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Silk-based nerve guidance conduits with macroscopic holes modulate the vascularization of regenerating rat sciatic nerve

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Neural Regeneration Research 2025年第6期20卷 1789-1800页

作者： Carina Hromada Patrick Heimel Markus Kerbl LászlóGál Sylvia Nürnberger Barbara Schaedl James Ferguson Nicole Swiadek Xavier Monforte Johannes C.Heinzel Antal Nógrádi Andreas H.Teuschl-Woller David Hercher department Life Science Engineering University of Applied Sciences Technikum WienViennaAustria Austrian Cluster for Tissue Regeneration ViennaAustria Ludwig Boltzmann Institute for traumatology The Research Center in Cooperation with AUVAViennaAustria University Clinic of Dentistry Medical University of ViennaViennaAustria department of Plastic Reconstructive and Aesthetic SurgeryLandesklinikum Wiener Neustadt2700 Wiener NeustadtAustria department of Anatomy Histology and EmbryologyAlbert Szent-Györgyi Medical SchoolUniversity of SzegedSzegedHungary Medical University of Vienna Department of Orthopedics and Trauma SurgeryDevision of Trauma SurgeryViennaAustria department of Hand- PlasticReconstructive and Burn SurgeryBG Unfallklinik TuebingenUniversity of TuebingenTuebingenGermany

Peripheral nerve injuries induce a severe motor and sensory deficit. Since the availability of autologous nerve transplants for nerve repair is very limited, alternative treatment strategies are sought, including the use of tubular nerve guidance conduits(tNGCs). However, the use of tNGCs results in poor functional recovery and central necrosis of the regenerating tissue, which limits their application to short nerve lesion defects(typically shorter than 3 cm). Given the importance of vascularization in nerve regeneration, we hypothesized that enabling the growth of blood vessels from the surrounding tissue into the regenerating nerve within the tNGC would help eliminate necrotic processes and lead to improved regeneration. In this study, we reported the application of macroscopic holes into the tubular walls of silk-based tNGCs and compared the various features of these improved silk^(+) tNGCs with the tubes without holes(silk^(–) tNGCs) and autologous nerve transplants in an 8-mm sciatic nerve defect in rats. Using a combination of micro-computed tomography and histological analyses, we were able to prove that the use of silk^(+) tNGCs induced the growth of blood vessels from the adjacent tissue to the intraluminal neovascular formation. A significantly higher number of blood vessels in the silk^(+) group was found compared with autologous nerve transplants and silk^(–), accompanied by improved axon regeneration at the distal coaptation point compared with the silk^(–) tNGCs at 7 weeks postoperatively. In the 15-mm(critical size) sciatic nerve defect model, we again observed a distinct ingrowth of blood vessels through the tubular walls of silk^(+) tNGCs, but without improved functional recovery at 12 weeks postoperatively. Our data proves that macroporous tNGCs increase the vascular supply of regenerating nerves and facilitate improved axonal regeneration in a short-defect model but not in a critical-size defect model. This study suggests that further optimizatio

关键词： axon regeneration blood vessel functional recovery macroporous nerve lesion peripheral nerve repair sciatic nerve silk-based nerve guidance conduit vascularization

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FK506 contributes to peripheral nerve regeneration by inhibiting neuroinflammatory responses and promoting neuron survival

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Neural Regeneration Research 2025年第7期20卷 2108-2115页

作者： Yuhui Kou Zongxue Jin Yusong Yuan Bo Ma Wenyong Xie Na Han department of trauma and Orthopedics Peking University People’s HospitalBeijingChina National Center for trauma Medicine Peking University People’s HospitalBeijingChina Key Laboratory of trauma and Neural Regeneration(Peking University) Ministry of EducationBeijingChina trauma Medicine Center Peking University People’s HospitalBeijingChina department of Orthopedics China-Japan Friendship HospitalBeijingChina

FK506(Tacrolimus)is a systemic immunosuppressant approved by the *** and Drug ***506 has been shown to promote peripheral nerve regeneration,however,its precise mechanism of action and its pathways remain *** this study,we established a rat model of sciatic nerve injury and found that FK506 improved the morphology of the injured sciatic nerve,increased the numbers of motor and sensory neurons,reduced inflammatory responses,markedly improved the conduction function of the injured nerve,and promoted motor function *** findings suggest that FK506 promotes peripheral nerve structure recovery and functional regeneration by reducing the intensity of inflammation after neuronal injury and increasing the number of surviving neurons.

