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Cureus Apr 2024Supracondylar humeral fractures are the most prevalent elbow fractures in pediatric patients. Current treatment modalities typically involve closed reduction and...
BACKGROUND
Supracondylar humeral fractures are the most prevalent elbow fractures in pediatric patients. Current treatment modalities typically involve closed reduction and fixation using percutaneous Kirschner wires. The lateral cross-wiring technique has demonstrated favorable functional and cosmetic outcomes, thereby reducing the incidence of ulnar nerve injury.
OBJECTIVES
This study aimed to assess the efficacy of the lateral cross-wiring technique in achieving optimal functional and cosmetic recovery while mitigating the risk of ulnar nerve injury in pediatric patients with displaced supracondylar humeral fractures.
MATERIALS AND METHODS
A prospective analysis was conducted on 48 patients who underwent lateral cross-wiring for displaced supracondylar fractures (Gartland type III, including extension and flexion types) of the humerus. Follow-up assessments were performed over a minimum period of eight months post-surgery.
RESULTS
Among the 48 patients, all demonstrated satisfactory restoration of the carrying angle and functional ability postoperatively. Notably, no iatrogenic cases of radial or ulnar nerve injury were observed during the follow-up period.
CONCLUSION
The lateral cross-wiring technique emerges as an effective treatment option for displaced supracondylar fractures of the humerus in pediatric patients. It facilitates both functional and cosmetic recovery while concurrently reducing the risk of ulnar nerve injury, thus warranting consideration in the management of such fractures.
PubMed: 38800146
DOI: 10.7759/cureus.59029 -
Plastic and Reconstructive Surgery.... May 2024A 51-year-old woman with diabetes and depression was referred to the anesthesia pain clinic with a 15-year history of complex regional pain syndrome type I of the right...
A 51-year-old woman with diabetes and depression was referred to the anesthesia pain clinic with a 15-year history of complex regional pain syndrome type I of the right forearm and hand in the radial sensory nerve distribution. There was no recognized antecedent trauma and she had failed both medical treatment and radial sensory nerve decompression surgery. An ultrasound-guided local anesthetic block of the radial nerve in the upper arm resulted in partial and temporary improvement in pain. She subsequently underwent trial of a peripheral nerve stimulator (PNS) followed by permanent PNS implant placement over the radial nerve proper proximal to the elbow. Within the first month of use, she endorsed substantially improved pain and strength in her right hand. These improvements were sustained for more than 1 year. Applications of PNS technology for treatment of extremity complex regional pain syndrome and neuropathic extremity pain in general are reviewed.
PubMed: 38798938
DOI: 10.1097/GOX.0000000000005764 -
European Journal of Neurology May 2024Nerve cross-sectional area (CSA) is not constant over the human lifespan. The relationship between an increasing CSA and age has been described as a linear positive...
BACKGROUND AND PURPOSE
Nerve cross-sectional area (CSA) is not constant over the human lifespan. The relationship between an increasing CSA and age has been described as a linear positive correlation, but few studies have found a linear decrease in nerve size with older age. The aim of the present study was to analyze the development of nerve CSA in a healthy population from early childhood to old age using high-resolution ultrasound.
METHODS
The median, ulnar, radial and sural nerves were examined bilaterally at 18 nerve sites in 110 healthy children, adolescents and adults aged between 2 and 98 years. The CSA of every nerve site was evaluated separately and in different age groups. The correlation of CSA with age, height and weight was analyzed in a linear, logarithmic and quadratic model and correlation coefficients were compared in a goodness-of-fit analysis. Models were then adjusted for weight and height.
RESULTS
Linear CSA-age correlations showed the lowest correlation coefficients for all nerve sites. An inverted parabolic curve suggesting a quadratic correlation of CSA and age was the best-fitting model. Weight and height had a higher predictive value than age in adjusted models.
CONCLUSIONS
There is an increase in nerve size during childhood and adolescence and a trend towards a decrease in old age, suggesting an inverted parabolic curve partly explained by age-related changes in weight and height. Enlarged nerves in elderly individuals should not be attributed to age alone.
PubMed: 38794961
DOI: 10.1111/ene.16330 -
Journal of Clinical Medicine May 2024: Systemic sclerosis is a complex autoimmune disease characterized by vasculopathy, fibrosis, and immune dysregulation. Ocular manifestations in these patients are...
