Influence of acute ethanol intoxication on neuronal apoptosis and Bcl-2 protein expression after severe traumatic brain injury in rats

To study the influence and mechanism of acute ethanol intoxication (AEI) on rat neuronal apoptosis after severe traumatic brain injury (TBI).Methods:Ninety-six Sprague-Dawley rats were randomly divided...     

Limited role of inducible nitric oxide synthase in blood-brain barrier function after experimental subarachnoid hemorrhage

Excessive nitric oxide (NO) produced by inducible nitric oxide synthase (iNOS) may play a pivotal role in blood-brain barrier (BBB) breakdown following subarachnoid hemorrhage (SAH). We investigated if the inhibition of iNOS could reduce BBB breakdown and cerebral edema, thereby leading to improved outcome 24 h after SAH. Forty male rats were assigned to three groups: control, SAH, and treatment groups. SAH was induced by perforating the bifurcation of the internal carotid artery. The neurological score and the mortality were evaluated 24 h after the surgery. The expression of iNOS, the concentration of NO metabolites, morphological changes in neuronal cells, water content, and IgG leakage were also evaluated. The expression of iNOS, as well as the concentration of NO metabolites, was elevated after SAH. Treatment with p-Toluenesulfonate decreased both the expression of iNOS and the concentration of NO metabolites. However, there was no significant change in water content, BBB disruption, or morphological findings between the SAH group and the treatment group. Furthermore no significant differences in neurological score or mortality were observed. The iNOS inhibitor failed to reduce BBB breakdown, brain edema, and neuronal cell death and failed to improve the neurological score and the mortality 24 h after SAH.     

Changes in autophagy proteins in a rat model of spinal cord injury

Objective：Autophagy is involved in several neurodegenerative diseases and recently its role in acute brain injury has won increasing interest.Spinal cord injuries （SCIs） often lead to permanent neurological deficit.Therefore,in this study,we examined the profiles of autophagy-linked proteins （MAP-LC3） after SCI to investigate whether the expression of autophagy contributes to neurological deficit after SCI.Methods：Adult female Sprague-Dawley rats were used and randomly divided into control and SCI groups.All the rates received laminectomy at T8-T10 level.Those in the SCI group received additional exposure of the dorsal surface of the spinal cord,followed by a weightdrop injury.Thereafter we investigated the expression levels of MAP-LC3,beclin-1,Cathepsin D and the beclin-1-binding protein bcl-2 by western blot analysis at 12 h,24 h,3 d,7 d,21 d and 28 d.One-way ANOVA with Tukey post hoc test was used to compare data between groups.Results：We observed significant increase in the level of LC3 （LC3-Ⅱ/LC3-Ⅰ） at 3 d and 7 d after SCI when compared with the sham group.While the level of beclin-1 and ratio of beclin-1/bcl-2 was found to have increased from 12 h to 24 h after injury.Cathepsin D expression was also elevated at 7 d （P＜0.01）.Conclusion：Based on the above mentioned data,we proposed that autophagy plays a role in the manifestation of cell injury following SCI.     

The association between plasma homocysteine levels, methylation capacity and incident osteoporotic fractures

BackgroundAn elevated level of plasma homocysteine (Hcy) is a known risk factor for osteoporotic fractures. In addition, Hcy is related to DNA-methylation metabolism. To determine whether the association between Hcy and fractures is explained by an altered methylation capacity, we investigated the associations between levels of s-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH) and fracture risk.MethodsWe studied 503 females aged 55 years and over from the Rotterdam Study (RS) in whom plasma Hcy, SAM and SAH levels were measured. Bone mineral density (BMD) at the hip was assessed using DXA. Incident fractures were recorded over a mean period of 7.0 years. Cox proportional hazards analysis and linear regression were used to assess relationships between plasma metabolite levels, incident osteoporotic fractures and BMD.ResultsOver a total of 3502 person-years of follow-up, 103 subjects sustained at least one osteoporotic fracture. Whereas incidence of osteoporotic fractures was associated with quartiles of Hcy (p = 0.047), it was not associated with quartiles of SAM, SAH or SAM/SAH-ratio (all p for trend > 0.6). Stepwise linear regression showed that SAM/SAH-ratio, but not Hcy, was independently associated with hip BMD (β = 0.073, p = 0.025).ConclusionSince SAM, SAH and SAM/SAH-ratio were not associated with osteoporotic fractures, alterations in methylation capacity most likely do not appear to be an important factor in the association between Hcy and fractures.     

