RESUMEN

Muscle trauma is one of the most common body injuries. Severe consequences of muscle trauma are ischemic injuries of the extremities. It is known that the intensification of free radical processes takes place in almost most acute diseases and conditions, including muscle trauma. C60 fullerene (C60) with powerful antioxidant properties can be considered a potential nanoagent for developing an effective therapy for skeletal muscle trauma. Here the water-soluble C60 was prepared and its structural organization has been studied by the atomic force microscopy and dynamic light scattering techniques. The selective biomechanical parameters of muscle soleus contraction and biochemical indicators of blood in rats were evaluated after intramuscular injection of C60 1 h before the muscle trauma initiation. Analysis of the force muscle response after C60 injection (1 mg kg-1 dose) showed its protective effect against ischemia and mechanical injury at the level of 30 ± 2 % and 17 ± 1 %, accordingly, relative to the pathology group. Analysis of biomechanical parameters that are responsible for correcting precise positioning confirmed the effectiveness of C60 at a level of more than 50 ± 3 % relative to the pathology group. Moreover, a decrease in the biochemical indicators of blood by about 33 ± 2 % and 10 ± 1 % in ischemia and mechanical injury, correspondingly, relative to the pathology group occurs. The results obtained demonstrate the ability of C60 to correct the functional activity of damaged skeletal muscle.

RESUMEN

This study sought to assess how post-game creatine kinase (CK) levels correlate with the number of sprints and the impact of the ACTN3 polymorphism on this response. This research constituted a descriptive/observational, retrospective cross-sectional study. DNA was extracted from blood samples for ACTN3 polymorphism genotyping. CK was measured 48 h after official matches, and the number of sprints (>19 km/h) was tracked using Global Positioning System (GPS) technology. The main cohort included 23 professional soccer players from the top tier of the Brazilian Championship. We analyzed 115 GPS + CK data sets. The replication cohort comprised 18 professional soccer players from the First Division of the Championship, had the same methodology applied, and featured a total of 90 GPS (sprints > 25.2 km/h) + CK data sets. For the main cohort, a significant positive correlation was seen between the number of sprints and the CK levels (p = 0.009). Athletes with the ACTN3 RR genotype had higher CK levels as more sprints were performed during the match (p = 0.017). However, the relationship was not found for X allele carriers (p > 0.05). For the replication cohort, there was a near-significant correlation between CK levels and the number of sprints (p = 0.05), and RR individuals showed a significant association (p = 0.01), whereas X allele carriers did not (p = 0.06). A greater number of sprints during matches is linked to higher CK levels, primarily among players with the ACTN3 RR genotype, which is potentially due to an increased presence of type II muscle fibers. These findings were replicated for both cohorts of elite Brazilian soccer players, emphasizing the importance of genetic factors in injury prevention.

Asunto(s)

Actinina , Creatina Quinasa , Carrera , Fútbol , Humanos , Actinina/genética , Brasil , Masculino , Creatina Quinasa/sangre , Creatina Quinasa/genética , Adulto , Atletas , Rendimiento Atlético , Estudios Transversales , Estudios Retrospectivos , Genotipo , Polimorfismo de Nucleótido Simple , Adulto Joven , Polimorfismo Genético

RESUMEN

The immune response to decellularized extracellular matrix (ECM) muscle injury is characterized by Th2 T cells, Tregs, M2-like macrophages, and an abundance of eosinophils. Eosinophils have previously been described as mediators of muscle regeneration but inhibit skin wound healing. In addition to response to wounding, a large number of eosinophils respond to biomaterial-treated muscle injury, specifically in response to decellularized ECM. ECM treatment of muscle wounds has been associated with positive outcomes in tissue regeneration, but the detailed mechanisms of action are still being evaluated. Here, this work investigates the role of these eosinophils in terms of their immunologic phenotype and subsequent effect on the local tissue microenvironment. These cells have a mixed phenotype showing both type-2 and regulatory gene upregulation and but are not required for macrophage polarization. Beyond the local tissue, ECM treatment is seen to induce a transient flux of eosinophils to the lungs but prevented a trauma-associated neutrophilia in the lungs of injured mice. This work believes this local and systemic immunomodulation contributes to the regenerative effects of the material and such distal tissue effects should be considered in therapeutic design and implementation.

