis of fiber- and cytoarchitecture, genetic marker expression, and connectivity using mice of both sexes, to create a comprehensive guide for identifying and delineating borders to CLCX, including an online reference atlas. Our data indicated four distinct subregions within CLCX, subdividing both CL and DEn into two. Additionally, we conducted brain-wide tracing of inputs to CLCX using a transgenic mouse line. Immunohistochemical staining against myelin basic protein (MBP), parvalbumin (PV), and calbindin (CB) revealed intricate fiber-architectural patterns enabling precise delineations of CLCX and its subregions. Myelinated fibers were abundant dorsally in CL but absent ventrally, whereas PV expressing fibers occupied the entire CL. CB staining revealed a central gap within CL, also visible anterior to the striatum. The Nr2f2, Npsr1, and Cplx3 genes expressed specifically within different subregions of the CLCX, and Rprm helped delineate the CL-insular border. Furthermore, cells in CL projecting to the retrosplenial cortex were located within the myelin sparse area. By combining own experimental data with digitally available datasets of gene expression and input connectivity, we could demonstrate that the proposed delineation scheme allows anchoring of datasets from different origins to a common reference framework.
Topics: Male; Female; Mice; Animals; Claustrum; Calbindins; Brain; Parvalbumins; Rodentia; Nerve Tissue Proteins; Adaptor Proteins, Signal Transducing
PubMed: 37782702
DOI: 10.1002/cne.25539 -
CNS Neuroscience & Therapeutics Nov 2023Lysine-specific demethylase 6B (KDM6B) serves as a key mediator of gene transcription. It regulates expression of proinflammatory cytokines and chemokines in variety of...
Upregulation of lysine-specific demethylase 6B aggravates inflammatory pain through H3K27me3 demethylation-dependent production of TNF-α in the dorsal root ganglia and spinal dorsal horn in rats.
AIMS
Lysine-specific demethylase 6B (KDM6B) serves as a key mediator of gene transcription. It regulates expression of proinflammatory cytokines and chemokines in variety of diseases. Herein, the role and the underlying mechanisms of KDM6B in inflammatory pain were studied.
METHODS
The inflammatory pain was conducted by intraplantar injection of complete Freund's adjuvant (CFA) in rats. Immunofluorescence, Western blotting, qRT-PCR, and chromatin immunoprecipitation (ChIP)-PCR were performed to investigate the underlying mechanisms.
RESULTS
CFA injection led to upregulation of KDM6B and decrease in the level of H3K27me3 in the dorsal root ganglia (DRG) and spinal dorsal horn. The mechanical allodynia and thermal hyperalgesia following CFA were alleviated by the treatment of intrathecal injection of GSK-J4, and by microinjection of AAV-EGFP-KDM6B shRNA in the sciatic nerve or in lumbar 5 dorsal horn. The increased production of tumor necrosis factor-α (TNF-α) following CFA in the DRGs and dorsal horn was inhibited by these treatments. ChIP-PCR showed that CFA-induced increased binding of nuclear factor κB with TNF-α promoter was repressed by the treatment of microinjection of AAV-EGFP-KDM6B shRNA.
CONCLUSIONS
These results suggest that upregulated KDM6B via facilitating TNF-α expression in the DRG and spinal dorsal horn aggravates inflammatory pain.
Topics: Animals; Rats; Demethylation; Freund's Adjuvant; Ganglia, Spinal; Histones; Hyperalgesia; Lysine; Pain; Pain Measurement; Rats, Sprague-Dawley; RNA, Small Interfering; Spinal Cord Dorsal Horn; Tumor Necrosis Factor-alpha; Up-Regulation
PubMed: 37287407
DOI: 10.1111/cns.14281 -
The Journal of Neuroscience : the... Aug 2023The brain is able to amplify or suppress nociceptive signals by means of descending projections to the spinal and trigeminal dorsal horns from the rostral ventromedial...