Differences in childhood adiposity influence upper limb fracture site

IntroductionAlthough it has been suggested that overweight and obese children have an increased risk of fracture, recent studies in post-menopausal women have shown that the relationship between obesity and fracture risk varies by fracture site. We therefore assessed whether adiposity and overweight/obesity prevalence differed by upper limb fracture site in children.MethodsHeight, weight, BMI, triceps and subscapular skinfold thickness (SFT) were measured in children aged 3–18 years with an acute upper limb fracture. Data was compared across three fracture sites (hand, forearm and upper arm/shoulder [UA]), and to published reference data.Results401 children (67.1% male, median age 11.71 years, range 3.54–17.27 years) participated. 34.2%, 50.6% and 15.2% had fractures of the hand, forearm and UA, respectively. Children with forearm fractures had higher weight, BMI, subscapular SFT and fat percentage z-scores than those with UA fractures (p < 0.05 for all). SFT and fat percentage z-scores were also higher in children with forearm fractures compared to hand fractures, but children with hand and UA fractures did not differ. Overweight and obesity prevalence was higher in children with forearm fractures (37.6%) than those with UA fractures (19.0%, p = 0.009). This prevalence was also higher than the published United Kingdom population prevalence (27.9%, p = 0.003), whereas that of children with either UA (p = 0.13) or hand fractures (29.1%, p = 0.76) did not differ. These differences in anthropometry and overweight/obesity prevalence by fracture site were evident in boys, but not present in girls.ConclusionMeasurements of adiposity and the prevalence of overweight/obesity differ by fracture site in children, and in particular boys, with upper limb fractures.     

Activation of AMP-activated protein kinase protects against homocysteine-induced apoptosis of osteocytic MLO-Y4 cells by regulating the expressions of NADPH oxidase 1 (Nox1) and Nox2

BackgroundElevated plasma homocysteine (Hcy) level is associated with the risk of osteoporotic fracture. While Hcy increases oxidative stress, AMP-activated protein kinase (AMPK) activation ameliorates it. This study aimed to investigate whether Hcy induces apoptosis of osteocytic MLO-Y4 cells through regulating expressions of oxidant and anti-oxidant enzymes and determine the effects of AMPK activation by 5-aminoimidazole-4-carboxamide-1-β-d-ribofuranoside (AICAR) and metformin on the Hcy-induced apoptosis of the cells.ResultsDNA fragment ELISA and TUNEL staining assays showed that Hcy treatments (0.1–5.0 mM) induced apoptosis of MLO-Y4 cells in a dose-dependent manner. The detrimental effect of Hcy was partly but significantly reversed by an antioxidant (N-acetylcysteine) and NADPH oxidase (Nox) inhibitors (apocynin and diphenyleneiodonium). In addition, treatment with AICAR (0.05–0.1 mM) and metformin (10–100 μM) ameliorated Hcy-induced apoptosis of the cells. The favorable effect of metformin on Hcy-induced apoptosis was completely canceled by an AMPK inhibitor Ara-A. Hcy increased the expression levels of Nox1 and Nox2, while it had no effects on the expressions of Nox4 or the anti-oxidant enzymes, superoxide dismutase 1 and 2. Hcy-induced increases in the expressions of Nox1 and Nox2 decreased significantly by treatments with AICAR.ConclusionThese findings suggest that Hcy induces apoptosis of osteocytes by increasing the expressions of Nox1 and Nox2, and AMPK activation by AICAR and metformin effectively prevents the detrimental reactions. Thus, AMPK activation may be a potent therapeutic candidate for preventing Hcy-induced osteocyte apoptosis and the resulting bone fragility.     

