Frequent mild head injury promotes trigeminal sensitivity concomitant with microglial proliferation, astrocytosis, and increased neuropeptide levels in the trigeminal pain system.

BACKGROUND: Frequent mild head injuries or concussion along with the presence of headache may contribute to the persistence of concussion symptoms. METHODS: In this study, the acute effects of recovery between mild head injuries and the frequency of injuries on a headache behavior, trigeminal allodynia, was assessed using von Frey testing up to one week after injury, while histopathological changes in the trigeminal pain pathway were evaluated using western blot, ELISA and immunohistochemistry. RESULTS: A decreased recovery time combined with an increased mild closed head injury (CHI) frequency results in reduced trigeminal allodynia thresholds compared to controls. The repetitive CHI group with the highest injury frequency showed the greatest reduction in trigeminal thresholds along with greatest increased levels of calcitonin gene-related peptide (CGRP) in the trigeminal nucleus caudalis. Repetitive CHI resulted in astrogliosis in the central trigeminal system, increased GFAP protein levels in the sensory barrel cortex, and an increased number of microglia cells in the trigeminal nucleus caudalis. CONCLUSIONS: Headache behavior in rats is dependent on the injury frequency and recovery interval between mild head injuries. A worsening of headache behavior after repetitive mild head injuries was concomitant with increases in CGRP levels, the presence of astrocytosis, and microglia proliferation in the central trigeminal pathway. Signaling between neurons and proliferating microglia in the trigeminal pain system may contribute to the initiation of acute headache after concussion or other traumatic brain injuries

Pressure Oscillation Tests of Porcine Aorta

ABSTRACT This paper addresses the problem of Traumatic Aorta Rupture (TAR) that is one of the causes of fatality in motor vehicle accidents. The mechanisms that have been suggested for TAR are speculative and inconclusive and a lot of the tests performed have not been repeatable. One of the reasons for these speculations is an incomplete understanding of the material properties of the aorta. The goal of this research is to study the response of the aorta to the oscillating pressure inputs in order to identify the structural properties of the aorta. The results of this study show that aorta stiffens as the rate of the loading increases, which is a characteristic of viscoelastic materials

Are generic and disease-specific health related quality of life correlated? The case of chronic lung disease due to sulfur mustard

<ul><li><strong>BACKGROUND</strong>: The aim of this study was to investigate the association between the two most commonly used generic and disease specific health-related quality of life (HRQoL) measures in patients with chronic lung disease due to SM: Medical Outcomes Study Short Form 36-Item (SF-36) and St George's Respiratory Questionnaire (SGRQ).</li><li><strong>METHODS</strong>: This is a secondary analysis of Iranian Chemical Warfare Victims Health Assessment Study (ICWVHAS) during October 2007 in Isfahan, Iran. In that survey, conducted in an outpatient setting, 292 patients with chronic lung disease due to SM were selected from all provinces in Iran. The total score and sub scores of correlations of SGRQ and SF-36 were assessed. Correlation of quality-of-life scores were evaluated using Pearson’s coefficient.</li><li><strong>RESULTS</strong>: Samples were 276 patients who were selected for our analysis. No significant correlation was found between the total score or sub scores of SF-36 and the total score or sub scores of SGRQ (p > 0.05).</li><li><strong>CONCLUSIONS</strong>: In patients with chronic lung disease due to SM, the SF-36 and SGRQ assess different aspects of HRQoL. Therefore applying both of them together, at least in the research setting is suggested.</li><li><strong>KEYWORDS</strong>: Chronic Lung Disease, Health Related Quality of Life, Generic Health Related Quality of Life, Disease Specific Health Related Quality of Life, Sulfur Mustard.</li></ul&gt

Plantar Plate Reconstruction for Stage IV Plantar Plate Tear Using Flexor Tendon Tenodesis