RESUMEN

Skeletal muscle injuries including volumetric muscle loss (VML) lead to excessive tissue scarring and permanent functional disability. Despite its high prevalence, there is currently no effective treatment for VML. Bioengineering interventions such as biomaterials that fill the VML defect to support cell and tissue growth are a promising therapeutic strategy. However, traditional biomaterials developed for this purpose lack the pore features needed to support cell infiltration. The present study investigates for the first time, the impact of granular hydrogels on muscle repair - hypothesizing that their flowability will permit conformable filling of the defect site and their inherent porosity will support the invasion of native myogenic cells, leading to effective muscle repair. Small and large microparticle fragments are prepared from photocurable hyaluronic acid polymer via extrusion fragmentation and facile size sorting. In assembled granular hydrogels, particle size and degree of packing significantly influence pore features, rheological behavior, and injectability. Using a mouse model of VML, it is demonstrated that, in contrast to bulk hydrogels, granular hydrogels support early-stage (satellite cell invasion) and late-stage (myofiber regeneration) muscle repair processes. Together, these results highlight the promising potential of injectable and porous granular hydrogels in supporting endogenous repair after severe muscle injury.

RESUMEN

Pyomyositis is an uncommon acute bacterial infection of the skeletal muscle. It is sometimes referred to as "tropical pyomyositis" because it has been primarily reported as an endemic disease in tropical regions. In temperate climates, it is mainly diagnosed in immunocompromised persons, such as those with human immunodeficiency virus infection, malignancy, diabetes, and various other medical conditions. Early diagnosis and appropriate antimicrobial therapy for pyomyositis are important, however, it is often missed in its early stage. Herein, we report the case of a patient with obesity and well-controlled diabetes in whom rapid onset pyomyositis developed in only 2 days after chest contusion and induced bacteremia in its early stage. He was successfully treated by antimicrobials without any drainage or surgical intervention. Even in patients with well-controlled diabetes or in healthy persons, pyomyositis should be considered for patients who present with fever and muscle swelling and pain, especially when they have obesity and a history of blunt trauma. It should also be noted that pyomyositis, mimicking muscle contusion or hematoma can appear very early after blunt muscle trauma. Prompt diagnosis and antimicrobial treatment for pyomyositis can lead to a favorable outcome, without surgical drainage.

RESUMEN

PURPOSE: To examine the changes in the pelvic floor structure caused by pregnancy and delivery. METHODS: A total of 141 nulliparous women were examined with three-dimensional transperineal ultrasound (3D-TPU) at the 24th and 34th weeks of gestation, 5th day postpartum, and 1 month postpartum. Puborectalis muscle trauma was diagnosed and the area of levator hiatus (ALH) was measured. RESULTS: One hundred and five normal vaginal deliveries, 19 vacuum/forceps deliveries, and 17 cesarean deliveries were included. In the normal delivery group, the rate of puborectalis muscle trauma was low and showed no significant change between the 24th and 34th weeks of gestation (12.5% vs. 17.2%, p = 0.42). The rate of trauma significantly increased to 70.2% at the 5th day postpartum (p < 0.001). There was no significant difference between the rates at the 5th day postpartum and 1 month postpartum (73.7%, p = 0.60). The same trend was found in the vacuum/forceps group. In the cesarean section group, no significant change was observed throughout pregnancy and postpartum periods. In the normal delivery group, ALH significantly increased between the 24th and 34th week (14.1 ± 2.6 cm2 vs. 14.6 ± 3.4 cm2, p = 0.007). ALH markedly increased to 20.9 ± 4.8 cm2 at the 5th day postpartum (p < 0.001). ALH at 1 month postpartum decreased to 17.0 ± 4.3 cm2 (p < 0.001), but did not return to the value at the 24th week (p < 0.001). CONCLUSIONS: Vaginal childbirth results in enlargement of the levator hiatus. Pelvic floor muscles in pregnant women are affected not only by mechanical damage associated with delivery but also by physiologic changes during pregnancy. The effects of pregnancy and delivery on pelvic floor muscles may persist after delivery.