关键词： FK506 inflammation motor neurons nerve regeneration neuron peripheral nerve injury sensory neurons

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Sex-dependent alterations in extracellular vesicles linking chronic spinal cord injury to brain neuroinflammation and neurodegeneration

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Neural Regeneration Research 2025年第2期20卷 483-484页

作者： Yun Li Junfang Wu department of Anesthesiology&Shock Trauma and Anesthesiology Research(STAR)CenterUniversity of Maryland School of MedicineBaltimoreMDUSA

traumatic spinal cord injury(SCI)is a devastating exogenous injury with long-lasting consequences and a leading cause of death and disability *** in assistive technology,rehabilitative interventions,and the ability to identify and intervene in secondary conditions have significantly increased the long-term survival rate of SCI patients,with some people even living well into their seventh or eighth *** survival changes have led neurotrauma researchers to examine how SCI interacts with brain *** health and epidemiological data showed that patients with long-term SCI can have a lower life expectancy and quality of life,along with a higher risk of comorbidities and complications.

关键词： alterations inflammation injury

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Pulmonary embolism after shoulder surgery:Is it a real threat?

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World Journal of Methodology 2025年第1期15卷 42-50页

作者： Charalampos Pitsilos Pericles Papadopoulos Panagiotis Givissis Byron Chalidis 2^(nd)orthopaedic department Aristotle University of ThessalonikiSchool of MedicineThessaloniki 54635Greece 1^(st)orthopaedic department Aristotle University of ThessalonikiSchool of MedicineThessaloniki 57010Greece

Pulmonary embolism(PE)is a rare but devastating complication of shoulder *** from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional *** frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 *** is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of *** usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be *** for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT *** ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 *** most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of *** with DVT may also present with swelling and pain of the respective *** treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,*** instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal *** important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital *** physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.

关键词： Pulmonary embolism Venous thromboembolism Shoulder surgery Shoulder arthroscopy Shoulder arthroplasty

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Return to sport following scaphoid fractures:A systematic review and meta-analysis

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World Journal of Orthopedics 2019年第2期10卷 101-114页

作者： Joaquim S Goffin Quintin Liao Gregory AJ Robertson department of orthopaedic and trauma surgery Ninewells Hospital department of orthopaedic and trauma surgery Forth Valley Royal Hospital Edinburgh orthopaedic trauma Unit Royal Infirmary of Edinburgh

BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient, accounting for over 85% of all sport-related carpal bone fractures, and is particularly common in sports involving high impact injuries to the wrist. The management of such injuries comprises both conservative and surgical techniques, as guided by fracture location and type. Athletes demonstrate a unique challenge with regards to the management of scaphoid fractures due to their requirement to return to sport, as soon as *** To review systemically all studies recording return to sport following scaphoid fractures, to collate information on return rates to sport(RRS) and mean return times(RTS) to sport and to determine differences in sporting outcome for the various treatment *** A systematic search of MEDLINE, EMBASE, CINAHAL, Cochrane, Google Scholar, Physiotherapy Evidence Database, SPORTDiscus, Web of Science and Scopus was performed in August 2018 using the keywords "scaphoid","fracture", "acute", "carpal", "athletes", "sports", "non-operative","conservative", "operative" and "return to sport". All studies that recorded RRS and RTS following scaphoid fractures were included. RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to *** Eleven studies were included: Two randomised controlled trials, six retrospective cohort studies and three case series. Seven studies reported on conservative management(n = 77), and eight studies reported on surgical management(n =83). For conservative management, RRS was 90%(69/77), and the mean RTS was9.6 wk. Three studies allowed to return to sport in cast [RRS 89%(25/28); RTS 1.9 wk], and four studies required completion of cast treatment prior to returning to sport [RRS 90%(44/49); RTS 13.9 wk]. Four studies recorded fracture union data:Union rate 85%(47/55); mean time to union 14.0 wk. For surgical management,RRS was 98