Blood-brain barrier permeability changes after experimental subarachnoid hemorrhage.

Basic mechanisms underlying cerebrovascular permeability responses to subarachnoid hemorrhage (SAH) are still to be defined in detail. Previous investigations examining the occurrence of blood-brain barrier (BBB) breakdown after SAH in the experimental setting have yielded conflicting results. In a rat model of SAH, we assessed BBB changes by means of the quantitative [14C]-alpha-aminoisobutyric acid technique. Experiments were carried out on the second day post-SAH. In blood-injected rats [14C]-alpha-aminoisobutyric acid transport across the BBB increased significantly in cerebral cortices and cerebellar gray matter, averaging 1.3 to 1.5 times control values. The present data indicate that SAH induces well-defined changes in BBB function, possibly involved in the pathogenesis of post-SAH cerebral dysfunction in humans. Results reported here have also potential clinical implications for the management of aneurysm patients.     

The effect of induced hypertension on neurological outcome in forebrain ischaemia model in rats

IntroductionThe present study investigated the effects of induced hypertension on hippocampal cell death after forebrain ischaemia in rats.Materials and methodsIn this study, forebrain ischaemia was induced in 20 Sprague-Dawley rats by clamping the bilateral common carotid arteries to induce systemic hypotension for 8 min. All rats then underwent reperfusion during which the induced hypertension group (n = 10) received intermittent intravenous injections of phenylephrine (5 μg) to maintain their mean arterial blood pressure at 20 mmHg above baseline for 10 min and the control group (n = 10) did not receive any treatment. In both groups, the numbers of viable and apoptotic neuronal cells in the cornu ammonis 1 (CA1) area of the hippocampus were evaluated 7 days after the induction of ischaemia.ResultsThe mean percentage of viable neuronal cells was higher in the induced hypertension group than in the control group (35% vs. 26%, respectively; p = 0.004), but there was no significant difference in the proportion of apoptotic neuronal cells between the groups (57% vs. 43%, respectively; p = 0.165).ConclusionsInduced hypertension significantly attenuated necrotic cell death in the hippocampal CA1 area, but apoptotic cell death was not affected.     

The contribution of periapical nerve block in transrectal ultrasound-guided prostate biopsy: Results from a prospective randomized trial

ObjectivePeriprostatic nerve block has been shown to be the most effective method to reduce pain during transrectal ultrasound (TRUS) guided prostate biopsy, but the ideal technique remains controversial. The aim of this study was to compare pain control between bilateral basal block (BBB) alone and BBB combined with periapical nerve block (PNB).Patients and methodsFrom November 2007 to May 2009, 182 consecutive patients with abnormally elevated serum prostate-specific antigen (PSA) or suspicious digital rectal examination (DRE) underwent TRUS-guided needle biopsy of the prostate. The patients were prospectively randomized after informed consent had been obtained. Group 1 (n = 90) underwent bilateral basal block (BBB) with periprostatic infiltration of 8 ml 1% lidocaine into the neurovascular bundle at the prostate-seminal vesicle junction on each side. Group 2 (n = 92) underwent BBB with the addition of periapical nerve block (PNB) using 2 ml 1% lidocaine per side. A visual analog scale (VAS) was used to evaluate the patient's perception of pain during the biopsy.ResultsThe mean patient age was 64.6 ± 8.2 years and the average VAS was 1.9 ± 2.0. The mean VAS was lower in Group 2 compared with Group 1, 1.6 ± 1.9 versus 2.2 ± 2.0 (p = 0.026). In the subgroup aged 56–65 years the mean VAS was 1.26 ± 0.6 in Group 1 versus 2.46 ± 0.5 in Group 2 (p = 0.001), and in the subgroup aged 66–87 years it was 1.41 ± 0.5 in Group 1 versus 1.66 ± 0.75 in Group 2 (p = 0.554).ConclusionsBBB combined with PNB seems to be more effective to BBB alone to reduce pain during TRUS-guided prostate biopsy and may be of maximum benefit for younger patients.     

