Histopathological changes in surrounding tissue of the sciatic nerve after spinal cord injury in rats

[Purpose] The purpose of this study was to examine histopathological changes in tissue surrounding the sciatic nerve after spinal cord injury (SCI) in rats. [Subjects and Methods] Thirty adult, nine-week-old, female Wistar rats were used in this study. Fifteen experimental rats underwent spinal cord transection at the level of Th8-9 and the other fifteen control rats were raised normally. Animals were assessed at 1, 2, 4, 8, and 12 weeks following surgery. After the experimental period, we obtained tissue surrounding the sciatic nerve of the thigh after hematoxylin and eosin staining under a microscope. [Results] Adherence between the nerve bundle and perineural innermost layer was observed in tissue surrounding the sciatic nerve in the SCI group. Adherence among the interperineurium was evident at 2 weeks after SCI. It had declined at 4 weeks after SCI, but was still evident at 8 and 12 weeks after SCI. [Conclusion] Histopathological findings in the SCI model may be related to compression of the nerve bundle and neurogenic contracture of tissue surrounding the nerve bundle.Thesis of Ippei Kitade / 北出 一平 博士論文 金沢大学医薬保健学総合研究科（保健学専攻

The histological effect of immobilization and unloading/reloading on articular cartilage of rat knee joint

これまで、ラット膝関節の不動化による関節周囲組織の組織学的変化が報告されているが、臨床の場においてギプス固定がなされる場合には非荷重の状態となることが多い。荷重の除去が長期に及ぶと膝半月板内の機械受容器数が減少し、長期臥床や免荷直後は関節損傷の危険性が高いとの報告もある。今回ラット膝関節をギプス固定するだけでなく、後肢懸垂法を用いて非荷重モデルと非荷重の後に再荷重を加えたモデルを作成し、荷重の有無による影響を調査した。　 ２ 週間片側下肢のギプス固定と後肢懸垂を行った群 ( ２ IS 群 )、 4 週間片側下肢のギプス固定と後肢懸垂を行った群 ( 4 IS 群 )、 ２ 週間片側下肢のギプス固定と後肢懸垂を行い、その後 ２ 週間ケージ内にて自由飼育とし再荷重を行った群 ( ２ IS+IL 群 )、 ２ 週間通常飼育の対照群( ２C 群)、4 週間通常飼育の対照群( 4C 群)で比較した。　 ２ IS 群では膝関節軟骨表面の不整が確認され、 4 IS 群では軟骨表面の変化はさらに進行していた。 ２ IS+IL 群では関節軟骨と周囲組織の癒着は確認されず、軟骨表面の変化は２ IS 群よりも軽減していた。　不動と非荷重が組み合わさった際には膝関節軟骨組織の変化について相加的な影響をもたらす可能性が明らかになり、再荷重により関節軟骨は修復されうることが考えられる。関節軟骨の正常状態維持には適切な関節運動と荷重が必要である。Purpose: Joint movement and loading are thought to maintain articular cartilage. In this study, we performed histological examination of the effects of immobilization and unloading/reloading on articular cartilage in the rat knee joint.　Materials and Methods: Twenty-five adult, 9-week-old, male rats were used in this study. The animals were randomly divided into five groups of equal size: two-week caged control (２C), 4-week caged control (4C), ２-week hind limb suspension with cast immobilization (２IS), 4-week hind limb suspension with cast immobilization (4IS), and ２-week hind limb suspension with cast immobilization and ２-week reloading with cast immobilization (２IS+IL). Rats in the experimental groups had one knee joint immobilized for ２ or 4 weeks in maximum flexion with a plaster cast of our own making and aluminum wire netting. After the end of each experimental period, tissue specimens of the knee joint were prepared for observation in the sagittal plane and examined under a light microscope with hematoxylin-eosin staining.　Results: In the control groups (２C or 4C), the surface of the articular cartilage was smooth and continuous. On the other hand, the surface of the femoral articular cartilage was irregular in the experimental groups. The pathological changes in the cartilage surfaces showed greater progression in the 4IS group than that the ２IS group. We observed adhesions between the cartilage surface layer and synovial membrane in some specimens in the 4IS group. The pathological changes in the cartilage surfaces were less severe in the ２IS+IL group than the ２IS group.　Conclusion: Immobilization and unloading caused irregularity of the femoral articular cartilage surface as well as adhesions between the cartilage surface layer and synovial membrane in some specimens. Reloading may be related to cartilage repair

Effect of the Intrathecal Baclofen Screening Test on the Spatiotemporal Gait Motion Parameters of Patients with Cervical Spinal Cord Injuries Who Exhibited Diffuse Spasticity: A Report of Three Cases