Asunto(s)

Diafragma Pélvico , Cesárea , Parto Obstétrico , Femenino , Humanos , Imagenología Tridimensional , Diafragma Pélvico/diagnóstico por imagen , Periodo Posparto , Embarazo , Ultrasonografía

RESUMEN

Avulsion or transection of three extraocular muscles following trauma is a rare finding, and there are few case reports and series discussing the approach to surgical repair. The authors report a case of a penetrating metal hook injury resulting in partial avulsion of a medial rectus muscle and transection of the inferior rectus and inferior oblique muscles. This case highlights the importance of identification and primary repair of a complete inferior rectus muscle transection and a partial medial rectus muscle avulsion with an excellent functional outcome.

Asunto(s)

Músculos Oculomotores , Humanos , Músculos Oculomotores/cirugía

RESUMEN

Fibrodysplasia ossificans progressiva is a very rare autosomal dominant genetic connective tissue disease with a progressive ectopic ossification of muscle (intramuscular) or perimuscular connective tissue such as tendons or joint capsules. The osseous masses produced will form bridges that abnormally connect sections of the skeleton, causing disfiguration and normal motor function inhibition. We reported a 5-year-old girl with multiple hard nodules on the back region which initially present as a painful soft mass on the posterior neck region. As the pain subsided, the mass hardened and also appeared in other parts of her back. We decided not to do a biopsy or excisional surgery to prevent flaring up of the disease. Early diagnosis prevents catastrophic diagnostic and treatment procedures. The progressive nature of this disease is difficult to stop but we should delay it as much as possible by preventing muscle trauma, giving disease modifying agent and long-term physiotherapy to counter further disabilities which will eventually develop.

RESUMEN

INTRODUCTION AND HYPOTHESIS: Objective of this study was to develop an MRI-based finite element model and simulate a childbirth considering the fetal head position in a persistent occiput posterior position. METHODS: The model involves the pelvis, fetal head and soft tissues including the levator ani and obturator muscles simulated by the hyperelastic nonlinear Ogden material model. The uniaxial test was measured using pig samples of the levator to determine the material constants. Vaginal deliveries considering two positions of the fetal head were simulated: persistent occiput posterior position and uncomplicated occiput anterior position. The von Mises stress distribution was analyzed. RESULTS: The material constants of the hyperelastic Ogden model were measured for the samples of pig levator ani. The mean values of Ogden parameters were calculated as: µ1 = 8.2 ± 8.9 GPa; µ2 = 21.6 ± 17.3 GPa; α1 = 0.1803 ± 0.1299; α2 = 15.112 ± 3.1704. The results show the significant increase of the von Mises stress in the levator muscle for the case of a persistent occiput posterior position. For the optimal head position, the maximum stress was found in the anteromedial levator portion at station +8 (mean: 44.53 MPa). For the persistent occiput posterior position, the maximum was detected in the distal posteromedial levator portion at station +6 (mean: 120.28 MPa). CONCLUSIONS: The fetal head position during vaginal delivery significantly affects the stress distribution in the levator muscle. Considering the persistent occiput posterior position, the stress increases evenly 3.6 times compared with the optimal head position.

Asunto(s)

Feto , Presentación en Trabajo de Parto , Animales , Parto Obstétrico , Femenino , Análisis de Elementos Finitos , Diafragma Pélvico/diagnóstico por imagen , Embarazo , Porcinos