Regular exercise limits alcohol effects on trabecular,cortical thickness and porosity,and osteocyte apoptosis in the rat

IntroductionExcessive alcohol consumption is known to be a cause of secondary osteoporosis whereas physical activity is recommended in prevention of osteoporosis. This study was designed to analyze the effects of physical exercise on bone parameters in chronic alcohol-fed rats.MethodsForty-eight male Wistar rats were divided in four groups: Control (C), Alcohol (A), Exercise (E) and Alcohol + Exercise (AE). A and AE groups drank a solution composed of ethanol and water (35% volume/volume for 17 weeks). E and AE groups were submitted to treadmill training for 14 weeks (60 min/day, 5 times/week). Bone mineral density (BMD) was assessed by DXA, the trabecular and cortical microarchitectural parameters by microCT and serum osteocalcin, NTx and leptin concentrations by ELISA assays. Bone mechanical parameters were evaluated through mechanical testing. Osteocyte apoptosis was analyzed with cleaved caspase-3 immunostaining.ResultsAlcohol-fed rats had significantly lower body weight (?28%), fat (?46%) and lean mass (?25%) compared to controls. BMD (?8%), trabecular (?12%) and cortical thickness (?27%) were significantly lower with alcohol whereas porosity (+38%) and pore number (+42%) were higher. Exercise combined with alcohol prevented lower Tb.Th (+20%), Ct.Th (+30%), stress (+26%) and higher Ct.Po (?24%) and osteocyte apoptosis (?91%) compared to A. However, WB BMD (?4%) and femur BMD were still lower in AE versus C.ConclusionRegular physical activity has beneficial effects on some microarchitectural parameters in alcohol-fed rats. However, regular treadmill exercise does not compensate for the effects of heavy chronic alcohol consumption on whole body bone density.     

Spinal schwannoma causes acute subarachnoid haemorrhage: A case report and literature review

BackgroundSpinal schwannomas that arise from spinal nerve root sheaths are the most common intradural extramedullary spinal tumours and are often accompanied by nerve roots or spinal cord irritation symptoms. The phenomenon of spinal schwannoma causing subarachnoid haemorrhage (SAH) is rare, with ependymoma of the conus medullaris accounting for most cases.Case reportA 45-year-old man was admitted to our hospital due to progressive lower limb weakness and sudden back pain after hard physical work. The patient had not been able to walk for 2 hours upon admission. An emergency magnetic resonance imaging (MRI) scan showed that the spinal cord at the C6-T4 level was severely compressed by a subdural mass. During the emergency operation, exploration of the dura and arachnoid mater revealed a fresh blood clot covering a tumour located on the ventral side of the spinal cord. The size of the tumour was approximately 3 × 2 × 1 cm without adhesion to the surrounding tissue, but the drainage vein was ruptured. Postoperative pathology showed that the tumour was a schwannoma with areas of fresh haemorrhage and focal necrosis.ConclusionsSpinal schwannomas presenting with SAH are rare events. In our opinion, spinal pathology with rapid progression of neurological symptoms requires early diagnosis and emergency management. Complete excision of haemorrhagic tumours is the goal of treatment to prevent recurrence, which can effectively avoid irreversible damage to the spinal cord resulting from spinal cord compression.     

French collaborative group series on giant intracranial aneurysms: Current management