We examine the quantitative changes in the gait motion of patients with cervical spinal cord injuries (CSCIs) before and after the intrathecal baclofen (ITB) screening test. The subjects were three patients with CSCI, who exhibited spasticity in the lower extremities. They could all walk 10 or more meters with/without aids. All patients were subjected to the ITB screening test, in which they had gabalon (50 μg) injected into their spinal column via paramedian puncture at the L3–4 level. The subjects had their ankle clonus; patellar tendon reflex; and modified Ashworth scale, Berg balance scale, Spinal Cord Independence Measure, and 10-meter walk test (10MWT) assessed before and 5 hours after the ITB screening test. At 5 hours after the ITB screening test, all of the patients exhibited decreased spasticity in static position, and improved balance. There were no differences in the abilities of any of the patients to perform ADL. One patient did not change the spatiotemporal gait motion parameters (walking time, step count, and step length in the 10MWT). Therefore, the pomp implantation for ITB therapy was not performed. Two patients who had suffered CSCI more than 20 years ago exhibited a reduced walking time, increased step count, and step length. Out of the two patients one received the pomp of implantation after ITB screening test, and the other was planned to operate. The spatiotemporal gait motion parameters might be one of the useful tests to decide the pomp implantation for CSCI patients who hope improvement of gait ability

Gradual loaded exercise of knee extension muscles using an orthosis after wide resection of a femoral sarcoma and quadriceps muscle: a case report

Abstract Background Details of improved gait ability after wide resection of soft tissue sarcomas that necessitate removal of portions of the quadricep muscle have not yet been reported. We describe a patient with improved gait ability following a rehabilitation program after wide resection of a soft tissue sarcoma that included four components of the quadricep muscle. Case presentation An 85-year-old Japanese man underwent wide resection of an undifferentiated pleomorphic sarcoma that included portions of the quadriceps femoris muscle. The rectus femoris, vastus medialis, sartorius, and vastus intermedius were separated in the maximally bulging region of the tumour. Three weeks postoperatively, gait exercise was initiated using a rigid knee orthosis with a dual-adjustable lock knee. The contraction loading of the knee extension muscle was controlled by adjusting the hinge motion range of the orthosis as follows: fully extended, fixed knee 0°–30°, and free range. Under this regimen, he could walk independently without a rigid orthosis within 5 weeks postoperatively but could not sit on his heels during daily living activities. At six months, there was no clinical evidence of recurrent tumours or complications. Conclusions Postoperative gait ability might be affected by not only the number of resected muscles but also by the function of the separated muscles and the cross-sectional area of the remaining muscle. Gradually loaded exercise of the knee extension muscles using an orthosis could result in an improved gait motion for patients who undergo wide resection of a sarcoma that includes four components of the quadriceps femoris

Differences in cartilage repair between loading and unloading environments in the rat knee

We investigated the histopathological and immunohistochemical effects of loading on cartilage repair in rat full-thickness articular cartilage defects. A total of 40 male 9-week-old Wistar rats were studied. Full-thickness articular cartilage defects were created over the capsule at the loading portion in the medial condyle of the femur. Twenty rats were randomly allocated into each of the 2 groups: a loading group and a unloading group. Twenty rats from these 2 groups were later randomly allocated to each of the 2 groups for evaluation at 1 and 2 weeks after surgery. At the end of each period, knee joints were examined histopathologically and immunohistochemically. In both groups at 1 and 2 weeks, the defects were filled with a mixture of granulation tissue and some remnants of hyaline cartilage. The repair tissue was not stained with toluidine blue in both groups. Strong staining of type I collagen was observed in the repair tissue of both groups. The area stained with type I collagen was smaller in the unloading group than in the loading groups, and the stained area was smaller at 2 weeks than at 1 week. In the staining for type II collagen, apparent staining of type II collagen was observed in the repair tissue of both groups at 1 week. At 2 weeks, there was a tendency toward a higher degree of apparent staining in the loading group than in the unloading group. Accordingly, these results indicated that loading and unloading in the early phase of cartilage repair have both merits and demerits

Functional outcomes after the treatment of hip fracture.

Osteoporotic hip fracture is a major public health issue. Estimation of the outcome and maximization of functional recovery after fracture is very important in the treatment of older patients. The purposes of this study were to clarify the functional outcomes after the treatment of hip fracture and to identify the factors that influence functional recovery. In the present study, 228 patients admitted to an acute-care hospital from January 2016 to June 2018 were evaluated. The patients were categorized into a trochanteric fracture group (n = 128) and a neck fracture group (n = 100). We retrospectively reviewed their ambulation ability 6 months after fracture using the Functional Ambulation Category (FAC) score. The other survey items were the presurgical duration, length of hospital stay, time until beginning to walk using parallel bars, complications affecting treatment, and mortality rate. The 6-month follow-up rate was 54.4% (n = 124). The results showed that the patients with trochanteric fracture were significantly older than those with neck fracture (86 vs. 82 years, respectively; p = 0.03). In total, 85.0% of patients with trochanteric fracture and 92.2% of patients with neck fracture were independent ambulators before injury (FAC score of 4 or 5). The FAC score 6 months after fracture was positively correlated with the FAC score before fracture and at discharge (all p<0.001) and negatively correlated with patient age (p<0.001) and presurgical duration for patients with neck fracture (p = 0.04). There was no statistically significant correlation with the length of hospital stay or the time until beginning to walk using parallel bars. In conclusion, patients with trochanteric fractures were older than those with neck fractures. In both fracture types, walking recovery 6 months after hip fracture was related to the FAC score before injury and at discharge from an acute-care hospital but not to the time until beginning to walk using parallel bars