关键词： Acute Fracture Scaphoid Carpal Return Sport Rate Time

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Mechanical and cellular processes driving cervical myelopathy

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World Journal of Orthopedics 2016年第1期7卷 20-29页

作者： Roisin T Dolan Joseph S Butler John M O'Byrne Ashley R Poynton department of trauma and orthopaedic surgery Waterford Regional Hospital National Spinal Injuries Unit Department of Trauma and Orthopaedic Surgery Mater Misericordiae University Hospital department of trauma and orthopaedic surgery Royal College of Surgeons in Ireland Cappagh National Orthopaedic Hospital department of trauma and orthopaedic surgery Mater Private Hospital

Cervical myelopathy is a well-described clinical syndrome that may evolve from a combination of etiological mechanisms. It is traditionally classified by cervical spinal cord and/or nerve root compression which varies in severity and number of levels involved. The vast array of clinical manifestations of cervical myelopathy cannot fully be explained by the simple concept that a narrowed spinal canal causes compression of the cord, local tissue ischemia, injury and neurological impairment. Despite advances in surgical technology and treatment innovations, there are limited neuro-protective treatments for cervical myelopathy, which reflects an incomplete understanding of the pathophysiological processes involved in this disease. The aim of this review is to provide a comprehensive overview of the key pathophysiological processes at play in the development of cervical myelopathy.

关键词： Cervical myelopathy Cervical spine Neck pain

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Total knee arthroplasty in patients with Paget's disease of bone: A systematic review

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World Journal of Orthopedics 2018年第10期9卷 229-234页

作者： Ravi Popat Konstantinos Tsitskaris Steven Millington Sebastian Dawson-Bowling Sammy A Hanna department of trauma and orthopaedic surgery the Hillingdon Hospitals NHS Foundation Trust department of trauma and orthopaedic surgery Barts Health NHS Trust

AIM To determine the functional outcomes, complications and revision rates following total knee arthroplasty(TKA) in patients with Paget's disease of bone(PDB). METHODS A systematic review of the literature was performed. Four studies with a total of 54 TKAs were included for analysis. Functional outcomes, pain scores, complications and revision rates were assessed. The mean age was 72.0 years and the mean follow-up was 7.5 *** All studies reported significant improvement in knee function and pain scores following TKA. There were 2 cases of aseptic loosening, with one patient requiring revision of the femoral component 10 years after the index procedure. Malalignment, bone loss, soft tissue contractures were the most commonly reported intraoperative challenges. There were five cases(9%) that were complicated by intra-operative patellar tendon *** The findings support the use of TKA in patients with PDB. The post-operative functional outcomes are largely similar to other patients, however there are specific perioperative challenges that have been highlighted, in particular the high risk for patellar tendon avulsion.

关键词： Total knee arthroplasty Paget’s disease of bone Revision Loosening Paget’s disease

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Managing extremely distal periprosthetic femoral supracondylar fractures of total knee replacements-a new PHILOS-ophy

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World Journal of Orthopedics 2017年第10期8卷 809-813页

作者： Kevin J Donnelly Adam Tucker Angel Ruiz Neville W Thompson department of trauma and orthopaedic surgery Altnagelvin Hospital

We report two cases where a proximal humeral locking plate was used for the fixation of an extremely distal, type Ⅲ peri-prosthetic femoral fractures in relation to a total knee replacement(TKR). In each case there was concern regarding the fixation that could be achieved using the available anatomic distal femoral plates due to the size and bone quality of distal fragment. The design of the Proximal Humeral Internal Locking System(PHILOS) allows nine 3.5-mm locking screws to be placed over a small area in multiple directions. This allowed a greater number of fixation points to be achieved in the distal fragment. Clinical and radiological short-term follow-up(6-12 mo) has been satisfactory in both cases with no complications. We suggest the use of this implant for extremely distal femoral fractures arising in relation to the femoral component of a TKR.