Category: Lesser Toes Introduction/Purpose: Outcomes of the surgical treatment of dislocated lesser toes have improved significantly over the past few years due to the development of techniques to repair plantar plate tears through a dorsal incision. However, treatment of stage 4 tears with no reparable plantar plate can be challenging. The current treatment involves flexor to extensor tendon transfer, requiring multiple incisions and surgical time. An alternative approach is presented, using the same modern techniques of plantar plate repair, but reconstructing the plantar plate using a flexor tendon tenodesis to the plantar base of the proximal phalanx. Methods: Four fresh frozen cadaver foot and ankle specimens were used to determine the stability of this new technique. A simulated Lachman’s test was performed on the 2nd, 3 rd, and 4th metatarsophalangeal joints utilizing a force measurement instrument with displacement control on specimens with an intact plantar plate, an excised plantar plate, and following a flexor tenodesis reconstruction. Results: The intact plantar plate force was 9.0+2.6kN for 2 mm displacement, and following excision of the plantar plate, the force reduced to 1.3+0.4kN. The flexor tenodesis reconstruction improved the force to 6.0+1.9kN. Conclusion: Plantar plate reconstruction with a flexor tenodesis to the proximal phalanx resulted in stability equal to 53% of the intact plantar plate, for the shear displacements between 2 to 6 mm. This procedure may be an alternative treatment option in patients with Stage 4 irreparable plantar plate tears

Marital Relationship and Its Associated Factors in Veterans Exposed to High Dose Chemical Warfare Agents

Objective: The aim of this study was to determine the associates of marital relationship in mustard exposed veterans. Materials and Methods: Two hundred ninety two married Iranian mustard exposed veterans, who had been exposed to single high dose mustard gas in Iraq-Iran war, were assessed for marital adjustment with Revised Dyadic Adjustment Scale (RDAS). Census sampling was done. The patients' quality of life (SF-36), spirometric measures and war related data were also extracted. Results: A total of 189 subjects (65%) completed our study. The mean (±SD) of the RDAS Total score, RDAS Dyadic Consensus , RDAS Affectional Expression, RDAS Dyadic Satisfaction , and RDAS Dyadic Cohesion were 50.61 (8.16), 16.67 (2.77), 7.62 (1.84), 14.76 (3.39), and 11.54 (3.79), respectively. RDAS Dyadic satisfaction was correlated with SF-36 and all its sub-scores (p<0.05). RDAS total score showed significant correlation with SF-36 total score and most of its sub-scores (p<0.05). RDAS affective expression was significantly correlated with role limitation, social function, general mental health, vitality, General health perceptions, physical composite score (PCS) and mental composite score (MCS) (p<0.05). RDAS dyadic consensus was not correlated with any SF-36 sub-scores. Conclusion: Veterans health team including physicians, psychologists and/or psychiatrists should know that poorer marital satisfaction is linked with lower quality of life scores, late after mustard exposure, although marital relationship is independent of spirometric findings, age, duration from exposure and comorbidity score

Evaluating the Subtalar Joint in Tibiotalocalcaneal Nail

Category: Hindfoot Introduction/Purpose: In tibiotalocalcaneal nails for arthrodesis, the path of the nail through the subtalar joint has not been well documented. Ideally, the defect caused by reaming and the nail does not pass through the joint surface so that the amount of bony contact between the talus and calcaneus is maintained in order to optimize fusion. Our hypothesis is that the TTC nail does not destroy a significant amount contact area between the talus and calcaneus. However, using larger diameter nails (which are inherently stronger) will have more of an effect on the contact surface. Methods: Five cadaveric below the knee specimens were obtained. The ankle was disarticulated on each specimen. Subsequently, a guidepin was drilled from the central dome of the talus down to the calcaneus. The 11 mm reamer was then passed over the guidepin through the calcaneus to simulate retrograde reaming of a TTC nail. Then, the subtalar joint was dissected open and the articular surface was documented in comparison with the area that was reamed out. Measurements were then made, using software that calculated two dimensional surface area to determine the percentage of actual subtalar joint area that was reamed out. The mean percentage of articular area that was removed with the reamer was then calculated. Results: Among the five specimens, in the calcaneus, the mean total articular area was 599mm2±113 and the mean drilled articular area was 21mm2±16. The percentage of the calcaneal articular surface that was removed with the reamer was 3.4%±1.9. In the talus, the mean total articular area was 782mm2±130 and the mean drilled articular area was 39mm2±18. The percentage of the talar articular surface that was removed with the reamer was 5.0%±2.3. Additionally, an 11 mm reamer makes a circular surface area of 95mm2, and the statistics above indicate that a significant portion of the reamed area is nonarticular, within the calcaneal sulcus or the talar sulcus. Conclusion: In a tibiotalocalcaneal nail the subtalar joint is typically incompletely visualized, however this anatomic study demonstrates that the 11 mm reamer eliminates about 3.4% of the calcaneal articular surface and about 5% of the talar articular surface. Therefore, the majority of the articular surface is left intact, which is ideal in optimizing arthrodesis outcomes. Furthermore, this study could extrapolate the effects of a larger nail on the availability of joint surface. It could also be used to argue for cartilage stripping of the affected joint surfaces in arthrodesis preparation, because the majority of the articular surface is, in fact, left intact