The brain is able to amplify or suppress nociceptive signals by means of descending projections to the spinal and trigeminal dorsal horns from the rostral ventromedial medulla (RVM). Two physiologically defined cell classes within RVM, "ON-cells" and "OFF-cells," respectively facilitate and inhibit nociceptive transmission. However, sensory pathways through which nociceptive input drives changes in RVM cell activity are only now being defined. We recently showed that indirect inputs from the dorsal horn via the parabrachial complex (PB) convey nociceptive information to RVM. The purpose of the present study was to determine whether there are also direct dorsal horn inputs to RVM pain-modulating neurons. We focused on the trigeminal dorsal horn, which conveys sensory input from the face and head, and used a combination of single-cell recording with optogenetic activation and inhibition of projections to RVM and PB from the trigeminal interpolaris-caudalis transition zone (Vi/Vc) in male and female rats. We determined that a direct projection from ventral Vi/Vc to RVM carries nociceptive information to RVM pain-modulating neurons. This projection included a GABAergic component, which could contribute to nociceptive inhibition of OFF-cells. This approach also revealed a parallel, indirect, relay of trigeminal information to RVM via PB. Activation of the indirect pathway through PB produced a more sustained response in RVM compared with activation of the direct projection from Vi/Vc. These data demonstrate that a direct trigeminal output conveys nociceptive information to RVM pain-modulating neurons with a parallel indirect pathway through the parabrachial complex. Rostral ventromedial medulla (RVM) pain-modulating neurons respond to noxious stimulation, which implies that they receive input from pain-transmission circuits. However, the traditional view has been that there is no direct input to RVM pain-modulating neurons from the dorsal horn, and that nociceptive information is carried by indirect pathways. Indeed, we recently showed that noxious information can reach RVM pain-modulating neurons via the parabrachial complex (PB). Using electrophysiology and optogenetics, the present study identified a direct relay of nociceptive information from the trigeminal dorsal horn to physiologically identified pain-modulating neurons in RVM. Combined tracing and electrophysiology data revealed that the direct projection includes GABAergic neurons. Direct and indirect pathways may play distinct functional roles in recruiting pain-modulating neurons.
Topics: Female; Rats; Male; Animals; Nociception; Rats, Sprague-Dawley; Pain; Medulla Oblongata; Neurons; Spinal Cord Dorsal Horn
PubMed: 37487738
DOI: 10.1523/JNEUROSCI.0680-23.2023 -
Urology Jul 2023To describe our technique for performing gender affirming graft only vaginoplasty.
OBJECTIVE
To describe our technique for performing gender affirming graft only vaginoplasty.
METHODS
In graft only vaginoplasty, penile skin is used only for the external genitals, and the entire vaginal canal is created from a full thickness skin graft. The inner scrotum is excised and used as a skin graft to line the vaginal canal. The outer scrotum is left in place then moved medially to form the labia majora. The penile skin and Dartos fascia are incised dorsally and ventrally then advanced to the posterior perineum to become the labia minora. The glans clitoris is constructed from a W-shaped dorsally-based portion of the glans penis, and the clitoral hood is constructed from the distal 2-3 cm of penile shaft skin. The posterior wall of the introitus is formed from a posterior perineal flap.
RESULTS
The patient presented here is a 26-year-old transgender woman with marked and sustained gender incongruence. She is circumcised, has typical penile length, scrotal contents are normal, and all hair has been removed on the scrotum and perineum. She underwent graft only vaginoplasty, as shown in the accompanying video.
CONCLUSION
Gender affirming graft only vaginoplasty allows for construction of the vaginal canal from a full thickness skin graft, and construction of external genitals from penile and scrotal skin. Advantages of this approach include availability of more tissue for construction of the external genitals and an external skin to graft anastomosis. The procedure is modified slightly when the patient has a small scrotum, short penis, or is uncircumcised.