ObjectivesGiant intracranial aneurysms represent a major therapeutic challenge for each surgical team. The aim of our study was to extensively review the French contemporary experience in treating giant intracranial aneurysms in order to assess the current management.Patients and methodsThis retrospective multicenter study concerned consecutive patients treated for giant intracranial aneurysms (2004–2008) in different French university hospitals (Bordeaux, Caen, Clermont-Ferrand, Lille, Lyon, Nice, Paris-Lariboisière, Rouen et Toulouse). Different variables were analyzed: the diagnostic circumstances, the initial clinical status based on the WFNS scale, aneurysmal features and exclusion procedure. At 6 months, the outcome was evaluated according to the modified Rankin Scale (mRS): favorable (mRS 0-2) and unfavorable (mRS 3-6). A multivariate logistic regression model included all the independent variables with P < 0.25 in the univariate analysis (P < 0.05).ResultsA total of 79 patients with a mean age of 51.5 ± 1.6 years (median: 52 years; range: 16–79) were divided into two groups, with the ruptured group (n = 26, 32.9%) significantly younger (P < 0.05, Student's-t-test) than the unruptured group (n = 53, 67.1%). After SAH, the initial clinical status was good in 12 patients (46.2%), and in the unruptured group, the predominant diagnosis circumstance was a pseudo-tumor syndrome occurring in 22 (41.5%). The first procedure of aneurysm treatment in the global population was endovascular in 42 patients (53.1%), microsurgical in 29 (36.7%) and conservative in 8 (10.2). An immediate neurological deterioration was reported in 38 patients (48.1%) after endovascular treatment in 19 (45.2% of endovascular procedures), after miscrosurgical in 15 (51.7% of microsurgical procedures) and after conservative in 4 (the half). At 6 months, the outcome was favorable in 45 patients (57%) and after multivariate analysis, the predictive factors of favorable outcome after management of giant cerebral aneurysm were the initial good clinical status in cases of SAH (P < 0.002), the endovascular treatment (P < 0.005), and the absence of neurological deterioration (P < 0.006). The endovascular procedure was obtained as a predictive factor because of the low risk efficacy of indirect procedures, in particular a parent vessel occlusion.ConclusionThe overall favorable outcome rate concerned 57% of patients at 6 months despite 53.8% of poor initial clinical status in cases of rupture. The predictive factors for favorable outcome were good clinical status, endovascular treatment and the absence of postoperative neurological deterioration. Endovascular treatment should be integrated into the therapeutic armenmatarium against giant cerebral aneurysms but the durability of exclusion should be taken into account during the multidisciplinary discussion by the neurovascular team.     

Temsirolimus improves cytotoxic efficacy of cisplatin and gemcitabine against urinary bladder cancer cell lines

ObjectivesTo analyze the cytotoxic action of temsirolimus using 3 established human bladder cancer cell lines and to assess whether temsirolimus potentiates the anticancer activity of gemcitabine and cisplatin.MethodsTemsirolimus (500, 1,000, 2,000, and 4,000 nM), in isolation, and combined with gemcitabine (100 nM) and cisplatin (2.5 µg/ml), was given to 5637, T24, and HT1376 bladder cancer cell lines. Cell proliferation, autophagy, early apoptosis, and cell cycle distribution were analyzed after a 72-hour period. The expression of mammalian target of rapamycin baseline, Akt, and their phosphorylated forms, before and after treatment with temsirolimus, was evaluated by immunoblotting.ResultsTemsirolimus slightly decreased the bladder cancer cell proliferation in all 3 cell lines. No significant differences in the expression of mammalian target of rapamycin, Akt, and their phosphorylated forms because of temsirolimus exposure were found in the 3 cell lines. As part of a combined regime along with gemcitabine, and especially with cisplatin, there was a more pronounced antiproliferative effect. This pattern of response was similar to the other parameters analyzed (increased autophagy and apoptosis). Also, in the combined regime, an enhanced cell cycle arrest in the G0/G1 phase was observed. The non–muscle invasive 5637 bladder cancer cell line was most sensitive to both combinations.ConclusionsTemsirolimus makes a moderate contribution in terms of cell proliferation, apoptosis, and autophagy. However, it does potentiate the activity of gemcitabine and particularly cisplatin. Therefore, cisplatin- or gemcitabine-based chemotherapy regimen used in combination with temsirolimus to treat bladder cancer represents a novel and valuable treatment option, which should be tested for future studies in urinary bladder xenograft models.     