: Systemic sclerosis is a complex autoimmune disease characterized by vasculopathy, fibrosis, and immune dysregulation. Ocular manifestations in these patients are increasingly recognized, suggesting potential correlations between systemic vascular abnormalities and ocular microvascular changes. Advancements in molecular immunology and imaging technology using ocular coherence tomography (OCT) have unveiled intricate pathways underlying possible disease pathogenesis. Understanding the interplay between retinal vascular abnormalities and molecular immunology parameters could provide insights into disease mechanisms and potential biomarkers. The aim of this study was to investigate vascular abnormalities, detected with optical coherence tomography angiography (OCT-A), in systemic sclerosis patients and to find correlations between the severity of the disease detected with molecular immunology findings and OCT-A parameters. A group of 32 systemic sclerosis patients were compared with 9 healthy controls. Ganglion cell complex thickness (GCC), retina thickness of the fovea and parafovea, nerve fiber layer thickness (RNFL) and cup/disc area ratio were investigated using OCT. Vessel density (VD) of the superficial (SCP) and deep capillary plexus (DCP) of the whole macular area and ETDRS grid, size of the foveal avascular zone (FAZ) and vessel density of the radial peripapillary capillary plexus (RPCP) were evaluated using OCT-A. Modified Rodnan skin score (mRSS), capillaroscopy and disease duration were used to stage disease severity. There was a statistically significant reduction in retina thickness of the fovea and parafovea, VD of the whole DCP, VD of the SCP and DCP in ETDRS grid in the patient group compared to controls ( < 0.001). The patients presented a significant enlargement of the FAZ ( 0.005). No significant correlation between OCT and OCT-A parameters and disease severity scores was found. OCT-A could represent a non-invasive tool to detect retinal microvascular damage in systemic sclerosis.
PubMed: 38792282
DOI: 10.3390/jcm13102738 -
European Journal of Orthopaedic Surgery... May 2024Radial tunnel syndrome (RTS) is a controversial diagnosis due to non-specific exam findings and frequent absence of positive electromyography (EMG) and nerve conduction... (Review)
Review
PURPOSE
Radial tunnel syndrome (RTS) is a controversial diagnosis due to non-specific exam findings and frequent absence of positive electromyography (EMG) and nerve conduction study (NCS) findings. The purpose of this study was to identify the methods used to diagnose RTS in the literature.
METHODS
We queried PubMed, Embase, Web of Science, and Cochrane databases per PRISMA guidelines. Extracted data included article and patient characteristics, diagnostic assessments utilized and their respective findings, and treatments. Objective data were summarized descriptively. The relationship between reported diagnostic findings (i.e., physical exam and diagnostic tests) and treatments was assessed via a descriptive synthesis.
RESULTS
Our review included 13 studies and 391 upper extremities. All studies utilized physical exam in diagnosing RTS; most commonly, patients had tenderness over the radial tunnel (381/391, 97%). Preoperative EMG/NCS was reported by 11/13 studies, with abnormal findings in 8.9% (29/327) of upper extremities. Steroid and/or lidocaine injection for presumed lateral epicondylitis was reported by 9/13 studies (46/295 upper extremities, 16%), with RTS being diagnosed after patients received little to no relief. It was also common to inject the radial tunnel to make the diagnosis (218/295, 74%). The most common reported intraoperative finding was narrowing of the PIN (38/137, 28%). The intraoperative compressive site most commonly reported was the arcade of Frohse (142/306, 46%).
CONCLUSIONS
There is substantial heterogeneity in modalities used to diagnose RTS and the reported definition of RTS. This, in conjunction with many patients having concomitant lateral epicondylitis, makes it difficult to compare treatment outcomes for RTS.
LEVEL OF EVIDENCE
Level III. Systematic review of retrospective and prospective cohort studies.
PubMed: 38782802
DOI: 10.1007/s00590-024-04003-8 -
Microscopy Research and Technique May 2024Teleost fish exhibit the most pronounced and widespread adult neurogenesis. Recently, functional development and the fate of newborn neurons have been reported in the...