关键词： Distal Femoral Periprosthetic Fracture PHILOS Open reduction and internal fixation

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Windsurfing vs kitesurfing:Injuries at the North Sea over a 2-year period

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World Journal of Orthopedics 2016年第12期7卷 814-820页

作者： Christiaan JA van Bergen Joris P Commandeur Rik IK Weber Daniel Haverkamp Roelf S Breederveld department of orthopaedic surgery Spaarne Gasthuis department of surgery Luzerner Kantonsspital department of orthopaedic surgery Slotervaartziekenhuis department of trauma surgery Red Cross Hospital

AIM To analyze all windsurfing and kitesurfing(kiteboarding) injuries presented at our coastal hospital over a 2-year period. METHODS Twenty-five windsurfers(21 male; aged 31 ± 8 years) and 32 kitesurfers(23 male; aged 29 ± 11 years) presented at our hospital during the 2-year study period. Various injury data were recorded,including transport to hospital and treatment. After a median follow-up of 16 mo(range,7-33 mo),18 windsurfers(72%) and 26 kitesurfers(81%) completed questionnaires on the trauma mechanisms,the use of protective gear,time spent on windsurfing or kitesurfing,time to return to sports,additional injuries,and chronic disability. RESULTS Most patients sustained minor injuries but severe injuries also occurred,including vertebral and tibial plateau fractures. The lower extremities were affected the most,followed by the head and cervical spine,the upperextremities,and the trunk. The injury rates were 5.2 per 1000 h of windsurfing and 7.0 per 1000 h of kitesurfing(P = 0.005). The injury severity was the same between groups(P = 1.0). Less than 30% of the study population used protective gear. Kitesurfers had a higher number of injuries,and required transport by ambulance,inpatient hospital stay and operative treatment more often than windsurfers,but these differences were not statistically significant(P > 0.05). The median time to return to windsurfing and kitesurfing was 5 and 4 wk,respectively(P = 0.79). Approximately one-third of the patients in each group experienced chronic *** Kitesurfing results in a significantly higher injury rate than windsurfing in the same environmental conditions but the severity of the injuries does not differ.

关键词： General sports trauma Extreme sports Surfing Epidemiology Prevention

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Cost-analysis of inpatient and outpatient parenteral antimicrobial therapy in orthopaedics: A systematic literature review

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World Journal of Clinical Cases 2019年第14期7卷 1825-1836页

作者： Christoph Kolja Boese Philipp Lechler Michael Frink Michael Hackl Peer Eysel Christian Ries department of orthopaedic and trauma surgery University Hospital of CologneCologne 50931Germany Clinic for trauma and Hand surgery KreisklinikenAltotting 84503Germany Center for orthopaedics and trauma surgery University Hospital Giessen and MarburgMarburg 35043Germany

BACKGROUND Increasing numbers of total joint arthroplasties and consecutive revision surgery are associated with the risk of periprosthetic joint infections (PPJI). Treatment of PPJI is complex and associated with immense socio-economic burden. One treatment aspect is parenteral antiinfective therapy, which usually requires an inpatient setting [Inpatient parenteral antibiotic therapy (IPAT)]. An alternative is outpatient parenteral treatment [Outpatient parenteral antibiotic therapy (OPAT)]. To conduct a health economic cost-benefit analysis of OPAT, a detailed cost analysis of IPAT and OPAT is required. So far, there is a lack of knowledge on the health economic effects of IPAT and OPAT for PPJI. AIM To review an economic comparison of IPAT and OPAT. METHODS A systematic literature review was performed through Medline following the PRISMA guidelines. RESULTS Of 619 identified studies, 174 included information of interest and 21 studies were included for quantitative analysis of OPAT and IPAT costs. Except for one study, all showed relevant cost savings for OPAT compared to IPAT. Costs for IPAT were between 1.10 to 17.34 times higher than those for OPAT. CONCLUSION There are only few reports on OPAT for PPJI. Detailed analyses to support economic or clinical guidelines are therefore limited. There is good clinical evidence supporting economic benefits of OPAT, but more high quality studies are needed for PPJI.

关键词： Antibiotic therapy Outpatient parenteral antibiotic therapy Inpatient parenteral antibiotic therapy Cost analysis Periprosthetic joint infection Parenteral

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