UNC-51-like kinase 1 expression in radical nephrectomy specimens as a predicting factor of progression-free survival in patients with metastatic renal cell carcinoma treated with mammalian target of rapamycin inhibitors

BackgroundTo analyze basal expression levels of multiple components in the autophagy pathway in radical nephrectomy specimens from patients with metastatic renal cell carcinoma (mRCC) treated with mammalian target of rapamycin (mTOR) inhibitors, to identify factors predicting susceptibility to these agents.MethodsThis study included 48 consecutive patients undergoing radical nephrectomy, who were diagnosed with mRCC and subsequently treated with either everolimus or temsirolimus. Expression levels of 5 major molecular markers involved in the signaling pathway associated with autophagy, including autophagy-related protein (Atg)5, Atg9, Beclin1, microtubule-associated protein light chain 3, and UNC-51-like kinase 1 (ULK1), were measured by immunohistochemical staining of primary renal cell carcinoma specimens.ResultsDuring the observation period of this study (median = 16.2 mo), 36 patients developed disease progression, with a median progression-free survival (PFS) period of 7.6 months. Of several factors examined, bone metastasis, liver metastasis, and ULK1 expression were shown to have significant effects on the response to mTOR inhibitors. PFS was significantly correlated with the expression level of ULK1 in addition to bone and liver metastases on univariate analysis. Of these significant factors, ULK1 expression and liver metastasis were independently associated with PFS on multivariate analysis.ConclusionsIt may be useful to consider expression levels of potential molecular markers in the autophagy pathway, particularly ULK1, in addition to conventional parameters, when selecting patients with mRCC who are likely to benefit from treatment with mTOR inhibitors.     

Effects of a moderately high-protein diet and interval aerobic training combined with strength-endurance exercise on markers of bone metabolism,microarchitecture and turnover in obese Zucker rats

BackgroundWeight loss is a public health concern in obesity-related diseases such as metabolic syndrome, and the protein level of the diets seem to be crucial for the development and maintenance of bone. The nature of exercise and whether exercise in combination with moderately high-protein dietary interventions could protect against potential bone mass deficits remains unclear.ObjectivesTo investigate the effects of a moderately high-protein diet and interval aerobic training combined with strength-endurance exercise (IASE) protocol on bone status, and to assess potential interaction effects (i.e. diet*IASE).MethodsMale Zucker fatty rats were randomized distributed into 4 groups (n = 8): normoprotein + sedentary; normoprotein + exercise; moderately high-protein + sedentary, and moderately high-protein + exercise. Training groups conducted an IASE program, 5 days/week for 2 months. Markers of bone metabolism were measured in plasma. Parameters of bone mass and 3D outcomes for trabecular and cortical bone microarchitecture were assessed by micro-computed tomography.ResultsFemur length, plasma osteocalcin, sclerostin, osteoprotegerin, receptor activator of nuclear factor kappa-B ligand, insulin, leptin, PTH, uric acid and urinary phosphorus levels were lower in the moderately high-protein compared to the normoprotein groups (all, p < 0.05), whereas plasma alkaline phosphatase, aspartate aminotransferase, alanine transaminase, and urinary uric acid concentrations, and cortical total volume (TV) and bone volume (BV) were higher in the moderately high-protein (all, p < 0.01). Final body weight and alkaline phosphatase levels were lower in the exercise compared to the sedentary (both, p < 0.05), whereas femur length and weight, aminoterminal propeptides of type I procollagen and C-terminal telopeptides of type I collagen concentrations, and cortical TV and BV were higher in the exercise compared to the sedentary groups (all, p < 0.05).ConclusionThe combination of interventions may be effective to enhance trabecular bone microarchitecture and BMD, and has a partial impact on cortical bone in obese rats. Nevertheless, they do not induce any alteration on the bone turnover markers.     