Teleost fish exhibit the most pronounced and widespread adult neurogenesis. Recently, functional development and the fate of newborn neurons have been reported in the optic tectum (OT) of fish. To determine the role of neurogenesis in the OT, this study used histological, immunohistochemical, and electron microscopic investigations on 18 adult Molly fish specimens (Poecilia sphenops). The OT of the Molly fish was a bilateral lobed structure located in the dorsal part of the mesencephalon. It exhibited a laminated structure made up of alternating fiber and cellular layers, which were organized into six main layers. The stratum opticum (SO) was supplied by optic nerve fibers, in which the neuropil was the main component. Radial bipolar neurons that possessed bundles of microtubules were observed in the stratum fibrosum et griseum superficiale (SFGS). Furthermore, oligodendrocytes with their processes wrapped around the nerve fibers could be observed. The stratum album centrale (SAC) consisted mainly of the axons of the stratum griseum centrale (SGC) and the large tectal, pyriform, and horizontal neurons. The neuronal cells of the SO and large tectal cells of the SAC expressed autophagy-related protein-5 (APG5). Interleukin-1β (IL-1β) was expressed in both neurons and glia cells of SGC. Additionally, inducible nitric oxide synthase (iNOS) was expressed in the neuropil of the SAC synaptic layer and granule cells of the stratum periventriculare (SPV). Also, transforming growth factor beta (TGF-β), SRY-box transcription factor 9 (SOX9), and myostatin were clearly expressed in the proliferative neurons. In all strata, S100 protein and Oligodendrocyte Lineage Transcription Factor 2 (Olig2) were expressed by microglia, oligodendrocytes, and astrocytes. In conclusion, it was possible to identify different varieties of neurons in the optic tectum, each with a distinct role. The existence of astrocytes, proliferative neurons, and stem cells highlights the regenerative capacity of OT. RESEARCH HIGHLIGHTS: The OT of the Molly fish exhibited a laminated structure made up of alternating fiber and cellular layers, which were organized into six main layers. Radial bipolar neurons that possessed bundles of microtubules were observed in the stratum fibrosum et griseum superficiale (SFGS). The stratum album central (SAC) consisted mainly of the axons of the stratum griseum centrale (SGC) and the large tectal, pyriform, and horizontal neurons. Inducible nitric oxide synthase (iNOS) was expressed in the neuropil of the SAC synaptic layer and granule cells of the stratum periventricular (SPV). Also, transforming growth factor beta (TGF-β), SRY-box transcription factor 9 (SOX9), and myostatin were clearly expressed in the proliferative neurons. The existence of astrocytes, proliferative neurons, and stem cells highlights the regenerative capacity of OT.
PubMed: 38778562
DOI: 10.1002/jemt.24617 -
Investigative Ophthalmology & Visual... May 2024A thin cornea is a potent risk factor for glaucoma. The underlying mechanisms remain unexplained. It has been postulated that central corneal thickness (CCT) may be a...
PURPOSE
A thin cornea is a potent risk factor for glaucoma. The underlying mechanisms remain unexplained. It has been postulated that central corneal thickness (CCT) may be a surrogate for biomechanical parameters of the posterior eye. In this study, we aimed to explore correlations of biomechanical responses between the cornea and the optic nerve head (ONH) and the peripapillary sclera (PPS) to elevated intraocular pressure (IOP), the primary risk factor of glaucoma.
METHODS
Inflation tests were performed in nine pairs of human donor globes. One eye of each pair was randomly assigned for cornea or posterior eye inflation. IOP was raised from 5 to 30 millimeters of mercury (mmHg) at 0.5 mmHg steps in the whole globe and the cornea or the ONH/PPS was imaged using a 50 MHz ultrasound probe. Correlation-based ultrasound speckle tracking was used to calculate tissue displacements and strains. Associations of radial, tangential, and shear strains at 30 mmHg between the cornea and the ONH or PPS were evaluated.
RESULTS
Corneal shear strain was significantly correlated with ONH shear strain (R = 0.857, P = 0.003) and PPS shear strain (R = 0.724, P = 0.028). CCT was not correlated with any strains in the cornea, ONH, or PPS.
CONCLUSIONS
Our results suggested that an eye that experiences a larger shear strain in the cornea would likely experience a larger shear strain in its ONH and PPS at IOP elevations. The strong correlation between the cornea's and the ONH's shear response to IOP provides new insights and suggests a plausible explanation of the cornea's connection to glaucoma risk.
Topics: Humans; Optic Disk; Cornea; Intraocular Pressure; Biomechanical Phenomena; Aged; Middle Aged; Sclera; Male; Female; Glaucoma; Aged, 80 and over; Tissue Donors; Adult
PubMed: 38776117
DOI: 10.1167/iovs.65.5.34 -
International Journal of Ophthalmology 2024To assess the repeatability, interocular correlation, and agreement of quantitative swept-source optical coherence tomography angiography (OCTA) optic nerve head (ONH)...
