Krzysztof Suszyński

Variable spatial magnetic field influences peripheral nerves regeneration in rats

Abstract Generator of spatial magnetic field is one of most recent achievements among the magnetostimulators. This apparatus allows to obtain the rotating magnetic field. This new method may be more effective than other widely used techniques of magnetostimulation and magnetotherapy. We investigated the influence of alternating, spatial magnetic field on the regeneration of the crushed rat sciatic nerves. Functional and morphological evaluations were used. After crush injury of the right sciatic nerve, Wistar C rats (n = 80) were randomly divided into four groups (control and three experimental). The experimental groups (A, B, C) were exposed (20 min/day, 5 d/week, 4 weeks) to alternating spatial magnetic field of three different intensities. Sciatic Functional Index (SFI) and tensometric assessments were performed every week after nerve crush. Forty-eight hours before the sacrificing of animals, DiI (1,1’-di-octadecyl-3,3,3’,3’-tetramethyloindocarbocyanine perchlorate) was applied 5 mm distally to the crush site. Collected nerves and dorsal root ganglia (DRG) were subjected to histological and immunohistochemical staining. The survival rate of DRG neurons was estimated. Regrowth and myelination of the nerves was examined. The results of SFI and tensometric assessment showed improvement in all experimental groups as compared to control, with best outcome observed in group C, exposed to the strongest magnetic field. In addition, DRG survival rate and nerve regeneration intensity were significantly higher in the C group. Above results indicate that strong spatial alternating magnetic field exerts positive effect on peripheral nerve regeneration and its application could be taken under consideration in the therapy of injured peripheral nerves.

Physiotherapeutic techniques used in the management of patients with peripheral nerve injuries.