Metal artifact reduction for intracranial projectiles on post mortem computed tomography

PurposeTo compare the image quality of cranial post-mortem computed tomography (CT) obtained with and without projection-based single-energy metal artifact reduction (SEMAR) in cadavers with intracranial metallic ballistic projectiles.Materials and methodsFrom January 2017 to January 2018, cadavers with ballistic projectile head wounds with metal fragments and without massive head destruction were investigated using post-mortem CT. All subjects underwent CT using a conventional iterative reconstruction (IR) and SEMAR. To evaluate the impact of metallic artifacts, the total intracranial area (TA), non-interpretable zone (NIZ), disturbed interpretation zone (DZ), and artifact total surface (ATS) were delineated. Two independent readers identified extra-axial hemorrhage (EAH) and subarachnoid hemorrhage (SAH). Autopsy reports were used as the standard of reference.ResultsEleven corpses (10 males, 1 female; mean age, 62.8 ± 17.9 [SD] years) were evaluated. SEMAR showed a significant decrease in the ATS ratio with respect to conventional IR (72.1 ± 26.1 [SD] % [range: 26.8-99.1] vs. 86.4 ± 17.8 [SD] % [range: 37.2-100]; P < 0.001) and NIZ/TA ratios (11.6 ± 8.26% [range: 0.95–33.4] versus 42.5 ± 30.5% [range: 3.86–100]; P < 0.001). The interobserver reproducibility in diagnosing EAH and SAH was excellent with conventional IR (0.82) and good with SEMAR (0.75). SEMAR reduced uncertain diagnoses of EAH in 7 subjects for Reader 1 and in 6 for Reader 2, but did not influence the diagnosis of SAH for either reader.ConclusionSEMAR reduces the influence of metallic artifacts and increases the confidence with which the diagnosis of EAH can be made on post-mortem CT.     

A survey of international antisepsis procedures for neuraxial catheterisation in labour

BackgroundNeuraxial analgesia during labour is a mainstay of anaesthetic practice globally. Despite the potential for significant neurological and infectious complications, international antisepsis practices for neuraxial anaesthesia vary widely.AimsThe primary aim of this study was to clarify international antisepsis practices prior to neuraxial analgesia in labour. The secondary aim was to determine an approximate international incidence of neuraxial infections and neurological complications secondary to neuraxial analgesia techniques in labour.Materials and methodsHeads of Departments of Anaesthesiology were invited to complete an online questionnaire exploring antisepsis practices and complications of neuraxial catheterisation. Data from 151 institutions in 13 countries were collected over 11 months.ResultsData were collected for an estimated 6 008 540 deliveries and 3 770 800 neuraxial catheterisations. The average annual birth rate per institution was 3979 births, with an average of 2497 neuraxial catheterizations (representing 62.8% of deliveries). Forty-nine percent of responders reported always wearing sterile gowns for the procedure, whereas 47.7% never wear gowns. Chlorhexidine was used by 88.1% of those surveyed, and 96.7% always wore facemasks. Thirty-four percent of institutions reported infectious complications over a 10-year period. Ninety neuraxial infections were estimated, giving an approximate incidence of 1:41 898 catheterisations (2.39 infections per 100 000 catheterisations). A total of 202 neurological complications were reported, with an approximate incidence of 1:18 667 catheterisations (5.36 neurological complications per 100 000 catheterisations).ConclusionThe survey demonstrated marked variation in aseptic practice between both responding centres and countries. The incidence of infectious and neurological complications secondary to neuraxial catherisation in labour has been approximated.     

Magnetic resonance imaging findings of chronic plantar fasciitis before and after extracorporeal shock wave therapy

IntroductionThe objective of this study is to examine the relationships between treatment outcome and changes in magnetic resonance (MR) imaging findings after extracorporeal shock wave therapy (ESWT) for chronic plantar fasciitis.MethodsThe subjects were 23 feet of 23 patients of refractory plantar fasciitis. The mean age was 53.7 years. The thickness of the plantar fascia (PF) and findings of a high-signal intensity area (HSIA) inside the PF, edema around the PF, and bone marrow edema (BME) of the calcaneus were investigated on MR images. The Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and a visual analogue scale (VAS) were used. Correlations between an improvement in symptoms and one in the MRI findings were analyzed.ResultsThe mean thickness of the PF was 4.4 ± 1.6 mm before ESWT and 4.6 ± 1.8 mm six months after ESWT. After ESWT, there was a decrease in the numbers of feet showing HSIA inside the PF from 15 to 6, in edema around the PF from 16 to 2, and in BME of the calcaneus from 11 to 4. Clinical outcomes improved with ESWT from 70.3 ± 5.5 to 88.6 ± 9.1 points (JSSF), 74.1 ± 25.3 to 28.5 ± 24.4 points (VAS), respectively. Improvements in symptoms according to the JSSF and VAS scores and improvement in edema around the PF on MR images showed a significant correlation.ConclusionsEdema around the PF improved significantly in association with an improvement in symptoms after ESWT.     