Manual Therapy Facilitates Homeostatic Adaptation to Bone Microstructural Declines Induced by a Rat Model of Repetitive Forceful Task

The effectiveness of manual therapy in reducing the catabolic effects of performing repetitive intensive force tasks on bones has not been reported. We examined if manual therapy could reduce radial bone microstructural declines in adult female Sprague&ndash;Dawley rats performing a 12-week high-repetition and high-force task, with or without simultaneous manual therapy to forelimbs. Additional rats were provided 6 weeks of rest after task cessation, with or without manual therapy. The control rats were untreated or received manual therapy for 12 weeks. The untreated TASK rats showed increased catabolic indices in the radius (decreased trabecular bone volume and numbers, increased osteoclasts in these trabeculae, and mid-diaphyseal cortical bone thinning) and increased serum CTX-1, TNF-&alpha;, and muscle macrophages. In contrast, the TASK rats receiving manual therapy showed increased radial bone anabolism (increased trabecular bone volume and osteoblast numbers, decreased osteoclast numbers, and increased mid-diaphyseal total area and periosteal perimeter) and increased serum TNF-&alpha; and muscle macrophages. Rest, with or without manual therapy, improved the trabecular thickness and mid-diaphyseal cortical bone attributes but not the mineral density. Thus, preventive manual therapy reduced the net radial bone catabolism by increasing osteogenesis, while rest, with or without manual therapy, was less effective

Blocking CCN2 Reduces Established Bone Loss Induced by Prolonged Intense Loading by Increasing Osteoblast Activity in Rats

ABSTRACT We have an operant model of reaching and grasping in which detrimental bone remodeling is observed rather than beneficial adaptation when rats perform a high‐repetition, high‐force (HRHF) task long term. Here, adult female Sprague–Dawley rats performed an intense HRHF task for 18 weeks, which we have shown induces radial trabecular bone osteopenia. One cohort was euthanized at this point (to assay the bone changes post task; HRHF‐Untreated). Two other cohorts were placed on 6 weeks of rest while being simultaneously treated with either an anti‐CCN2 (FG‐3019, 40 mg/kg body weight, ip; twice per week; HRHF‐Rest/anti‐CCN2), or a control IgG (HRHF‐Rest/IgG), with the purpose of determining which might improve the trabecular bone decline. Results were compared with food‐restricted control rats (FRC). MicroCT analysis of distal metaphysis of radii showed decreased trabecular bone volume fraction (BV/TV) and thickness in HRHF‐Untreated rats compared with FRCs; responses improved with HRHF‐Rest/anti‐CCN2. Rest/IgG also improved trabecular thickness but not BV/TV. Histomorphometry showed that rest with either treatment improved osteoid volume and task‐induced increases in osteoclasts. Only the HRHF‐Rest/anti‐CCN2 treatment improved osteoblast numbers, osteoid width, mineralization, and bone formation rate compared with HRHF‐Untreated rats (as well as the latter three attributes compared with HRHF‐Rest/IgG rats). Serum ELISA results were in support, showing increased osteocalcin and decreased CTX‐1 in HRHF‐Rest/anti‐CCN2 rats compared with both HRHF‐Untreated and HRHF‐Rest/IgG rats. These results are highly encouraging for use of anti‐CCN2 for therapeutic treatment of bone loss, such as that induced by chronic overuse. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research