RESUMEN

Muscle injuries are frequent, both in sports and work, and may be caused by stretching, distension, repetitive effort or bruising. Such lesions can lead to the generation of free radicals, triggering oxidative stress and the release of some inflammatory mediators. Therapeutic ultrasound (UST) is one of the most used electrotherapy resources in the physiotherapist's clinical practice. Our aim was to evaluate the use of therapeutic ultrasound on oxidative stress and inflammatory process in an experimental model of single quadriceps muscle injury in Wistar rats. We used a total of 28 male rats, weighing between 250-300 grams, randomly divided into four groups. In the right quadriceps, a simple impact of contusion was induced by means of a press. The animals were submitted to a daily UST treatment for a total of seven consecutive applications for three minutes each, that started 24 hours after the trauma induction. The results in the Trauma + Therapeutic ultrasound group at TBARS levels and in the enzymatic activity of SOD and GPx presented a significant difference. In the histological analysis of the Trauma + Therapeutic ultrasound group presented a reorganization of the fiber's structure and a reduction of the presence of inflammatory infiltrate. In the results of the immunohistochemistry of iNOS, TNF-α and NF-κB in muscle tissue, we observed that the group treated with ultrasound showed a reduction in the expression of the proteins. The use of UST was effective in protecting muscle tissue from oxidative stress, inflammatory process and in the rearrangement of muscle fibers.

RESUMEN

Diseases that jeopardize the musculoskeletal system and cause chronic impairment are prevalent throughout the Western world. In Germany alone, ~1.8 million patients suffer from these diseases annually, and medical expenses have been reported to reach 34.2bn Euros. Although musculoskeletal disorders are seldom fatal, they compromise quality of life and diminish functional capacity. For example, musculoskeletal disorders incur an annual loss of over 0.8 million workforce years to the German economy. Among these diseases, traumatic skeletal muscle injuries are especially problematic because they can occur owing to a variety of causes and are very challenging to treat. In contrast to chronic muscle diseases such as dystrophy, sarcopenia, or cachexia, traumatic muscle injuries inflict damage to localized muscle groups. Although minor muscle trauma heals without severe consequences, no reliable clinical strategy exists to prevent excessive fibrosis or fatty degeneration, both of which occur after severe traumatic injury and contribute to muscle degeneration and dysfunction. Of the many proposed strategies, cell-based approaches have shown the most promising results in numerous pre-clinical studies and have demonstrated success in the handful of clinical trials performed so far. A number of myogenic and non-myogenic cell types benefit muscle healing, either by directly participating in new tissue formation or by stimulating the endogenous processes of muscle repair. These cell types operate via distinct modes of action, and they demonstrate varying levels of feasibility for muscle regeneration depending, to an extent, on the muscle injury model used. While in some models the injury naturally resolves over time, other models have been developed to recapitulate the peculiarities of real-life injuries and therefore mimic the structural and functional impairment observed in humans. Existing limitations of cell therapy approaches include issues related to autologous harvesting, expansion and sorting protocols, optimal dosage, and viability after transplantation. Several clinical trials have been performed to treat skeletal muscle injuries using myogenic progenitor cells or multipotent stromal cells, with promising outcomes. Recent improvements in our understanding of cell behaviour and the mechanistic basis for their modes of action have led to a new paradigm in cell therapies where physical, chemical, and signalling cues presented through biomaterials can instruct cells and enhance their regenerative capacity. Altogether, these studies and experiences provide a positive outlook on future opportunities towards innovative cell-based solutions for treating traumatic muscle injuries-a so far unmet clinical need.

Asunto(s)

Tratamiento Basado en Trasplante de Células y Tejidos/métodos , Desarrollo de Músculos/fisiología , Músculo Esquelético/lesiones , Enfermedades Musculares/terapia , Regeneración , Ensayos Clínicos como Asunto , Humanos , Músculo Esquelético/fisiopatología , Enfermedades Musculares/complicaciones , Enfermedades Musculares/fisiopatología , Calidad de Vida , Traumatismos de los Tejidos Blandos/complicaciones , Traumatismos de los Tejidos Blandos/fisiopatología , Traumatismos de los Tejidos Blandos/terapia , Resultado del Tratamiento

