Modern MRI Diagnostics of Upper-Extremity-Related Nerve Injuries—A Prospective Multi-Center Study Protocol for Diagnostics and Follow Up of Peripheral Nerve Injuries

(1) Background: Peripheral nerve injuries are severe injuries with potentially devastating impairment of extremity function. Correct and early diagnosis as well as regular regeneration observation is of utmost importance for individualized reconstruction and the best possible results. Currently, diagnoses and follow-up examinations are based on clinical examinations supported with electroneurography, which often causes delays in treatment and can result in impaired healing. However, there is currently no diagnostic device that can reliably correlate the anatomic–pathological parameters with the functional–pathological changes initially and during therapy. With new technologies such as MR neurography (MRN), precise visualization of potential nerve damage and visualization of the reinnervation processes is assumed to accelerate clinical decision making and accompaniment of individualized treatment. (2) Methods/Design: This prospective clinical study will examine 60 patients after peripheral nerve lesion aged 18–65 years from trauma timepoint onward. Patients should be observed over a period of 18–24 months with regular clinical examinations, electroneurography, and ultrasound to compare the potential of MRN to current gold-standard diagnostic tools. Furthermore, 20 patients with the same inclusion criteria stated above, with an internal fixation and osteosyntheses of humerus fractures, will be examined to determine the visibility of peripheral nerve structures in close proximity to metal. (3) Discussion: Peripheral nerve injuries are often accompanied with severe, expensive, and long-lasting impairment of extremity function. An early and precise diagnosis of the nerve lesion, as well as the healing course, is crucial to indicate the right therapy as soon as possible to save valuable time for nerve regeneration. Here, new technologies such as MRN aim to visualize nerve injuries on fascicular level, providing not only early diagnosis and therapy decisions, but also providing a precise tool for monitoring of reinnervation processes. As severe injuries of a nerve are often accompanied with bone fractures and internal fixation, we also aim to evaluate the visualization feasibility of nerves in close proximity to metal, and ultimately improve the outcome and extremity function of patients after a peripheral nerve injury

Retrograde tracing and toe spreading after experimental autologous nerve transplantation and crush injury of the sciatic nerve: a descriptive methodological study

Abstract Evaluation of functional and structural recovery after peripheral nerve injury is crucial to determine the therapeutic effect of a nerve repair strategy. In the present study, we examined the relationship between the structural evaluation of regeneration by means of retrograde tracing and the functional analysis of toe spreading. Two standardized rat sciatic nerve injury models were used to address this relationship. As such, animals received either a 2 cm sciatic nerve defect (neurotmesis) followed by autologous nerve transplantation (ANT animals) or a crush injury with spontaneous recovery (axonotmesis; CI animals). Functional recovery of toe spreading was observed over an observation period of 84 days. In contrast to CI animals, ANT animals did not reach pre-surgical levels of toe spreading. After the observation period, the lipophilic dye DiI was applied to label sensory and motor neurons in dorsal root ganglia (DRG; sensory neurons) and spinal cord (motor neurons), respectively. No statistical difference in motor or sensory neuron counts could be detected between ANT and CI animals. In the present study we could indicate that there was no direct relationship between functional recovery (toe spreading) measured by SSI and the number of labelled (motor and sensory) neurons evaluated by retrograde tracing. The present findings demonstrate that a multimodal approach with a variety of independent evaluation tools is essential to understand and estimate the therapeutic benefit of a nerve repair strategy.</p

An Epidemiological and Etiological Analysis of 5026 Peripheral Nerve Lesions from a European Level I Trauma Center

Background: Peripheral nerve lesions are associated with debilitating long-term consequences. Albeit being essential for evidence-based clinical decision making, epidemiological and etiological data are scarce. We therefore aimed to comprehensively analyze epidemiological and etiological factors of peripheral nerve lesions in one of the largest cohorts. Methods: We screened a total of 110,667 patients treated at our level I trauma center between January 2012 and July 2020 for nerve lesions. Subsequently, demographics, etiologies, concomitant injuries, and lesion characteristics were analyzed. Results: A total of 5026 patients, predominantly young males suffering from non-work-related nerve injuries, were treated. Proximal levels of injury were more likely to be accompanied by fractures, whereas more distal injuries with concomitant vessel or tendon injury. Main causes were 54.6% lacerations. Acute traumatic nerve injury was treated within 24 h in 55.9% of cases. Conclusions: Given the young age of affected patients, early diagnosis and treatment in specialized centers may facilitate their early return to work and improve long-term functional outcomes. The data show the importance of a special attention on nerve injuries, which may be masked by large accompanying injuries. New findings on lesion characteristics of selected subgroups and accompanying circumstances can support a change in treatment strategies

Alirocumab and cardiovascular outcomes after acute coronary syndrome

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Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome

BACKGROUN