AIM
To assess the repeatability, interocular correlation, and agreement of quantitative swept-source optical coherence tomography angiography (OCTA) optic nerve head (ONH) parameters in healthy subjects.
METHODS
Thirty-three healthy subjects were enrolled. The ONH of both eyes were imaged four times by a swept-source-OCTA using a 3 mm ×3 mm scanning protocol. Images of the radial peripapillary capillary were analyzed by a customized Matlab program, and the vessel density, fractal dimension, and vessel diameter index were measured. The repeatability of the four scans was determined by the intraclass correlation coefficient (ICC). The most well-centered optic disc from the four repeated scans was then selected for the interocular correlation and agreement analysis using the Pearson correlation coefficient, ICC and Bland-Altman plots.
RESULTS
All swept-source-OCTA ONH parameters exhibited certain repeatability, with ICC>0.760 and coefficient of variation (CoV)≤7.301%. The obvious interocular correlation was observed for papillary vessel density (ICC=0.857), vessel diameter index (ICC=0.857) and fractal dimension (ICC=0.906), while circumpapillary vessel density exhibited moderate interocular correlation (ICC=0.687). Bland-Altman plots revealed an agreement range of -5.26% to 6.21% for circumpapillary vessel density.
CONCLUSION
OCTA ONH parameters demonstrate good repeatability in healthy subjects. The interocular correlations of papillary vessel density, fractal dimension and vessel diameter index are high, but the correlation for circumpapillary vessel density is moderate.
PubMed: 38766332
DOI: 10.18240/ijo.2024.05.14 -
Aging May 2024We investigated the effects and targets of gastrodin (GAS) for improving cognitive ability in Alzheimer's disease (AD).
AIM
We investigated the effects and targets of gastrodin (GAS) for improving cognitive ability in Alzheimer's disease (AD).
METHODS
The targets and mechanisms of GAS were analyzed by network pharmacology. Morris water and eight-arm radial mazes were used to detect the behaviors of 7-months-old APP/PS1 mice. The levels of IBA-1 and PPARγ were examined by histochemical staining, nerve cells were detected by Nissl staining, inflammatory cytokines were measured by ELISA, and protein expressions were monitored by Western blotting. The neurobehavioral effects of GAS on mice were detected after siRNA silencing of PPARγ. Microglia were cultured and Aβ1-42 was used to simulate the pathology of AD. After treatment with GAS, the levels of inflammatory cytokines and proteins were assayed.
RESULTS
Network pharmacological analysis revealed that PPARγ was the action target of GAS. By stimulating PPARγ, GAS inhibited NF-κB signaling activation and decreased neuroinflammation and microglial activation, thereby ameliorating the cognitive ability of AD mice. After silencing PPARγ, GAS could not further improve such cognitive ability. Cellular-level results demonstrated that GAS inhibited microglial injury, reduced tissue inflammation, and activated PPARγ.
CONCLUSIONS
GAS can regulate microglia-mediated inflammatory response by stimulating PPARγ and inhibiting NF-κB activation, representing a mechanism whereby it improves the cognitive behavior of AD.
Topics: Animals; Alzheimer Disease; Glucosides; PPAR gamma; Benzyl Alcohols; NF-kappa B; Mice; Signal Transduction; Microglia; Mice, Transgenic; Neuroinflammatory Diseases; Disease Models, Animal; Male; Amyloid beta-Peptides
PubMed: 38752930
DOI: 10.18632/aging.205831 -
Plastic and Reconstructive Surgery.... May 2024Wartenberg syndrome, also known as Cheiralgia paresthetica, is an uncommon neuropathy affecting the superficial branch of the radial nerve. Typically caused by external...
Wartenberg syndrome, also known as Cheiralgia paresthetica, is an uncommon neuropathy affecting the superficial branch of the radial nerve. Typically caused by external compression, it manifests as paresthesia or pain in the radial side of the hand. We present a case of Wartenberg syndrome resulting from combat shrapnel injury, illustrating an uncommon etiology. A 21-year-old soldier was presented with allodynia and paresthesia after a shrapnel explosion, with positive clinical findings and radiographic evidence supporting the diagnosis. Nonoperative management led to significant improvement, highlighting the importance of conservative treatment in such cases. This report underscores the significance of considering unconventional causes in nerve entrapment syndromes post combat trauma, emphasizing adherence to established therapeutic guidelines.
PubMed: 38752214
DOI: 10.1097/GOX.0000000000005818