Effect of hypothermia on apoptosis in traumatic brain injury and hemorrhagic shock model

IntroductionThe neuroprotective mechanisms of therapeutic hypothermia against trauma-related injury have not been fully understood yet. In this study, we aimed to investigate the effects of therapeutic hypothermia on biochemical and histopathological markers of apoptosis using Traumatic brain injury (TBI) and hemorrhagic shock (HS) model.MethodsA total of 50 male albino-wistar rats were divided into five groups: Group isolated TBI, Group NT (HT + HS + normothermia), Group MH (HT + HS + mild hypothermia), Group MoH (HT + HS + moderate hypothermia) and Group C (control). Neurological deficit scores were assessed at baseline and at 24 h. The rats were, then, sacrificed to collect serum and brain tissue samples. Levels of Caspase-3,6,8, proteoglycan-4 (PG-4), malondialdehyde (MDA), and nitric oxide (NO) were measured in serum and brain tissue samples. Histopathological examination was performed in brain tissue.ResultsThere were significant differences in the serum levels of Caspase-3 between Group NT and Group C (p = 0.018). The serum levels of Caspase-6 in Group NT (0.70 ± 0.58) were lower than Group MH (1.39 ± 0.28), although the difference was not statistically significant (p = 0.068). There were significant differences in the brain tissue samples for Caspase-3 levels between Group NT and Group C (p = 0.049). A significant difference in the Caspase-8 brain tissue levels was also observed between Group NT and Group C (p = 0.022). Group NT had significantly higher scores of all the pathological variables (for edema p < 0.017; for gliosis p < 0.001; for congestion p < 0.003, for hemorrhage p < 0.011) than Group C.ConclusionOur study results suggest that hypothermia may exert its neuroprotective effects by reducing markers of apoptotic pathway, particularly Caspase-3 on TBI and HS.     

Effects of ovariectomy on the changes in microarchitecture and material level properties in response to hind leg disuse in female rats

BackgroundOvariectomy (OVX) and immobilization are known to decrease bone mineral density and alter its microarchitecture. Their effects on the material level properties of bone, a determinant of bone strength, are still largely unknown. We investigated the effect of OVX and/or disuse achieved by sciatic neurectomy (NX) in 6-month-old Sprague Dawley female rats.MethodsAt baseline, animals underwent OVX or sham operation. At week 16, NX was performed on the left hindlimb while the right hindlimb was sham-operated. All animals were sacrificed at week 40. Proximal tibiae and vertebral bodies (L4) were evaluated by micro-computed tomographic morphometry (μCT). Material level properties (elastic modulus, hardness, and dissipated energy) were evaluated by a nanoindentation test.ResultsAt the proximal tibia, OVX and NX decreased relative bone volume, the former mainly through a reduction in trabecular number, and the latter through a decrease in trabecular thickness. NX decreased modulus (? 10%; p < 0.001) and dissipated energy (? 13.3%, p < 0.001) in cortical bone, and modulus (? 16.8%, p = 0.004), hardness (? 29.3%, p = 0.004), and dissipated energy (? 17.7%, p = 0.01) in trabecular bone, while OVX decreased cortical bone dissipated energy (? 14.6%, p < 0.001) and trabecular bone hardness (? 19.4%, p = 0.05). In the vertebral body, OVX altered mainly the trabecular microarchitecture and nanoindentation variables.ConclusionThese results show that NX with and without OVX markedly alter material level properties in addition to an alteration of bone microarchitecture, although not in the same manner.