RESUMEN

PURPOSE: Research regarding exercise-induced muscle-damage mainly focuses on adults. The present study examined exercise-induced muscle-damage responses in adults compared with children. METHOD: Eleven healthy boys (10-12 y) and 15 healthy men (18-45 y) performed 5 sets of 15 maximal eccentric contractions of the knee extensors. Range of motion (ROM), delayed onset muscle soreness (DOMS) during squat and walking, and peak isometric, concentric and eccentric torque were assessed before, post, 24, 48, 72, and 96 hr postexercise. Creatine kinase (CK) activity was assessed before and 72 hr postexercise. RESULTS: Eccentric exercise resulted in DOMS during squat that persisted for up to 96h in men, and 48 hr in boys (p < .05), and DOMS during walking that persisted for up to 72 hr in men, and 48 hr in boys (p < .01). The ROM was lower in both age groups 48 hr postexercise (p < .001). Isometric (p < .001), concentric (p < .01) and eccentric (p < .01) force decreased post, and up to 48 hr postexercise in men. Except for a reduction in isometric force immediately after exercise, no other changes occurred in boys' isokinetic force. CK activity increased in men at 72 hr postexercise compared with pre exercise levels (p = .05). CONCLUSION: Our data provide further confirmation that children are less susceptible to exercise-induced muscle damage compared with adults.

Asunto(s)

Ejercicio Físico , Músculo Esquelético/lesiones , Adulto , Niño , Creatina Quinasa/sangre , Humanos , Articulación de la Rodilla , Masculino , Persona de Mediana Edad , Fuerza Muscular , Músculo Esquelético/fisiología , Mialgia/fisiopatología , Rango del Movimiento Articular , Torque , Adulto Joven

RESUMEN

The purpose of this work was to investigate the effect of early and long-term low-level laser therapy (LLLT) on oxidative stress and inflammatory biomarkers after acute-traumatic muscle injury in Wistar rats. Animals were randomly divided into the following four groups: control group (CG), muscle injury group (IG), CG + LLLT, and IG + LLLT: laser treatment with doses of 3 and 5 J/cm(2). Muscle traumatic injury was induced by a single-impact blunt trauma in the rat gastrocnemius. Irradiation for 3 or 5 J/cm(2) was initiated 2, 12, and 24 h after muscle trauma induction, and the treatment was continued for five consecutive days. All the oxidant markers investigated. namely thiobarbituric acid-reactive substance, carbonyl, superoxide dismutase, glutathione peroxidase, and catalase, were increased as soon as 2 h after muscle injury and remained increased up to 24 h. These alterations were prevented by LLLT at a 3 J/cm(2) dose given 2 h after the trauma. Similarly, LLLT prevented the trauma-induced proinflammatory state characterized by IL-6 and IL-10. In parallel, trauma-induced reduction in BDNF and VEGF, vascular remodeling and fiber-proliferating markers, was prevented by laser irradiation. In order to test whether the preventive effect of LLLT was also reflected in muscle functionality, we tested the locomotor activity, by measuring distance traveled and the number of rearings in the open field test. LLLT was effective in recovering the normal locomotion, indicating that the irradiation induced biostimulatory effects that accelerated or resolved the acute inflammatory response as well as the oxidant state elicited by the muscle trauma.

Asunto(s)

Biomarcadores/metabolismo , Inflamación/metabolismo , Músculo Esquelético/metabolismo , Estrés Oxidativo/efectos de la radiación , Animales , Factor Neurotrófico Derivado del Encéfalo/metabolismo , Catalasa/metabolismo , Glutatión Peroxidasa/metabolismo , Humanos , Inflamación/fisiopatología , Interleucina-10/metabolismo , Terapia por Luz de Baja Intensidad , Músculo Esquelético/lesiones , Músculo Esquelético/fisiopatología , Músculo Esquelético/efectos de la radiación , Ratas , Superóxido Dismutasa/metabolismo , Sustancias Reactivas al Ácido Tiobarbitúrico/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismo , Cicatrización de Heridas/efectos de la radiación