Peripheral nerve injuries affect a wide range of functional, manual and social function, and frequently lead to constant disabilities. After complete transection of nerve, axonal degeneration process gives rise to a variety of symptoms including hyperesthesia, reduced or altered sensation, pain and atrophy (Lee and Wolfe, 2000). With an array of choices for surgical and treating peripheral nerve injuries, there is also, a lot of new, coherent strategies on rehabilitation and physiotherapy protocols - which should be indispensable after injury. Physiotherapy, with a view to compensate dysfunctions relieves in sensory symptoms and creates grater neuroplasticital potential, forms essential part of the treatment for people after peripheral nerve injuries (Inoue et al., 2003). In the present paper we present the physiotherapeutic methods, protocols, and strategy currently used for initiation and support of peripheral nerve regeneration after injuries. Kinetic therapy in peripheral nerve injuries: Impact of kinetic therapy on peripheral nerve repair after its damage is mostly determined by the time required for regeneration of nerve fibers as well as for muscle reinnervation. Stress put on a paralyzed muscle through stretching or strengthening delays, and may even prevent full nerve recovery, and such treatment should not be started until the late stage of nerve regeneration, when progressive strength return can be seen. After injury of the nerve, physiotherapeutic methods are dedicated to eliminate paresis and to restore normal function of muscles as well as to improve circulation and following energetic supply to the tissues. Table 1 presents an overview of the current methods most commonly used in physiotherapy after peripheral nerve injury. Table 1 The most commonly used methods of kinetic therapy in peripheral nerve damage Electrostimulation: Electric stimulation plays an important role in the treatment of various neuromuscular dysfunctions. With a wide range of applications and the possibility of combining this method with others, it is considered as one of the most effective. There are many types and ways of electrostimulation which differ one from another with the technical embodiment. The most common method is transcutaneous electrical nerve stimulation (TENS), which consists of transcutaneous stimulation pulses of electric current with a frequency of 90–130 Hz. Chen et al. (2001) showed that percutaneous electric stimulation of 2 Hz frequency enhanced the mean values of the axon density, blood vessel number, blood vessel area and percentage of blood vessel area in total nerve area in injured rat sciatic nerve. As studies show, stimulation current of low frequency (20 Hz) for 1 hour a day for 2 weeks after the injury shortens the period of axonal outgrowth of three nerve bundles through the implanted graft (Al-Majed et al., 2000; Gordon et al., 2003. It also showed that electrical stimulation has a positive influence on regeneration processes by stabilizing the cholinergic receptors at the neuromuscular junction. Electroacupuncture is a simple method of indirect application of an electrical stimulation to injured nerve. Pomeranz and Campbell (1993) revealed that the regeneration of injured nerve was enhanced by continuous electrical stimulation at the site of the injury via chronically implanted electrodes. However, Inoue et al. (2003) showed that it is unclear whether electroacupuncture enhanced the axonal regeneration processes. Most frequently used patterns of electrical stimulation of peripheral nerve trauma are presented in Table 2. Table 2 The most commonly used patterns of electrical stimulation of peripheral nerves after injury Magnetotherapy: For the treatment of damaged peripheral nerve, a pulsed low frequency magnetic field can also be applied. Magnetic field therapy has well-known effects on enhancing enzymatic activity, oxy-reductive processes and better blood circulation what results in better oxygenation and conduction characteristics of regenerating peripheral nerves. These mechanisms base on the influence of magnetic field on liquid-crystal structure of many membranes and cell organelles resulting in ion-channels transmission changes. Alteration in intra- or extracellular ion distribution leads to changes in electric potentials in organella membranes as well as in cellular membranes of living biological systems. Magnetic stimulation enhances the regeneration of nerve fibers, as the nerve conductivity increases as well as the amplitude of the action potential (Negredo et al., 2004; Mert et al., 2006). The pulsed electromagnetic field (PEMF) has a high clinical value, as applied immediately after peripheral nerve injury - shortens the duration of functional defects (Mert et al., 2006). Unlike electrical stimulation, magnetic stimulation carries no risk of infection due to electrodes pinned around the wound, and it is completely painless, even in patients with well-preserved sensation. Therapeutic effects of PEMF and CEMF in the case of peripheral nerve damage are comparable and may be used complementarily (Bannaga et al., 2006). Spatial magnetic field generator is one of most recent achievements among the magnetostimulators. Prototype generates magnetic field through 3 pairs perpendicularly arranged magnetic coils. This allows for the interference of fields and results in obtaining the rotational magnetic field focused in small area. This new method may be more effective than other widely used techniques of magnetostimulation and magnetotherapy, as shown in animal experiments where strong spatial alternating magnetic field exerted positive effect on peripheral nerve regeneration. This improvement was found in all experimental groups, with best outcome observed in group exposed to the strongest magnetic field. Also dorsal root ganglion survival rate and nerve regeneration intensity were significantly higher in the group treated with the strongest field (Suszynski et al., 2014). Magnetic fields used in treatment of peripheral nerve injury are shown in Table 3. Table 3 The use of magnetic fields in the treatment of peripheral nerve injuries Bio-laser stimulation: For the treatment of peripheral nerve injury, low energy biostimulation lasers are used, applied in the way of pulsatile (905 nm), continuous (808 nm), or pulsing-constant rays. Laser therapy increases the formation of ATP, and the energy of the ATP hydrolysis can be used by nerve cell to restore normal transmembrane potential, which facilitates the generation of electrical impulses and thereby restoring nerve conduction (bioelectric effect). Application of laser beams improves microcirculation and hence nutrition and regeneration of nerve cells – bio-stimulation effect – and increases the release of endorphins and the concentration of neurotransmitters in the synapses – analgetic effect. Laser radiation can also be used to rejoin the nerve stumps (Lanre method – laser-assisted nerve repair). Studies evaluating the use of this method show comparable or even more effective reconstruction then surgical treatment. Less scar formation is observed in the site of anastomosis, which creates favorable conditions for the regeneration of nerve fibers (Huang and Huang, 2006). There are also promising results of the coupled use of fiber membranes or Gore-Tex™ with laser beams. This aids in assembling the ends of the nerve, and affects the speed and efficiency of the regeneration process. Application of laser irradiation (Ga-As laser) in the site of the anastomosis inhibits the degeneration process, accelerate remyelination, and nerve function recovery (Bae et al., 2004; Miloro et al., 2002). One of the major complications of peripheral nerve damage is the formation of a neuroma at the end of the proximal stump. Biostimulation with CO2 or Neodymium-Yag lasers reduces the risk of its formation, or at least alleviates severe pain caused by the formation of a neuroma (Kuzbari et al., 1996). Therapeutic use of ultrasounds (US) gave some promising results in animal experiment (Raso et al., 2005). However, before this technique might be implemented in human therapy, it is indispensable to precisely elucidate the influence of the US on nervous tissue, as well as to determine the most effective and safest therapeutic protocol that could be used in clinical practice. In general, there is a lack of randomized, good quality data representing results of clinical application of particular therapeutic methods using standardized dozymetry. Current research encompassing treatment and intervention in nerve injuries is limited, consisting mostly of descriptive and exploratory studies. Especially nonsurgical or post-surgical physical therapy is poorly understood by many physical therapists and even physicians, many clinicians fail to recognize that such nerves often need considerable time to regenerate.

