Tadahiro Natsume

Targeting Anti-Inflammatory Treatment Can Ameliorate Injury-Induced Neuropathic Pain

Tumor necrosis factor-α plays important roles in immune system development, immune response regulation, and T-cell-mediated tissue injury. The present study assessed the net value of anti-tumor necrosis factor-α treatment in terms of functional recovery and inhibition of hypersensitivity after peripheral nerve crush injury. We created a right sciatic nerve crush injury model using a Sugita aneurysm clip. Animals were separated into 3 groups: the first group received only a skin incision; the second group received nerve crush injury and intraperitoneal vehicle injection; and the third group received nerve crush injury and intraperitoneal etanercept (6 mg/kg). Etanercept treatment improved recovery of motor nerve conduction velocity, muscle weight loss, and sciatic functional index. Plantar thermal and von Frey mechanical withdrawal thresholds recovered faster in the etanercept group than in the control group. On day 7 after crush injury, the numbers of ED-1-positive cells in crushed nerves of the control and etanercept groups were increased compared to that in the sham-treated group. After 21 days, ED-1-positive cells had nearly disappeared from the etanercept group. Etanercept reduced expression of interleukin-6 and monocyte chemotactic and activating factor-1 at the crushed sciatic nerve. These findings demonstrate the utility of etanercept, in terms of both enhancing functional recovery and suppressing hypersensitivity after nerve crush. Etanercept does not impede the onset or progression of Wallerian degeneration, but optimizes the involvement of macrophages and the secretion of inflammatory mediators.

Prostaglandin E1 alleviates neuropathic pain and neural dysfunction from entrapment neuropathy associated with diabetes mellitus.

In this report, we present the results of investigation of the effects of prostaglandin E1 (PGE1) on entrapment neuropathy using a diabetic rat. A total of 60 male Sprague‐Dawley rats were used in the study. The model of tibial nerve entrapment neuropathy associated with diabetes mellitus was created by streptozotocin‐induced diabetic rats reared in cages with wire grid flooring. Rats were assigned to four groups: nondiabetic (n = 15), untreated diabetic (n = 15), diabetic treated with 30 μg/kg PGE1 (n = 15), and diabetic treated with 100 μg/kg PGE1 (n = 15). Pain tests and electrophysiological tests were performed at 0, 2, and 4 weeks, and assessments of gait, histology, and mRNA expression levels were performed at 4 weeks after initiating the PGE1 administration. In the 30 and 100 μg groups, the mechanical withdrawal thresholds measured by pain tests at 4 weeks (36.2 ± 16.4 g and 31.7 ± 15.3 g, respectively) and the motor conduction velocity (24.0 ± 0.2 m/s and 24.4 ± 0.3 m/s, respectively) were significantly higher than the untreated diabetic group (all P < 0.05) and lower than the nondiabetic group (all P < 0.001). In the gait analysis, the mean intensities in the 30 and 100 μg group (128.0 ± 20.1 a.u. and 109.0 ± 27.8 a.u., respectively) were significantly higher than the untreated diabetic (P < 0.01) and were not significantly different from the nondiabetic group (P = 0.81). Fiber density (P = 0.46) and fiber diameter (P = 0.15) did not show any significant differences. PGE1 significantly decreased nerve growth factor (NGF) mRNA and increased vascular endothelial growth factor (VEGF) mRNA in the tibial nerve (both P < 0.01). In conclusion, neurological deteriorations of diabetic rats were alleviated with PGE1, which is associated with inhibition of NGF and enhancement of VEGF at the entrapment site.

Clinical effects of internal fixation for ulnar styloid fractures associated with distal radius fractures: A matched case-control study

BACKGROUND Ulnar styloid fractures are often associated with distal radius fractures. However, controversy exists regarding whether to treat ulnar styloid fractures. This study aimed to evaluate clinical effects of internal fixation for ulnar styloid fractures after distal radius fractures were treated with the volar locking plate system. METHODS We used prospectively collected data of distal radius fractures. 111 patients were enrolled in this study. A matched case-control study design was used. We selected patients who underwent fixation for ulnar styloid fractures (case group). Three control patients for each patient of the case group were matched on the basis of age, sex, and fracture type of distal radius fractures from among patients who did not undergo fixation for ulnar styloid fractures (control group). The case group included 16 patients (7 men, 9 women; mean age: 52.6 years; classification of ulnar styloid fractures: center, 3; base, 11; and proximal, 2). The control group included 48 patients (15 men, 33 women; mean age: 61.1 years; classification of ulnar styloid fractures: center, 10; base, 31; and proximal, 7). For radiographic examination, the volar tilt angle, radial inclination angle, and ulnar variance length were measured, and the union of ulnar styloid fractures was judged. For clinical examination, the range of motions, grip strength, Hand20 score, and Numeric Rating Scale score were evaluated. RESULTS There was little correction loss for each radiological parameter of fracture reduction, and these parameters were not significantly different between the groups. The bone-healing rate of ulnar styloid fractures was significantly higher in the case group than in the control group, but the clinical results were not significantly different. CONCLUSIONS We revealed that there was no need to fix ulnar styloid fractures when distal radius fractures were treated via open reduction and internal fixation with a volar locking plate system.

Teletriage for patients with traumatic finger injury directing emergency medical transportation services to appropriate hospitals: A pilot project in Nagoya City, Japan

INTRODUCTION Emergency medical technicians in Japan have experienced difficulties in identifying hospitals that will accept patients with severe finger injuries. We developed and managed a system named Interactive Teletriage using mobile phone photos to aid efficient patient transportation. The aim of this study was to investigate features related to the transportation of patients with severe finger injuries and to evaluate the feasibility of this system. MATERIALS AND METHODS We prospectively analysed data from the medical association of Aichi Prefecture and the Nagoya City Fire Department in Japan. We investigated features related to the transportation of 474 patients with severe finger injuries in Nagoya from 2010 to 2013: 100 in 2010, 134 in 2011, 125 in 2012, and 115 in 2013. We began using Teletriage in August 2011 and compared the periods before and after its implementation. RESULTS The time of injury showed two different peaks from 09:00 to 11:00h and at 13:00h. The number of patients injured during each weekday was generally the same, while cases on Saturdays and Sundays reflected 70% and 47% of the weekday average, respectively. Of the 474 patients, 395 (83%) were accepted to hospitals after 3 or fewer requests for admission: 160 of 202 (79.2%) before and 235 of 272 (86.4%) after Teletriage, constituting a significant increase (p=0.039). Furthermore, the number of patients who required 4 or more requests significantly decreased after implementation of Teletriage (p=0.039): 42 patients (20.8%) before and 37 (13.6%) after Teletriage. Our data showed that as the number of requests until final determination increased, the transportation period increased. Furthermore, the mean transportation period significantly decreased from 22.3min before to 18.1min after Teletriage (p=0.021). As the number of requests until final determination increased, the proportion of patients transported to Level I and II hospitals decreased; conversely, the proportion of patients transported to Level III, IV, and V hospitals increased. CONCLUSIONS Our results indicated that the implementation of Teletriage has the potential to ease the problem of emergency medical transportation for those with severe finger injuries.