RESUMEN

INTRODUCTION AND HYPOTHESIS: It is known that pelvic floor muscle trauma (PFMT) after vaginal delivery is associated with pelvic organ prolapse (POP) symptoms (sPOP) and signs (POP-Q ≥2) in patient populations. Our aims were to establish the prevalence and investigate a possible association between PFMT and sPOP and POP-Q ≥2 in healthy women 20 years after their first delivery. METHODS: During 2013 and 2014 we conducted a cross-sectional study among 847 women who delivered their first child between 1990 and 1997. Women responded to a postal questionnaire and were offered a clinical examination including prolapse grading and pelvic floor ultrasonography. The main outcome measures were sPOP, POP-Q ≥2 and PFMT, defined by levator avulsion or a levator hiatal area on Valsalva manoeuvre of >40 cm(2) on ultrasonography. RESULTS: Of the 847 eligible women, 608 (72 %) were examined. Data on POP symptoms, POP-Q stage, levator avulsion and levator hiatal area were available in 598, 608, 606 and 554 women, respectively, and of these 75 (13%) had sPOP, 275 (45%) had POP-Q ≥2, 113 (19 %) had levator avulsion and 164 (30%) had a levator hiatal area >40 cm(2). Levator avulsion was associated with POP-Q ≥2 with an odds ratio (OR) of 9.91 and a 95% confidence interval (CI) of 5.73 - 17.13, and with sPOP (OR 2.28, 95% CI 1.34 - 3.91). Levator hiatal area >40 cm(2) was associated with POP-Q ≥2 (OR 6.98, 95% CI 4.54, - 10.74) and sPOP (OR 3.28, 95 % CI 1.96 - 5.50). CONCLUSION: Many healthy women selected from the general population have symptoms and signs of POP 20 years after their first delivery, and PFMT is associated with POP-Q ≥2 and sPOP.

Asunto(s)

Diafragma Pélvico/lesiones , Prolapso de Órgano Pélvico/epidemiología , Prolapso de Órgano Pélvico/etiología , Adulto , Estudios Transversales , Parto Obstétrico , Femenino , Humanos , Persona de Mediana Edad , Prevalencia , Factores de Tiempo

RESUMEN

OBJECTIVES: To study possible associations between mode of delivery and pelvic organ prolapse (POP) and pelvic floor muscle trauma 16-24 years after first delivery and, in particular, to identify differences between forceps and vacuum delivery. METHODS: This was a cross-sectional study including 608 women who delivered their first child in 1990-1997 and were examined with POP quantification (POP-Q) and pelvic floor ultrasound in 2013-2014. Outcome measures were POP ≥ Stage 2 or previous prolapse surgery, levator avulsion and levator hiatal area on Valsalva. Univariable and multivariable logistic regression analyses and ANCOVA were applied to identify outcome variables associated with mode of delivery. RESULTS: Comparing forceps to vacuum delivery, the adjusted odds ratios (aOR) were 1.72 (95% CI, 1.06-2.79; P = 0.03) for POP ≥ Stage 2 or previous prolapse surgery and 4.16 (95% CI, 2.28-7.59; P < 0.01) for levator avulsion. Hiatal area on Valsalva was larger, with adjusted mean difference (aMD) of 4.75 cm(2) (95% CI, 2.46-7.03; P < 0.01). Comparing forceps with normal vaginal delivery, the adjusted odds ratio (aOR) was 1.74 (95% CI, 1.12-2.68; P = 0.01) for POP ≥ Stage 2 or surgery and 4.35 (95% CI, 2.56-7.40; P < 0.01) for levator avulsion; hiatal area on Valsalva was larger, with an aMD of 3.84 cm(2) (95% CI, 1.78-5.90; P < 0.01). Comparing Cesarean delivery with normal vaginal delivery, aOR was 0.06 (95% CI, 0.02-0.14; P < 0.01) for POP ≥ Stage 2 or surgery and crude OR was 0.00 (95% CI, 0.00-0.30; P < 0.01) for levator avulsion; hiatal area on Valsalva was smaller, with an aMD of -8.35 cm(2) (95% CI, -10.87 to -5.84; P < 0.01). No differences were found between vacuum and normal vaginal delivery. CONCLUSIONS: We found that mode of delivery was associated with POP and pelvic floor muscle trauma in women from a general population, 16-24 years after their first delivery. Forceps was associated with significantly more POP, levator avulsion and larger hiatal areas than were vacuum and normal vaginal deliveries. There were no statistically significant differences between vacuum and normal vaginal deliveries. Cesarean delivery was associated with significantly less POP and pelvic floor muscle trauma than were normal or operative vaginal delivery.