Application of peripheral nerve conduits in clinical practice: A literature review

Understanding the pathomechanisms behind peripheral nerve damage and learning the course of regeneration seem to be crucial for selecting the appropriate methods of treatment. Autografts are currently the gold standard procedure in nerve reconstruction. However, due to the frequency of complications resulting from autografting and a desire to create a better environment for the regeneration of the damaged nerve, artificial conduits have become an approved alternative treatment method. The aim of this mini-review is to present the nerve scaffolds that have been applied in clinical practice to date, and the potential directions of developments in nerve conduit bioengineering. Articles regarding construction and characterization of nerve conduits were used as the theoretical background. All papers, available in PubMed database since 2000, presenting results of application of artificial nerve conduits in clinical trials were included into this mini-review. Fourteen studies including ≤10 patients and 10 trials conducted on >10 patients were analyzed as well as 24 papers focused on artificial nerve conduits per se. Taking into consideration the experiences of the authors investigating nerve conduits in clinical trials, it is essential to point out the emergence of bioresorbable scaffolds, which in the future may significantly change the treatment of peripheral nerve injuries. Also worth mentioning among the advanced conduits are hybrid conduits, which combine several modifications of a synthetic material to provide the optimal regeneration of a damaged nerve.

Endovascular Approach to Glomus Jugulare Tumors

Summary Background Paragangliomas are benign neuroendocrine tumors derived from the glomus cells of the vegetative nervous system. Typically, they are located in the region of the jugular bulb and middle ear. The optimal management is controversial and can include surgical excision, stereotactic radiosurgery and embolization. Case Report We report the endovascular approach to three patients harboring glomus jugulare paragangliomas. In all cases incomplete occlusion of the lesions was achieved and recanalization in the follow-up period was revealed. Two patients presented no clinical improvement and the remaining one experienced a transient withdrawal of tinnitus. Conclusions It is technically difficult to achieve complete obliteration of glomus jugulare tumors with the use of embolization and the subtotal occlusion poses a high risk of revascularization and is not beneficial in terms of alleviating clinical symptoms.

Can we use thermal imaging to evaluate the effects of carpal tunnel syndrome surgical decompression

Abstract Research is intended to verify if thermal imaging can be used in diagnosing and monitoring the carpal tunnel syndrome (CTS). This disease is not easy to diagnose using traditional methods. Also, the difficulties in monitoring carpal tunnel surgery effects necessitate new, noninvasive method, which gives more information. The research group consists of 15 patients with CTS and control group of healthy people. All patients who were examined before surgery were also tested 4 weeks after surgery, to check the effects of treatment. In addition a lot of our patients had or will have open carpel tunnel release surgery. Diagnosis of CTS was performed by thermal imaging in both hands from phalanges to the area of the wrist on the external and palmar side of the palm. Using infrared (IR) camera one can observe high temperature gradient on hand-tested areas and these differences prove the diagnosis. Moreover patients after surgery have better temperature distribution and it was closer to control group. Results prove that surgery is the best, and currently, the only method to treat CTS. Thermal imaging may be helpful in diagnosing CTS.

University Sports Association as the way to sport activity development among Silesian students

Introduction. There are two fundaments of healthy lifestyle philosophy: regular physical activity and proper diet. The development of physical activity among students is determined by many complex factors. We can distinguish certain aspects such as university profile, access to the sport facilities and the opportunity to participate in sport activities which are organized by sport clubs or University Sports Association. The aim of the study. The aim of the study was to analyze the factors that affect self-assessment of students physical activity. The following questions have been asked: 1.Is the choice of the university related to the access to sport activities which are organized by University Sport Association? 2.Does the participating in activities, which are organized by University Sport Association, help in physical development? 3.Is there any relation between the location, time, type, the way of sport activities which are offered by University Sport Association and participating in them? Material and methods. 395 students took part in research: 257 women (18-27 years old) (x=20,7 ; SD=1,4) and 108 men (18-26 years old) (x=21; SD=1,45). All the students are from five Silesian universities. Method used for the research was the anonymous questionnaire consisting of 37 questions which concerned: the way of the physical activity taken by students, the issue of University Sport Association and the influence of the university profile on physical activity development. The Likert scale was used in 21 questions. Statistical description included descriptive statistics. Degree of difference was defined by ANOVA analysis. Results. Descriptive analysis showed significant dependence between the type of the university and the location of sport facilities (p=0,04). The type of the university has no influence on the factors like: time (p=0,07) and type of sport activities offered by University Sport Association (p=0,39). There is also an important connection between the type of the university and resignation from doing sport (p=0,0002). Mostly – Medical University of Silesia students, least frequently – University of Silesia students. There is dependence between approach to doing sport among students and the type of university (p=0,01). The university which helps the most in sport career is University of Economics in Katowice. Conclusions: 1.Taking the physical activity by student depends on location of the university and sport facilities. 2.The factors such as time and type of sport activities are not related to the type of the university. 3.The type of the university influence the resignation from doing sport by students.