Topics: Male; Female; Humans; Adult; Sex Reassignment Surgery; Transsexualism; Surgical Flaps; Vulva; Clitoris; Penis; Vagina
PubMed: 37187273
DOI: 10.1016/j.urology.2023.05.006 -
Current Biology : CB Nov 2023The elephant trunk operates as a muscular hydrostat and is actuated by the most complex musculature known in animals. Because the number of trunk muscles is unclear, we...
The elephant trunk operates as a muscular hydrostat and is actuated by the most complex musculature known in animals. Because the number of trunk muscles is unclear, we performed dense reconstructions of trunk muscle fascicles, elementary muscle units, from microCT scans of an Asian baby elephant trunk. Muscle architecture changes markedly across the trunk. Trunk tip and finger consist of about 8,000 extraordinarily filigree fascicles. The dexterous finger consists exclusively of microscopic radial fascicles pointing to a role of muscle miniaturization in elephant dexterity. Radial fascicles also predominate (at 82% volume) the remainder of the trunk tip, and we wonder if radial muscle fascicles are of particular significance for fine motor control of the dexterous trunk tip. By volume, trunk-shaft muscles comprise one-third of the numerous, small radial muscle fascicles; two-thirds of the three subtypes of large longitudinal fascicles (dorsal longitudinals, ventral outer obliques, and ventral inner obliques); and a small fraction of transversal fascicles. Shaft musculature is laterally, but not radially, symmetric. A predominance of dorsal over ventral radial muscles and of ventral over dorsal longitudinal muscles may result in a larger ability of the shaft to extend dorsally than ventrally and to bend inward rather than outward. There are around 90,000 trunk muscle fascicles. While primate hand control is based on fine control of contraction by the convergence of many motor neurons on a small set of relatively large muscles, evolution of elephant grasping has led to thousands of microscopic fascicles, which probably outnumber facial motor neurons.
Topics: Animals; Elephants; Muscle, Skeletal; Motor Neurons
PubMed: 37757829
DOI: 10.1016/j.cub.2023.09.007 -
European Archives of... Jul 2024To compare the functional and esthetic outcomes of dorsal preservation rhinoplasty (DPR) and conventional dorsal hump reduction (DHR) in primary rhinoplasty using... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
PURPOSE
To compare the functional and esthetic outcomes of dorsal preservation rhinoplasty (DPR) and conventional dorsal hump reduction (DHR) in primary rhinoplasty using patient-reported outcome measures (PROMs) and cone beam computed tomography (CBCT).
METHODS
In our randomized prospective double-blinded clinical trial, 50 patients had dorsal nasal hump surgery between October 2021 and November 2022 in our tertiary referral center. All surgeries were done by the same surgeon. Patients were randomly assigned to two groups: Group (A): 25 patients had DPR, and group (B): 25 patients underwent DHR. Pre-operative and post-operative evaluations were conducted using standardized cosmesis and health nasal outcomes survey (SCHNOS), surgeons' rhinoplasty evaluation questionnaire (SREQ), and the CBCT.
RESULTS
Following an average of 7.22 ± 2.07 months, patients in both groups reported significantly higher levels of satisfaction, as measured by the SCHNOS score (p < 0.001) and the average of three SREQ scores (p < 0.001). These results align with the radiological analysis, which denoted an overall improvement in the average of both sides' internal nasal valve angle and cross-sectional area after surgery with (p = 0.001) and (p = 0.085), respectively, for the DPR group and with (p = 0.281) and (p = 0.014), respectively, for the DHR group. There was no statistically significant difference in outcomes between both groups (p > 0.05).
CONCLUSION
Dorsal preservation is a viable alternative to conventional dorsal hump reduction in primary rhinoplasty. There was no difference in the functional and esthetic outcomes between both techniques, which were verified by radiological investigation.
Topics: Humans; Rhinoplasty; Female; Male; Adult; Prospective Studies; Esthetics; Double-Blind Method; Patient Satisfaction; Patient Reported Outcome Measures; Cone-Beam Computed Tomography; Treatment Outcome; Young Adult; Middle Aged
PubMed: 38485745
DOI: 10.1007/s00405-024-08546-8