Asunto(s)

Enfermedades del Ano/epidemiología , Dolor/epidemiología , Trastornos del Suelo Pélvico/epidemiología , Prolapso de Órgano Pélvico/epidemiología , Instrumentos Quirúrgicos/estadística & datos numéricos , Extracción Obstétrica por Aspiración/estadística & datos numéricos , Adulto , Enfermedades del Ano/diagnóstico por imagen , Enfermedades del Ano/etiología , Enfermedades del Ano/patología , Cesárea/efectos adversos , Cesárea/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Noruega/epidemiología , Dolor/diagnóstico por imagen , Dolor/etiología , Dolor/patología , Paridad , Trastornos del Suelo Pélvico/diagnóstico por imagen , Trastornos del Suelo Pélvico/etiología , Trastornos del Suelo Pélvico/patología , Prolapso de Órgano Pélvico/diagnóstico por imagen , Prolapso de Órgano Pélvico/etiología , Embarazo , Calidad de Vida , Instrumentos Quirúrgicos/efectos adversos , Ultrasonografía , Extracción Obstétrica por Aspiración/efectos adversos

RESUMEN

Intact abductors of the hip play a crucial role in preventing limping and are known to be damaged through the direct lateral approach. The extent of trauma to the abductors after revision total hip replacement (THR) is unknown. The aim of this prospective study was to compare the pre- and post-operative status of the gluteus medius muscle after revision THR. We prospectively compared changes in the muscle and limping in 30 patients who were awaiting aseptic revision THR and 15 patients undergoing primary THR. The direct lateral approach as described by Hardinge was used for all patients. MRI scans of the gluteus medius and functional analyses were recorded pre-operatively and six months post-operatively. The overall mean fatty degeneration of the gluteus medius increased from 35.8% (1.1 to 98.8) pre-operatively to 41% (1.5 to 99.8) after multiple revision THRs (p = 0.03). There was a similar pattern after primary THR, but with considerably less muscle damage (p = 0.001), indicating progressive muscle damage. Despite an increased incidence of a positive Trendelenburg sign following revision surgery (p = 0.03) there was no relationship between the cumulative fatty degeneration in the gluteus medius and a positive Trendelenburg sign (p = 0.26). The changes associated with other surgical approaches to the hip warrant investigation.

Asunto(s)

Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Músculo Esquelético/patología , Anciano , Estudios de Casos y Controles , Femenino , Inclinación de Cabeza , Cadera , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Músculo Esquelético/fisiopatología , Estudios Prospectivos , Reoperación/efectos adversos

RESUMEN

BACKGROUND: Skeletal muscle trauma leads to severe functional deficits, which cannot be addressed by current treatment options. Previous investigation could show the efficacy of a local transplantation (TX) of mesenchymal stroma cells (MSCs) for the therapy of muscle injury. Underlying mechanisms remain to be elucidated. The aim of the present work was to characterize the fiber composition changes following MSC-TX after open crush injury. METHODS: 20 male SD rats received an open crush trauma of the left soleus muscle. 2.5 × 10(6) autologous MSCs were transplanted into the crushed soleus muscle of 10 animals 7 days after trauma (group 1, n = 10). Control animals received an injection of saline solution (group 2, n = 10). Histologic analysis of fibrosis, fiber type composition, and muscle force measurements were performed 28 days after trauma. RESULTS: MSC-TX improved muscle force significantly (fast-twitch, treated: 0.76 (0.51-1.15), untreated: 0.45 (0.32-0.73); p = 0.01). Tetanic stimulation resulted in a significant increase of force development (treated: 0.63 (0.4-1.21), untreated: 0.34 (0.16-0.48); p = 0.04). Histological analyses showed no differences in the amount of fibrotic tissue (treated vs. untreated, p = 0.42). A shift towards fastMHC-positive fibers was observed following MSC-TX (treated vs. untreated; p = 0.01 (mm(2)) or 0.007 (%)). CONCLUSION: This study demonstrated an effect of locally administered MSCs in the treatment of skeletal muscle injuries on a structural level. For the first time a fiber type shift towards fastMHC following MSC-TX after crush injury could be demonstrated and related to MSC-TX. These results might open the discussion of an alternative mode of action of MSCs in tissue regeneration.