Academic literature on the topic 'Tendons – wounds and injuries – treatment'
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Journal articles on the topic "Tendons – wounds and injuries – treatment"
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Zhang, Kairui, Michael W. Hast, Soutarou Izumi, Yu Usami, Snehal Shetye, Ngozi Akabudike, Nancy J. Philp, et al. "Modulating Glucose Metabolism and Lactate Synthesis in Injured Mouse Tendons: Treatment With Dichloroacetate, a Lactate Synthesis Inhibitor, Improves Tendon Healing." American Journal of Sports Medicine 46, no. 9 (June 21, 2018): 2222–31. http://dx.doi.org/10.1177/0363546518778789.
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Background: Tendon injuries are common problems among athletes. Complete recovery of the mechanical structure and function of ruptured tendons is challenging. It has been demonstrated that upregulation of glycolysis and lactate production occurs in wounds, inflammation sites, and cancerous tumors, and these metabolic changes also control growth and differentiation of stem and progenitor cells. Similar metabolic changes have been reported in human healing tendons. In addition, lactate production has increased in progenitors isolated from injured tendons after treatment with IL-1β. It is thought that the metabolic changes play a role in tendon healing after injury. Hypothesis: Glucose metabolism is altered during tendon injury and healing, and modulation of this altered metabolism improves tendon repair. Study Design: Controlled laboratory study. Methods: The authors used the tendon injury model involving a complete incision of the Achilles tendon in C57BL/6J female mice and studied alterations of glucose metabolism in injured tendons with [U-13C]glucose and metabolomics analysis 1 and 4 weeks after surgery. They also examined the effects of dichloroacetate (DCA; an indirect lactate synthesis inhibitor) treatment on the recovery of structure and mechanical properties of injured tendons 4 weeks after surgery in the same mouse model. Results: Significant changes in glucose metabolism in tendons after injury surgery were detected. 13C enrichment of metabolites and intermediates, flux through glycolysis, and lactate synthesis, as well as tricarboxylic acid cycle activity, were acutely increased 1 week after injury. Increased glycolysis and lactate generation were also found 4 weeks after injury. DCA-treated injured tendons showed decreased cross-sectional area and higher values of modulus, maximum stress, and maximum force when compared with vehicle-treated injured tendons. Improved alignment of the collagen fibers was also observed in the DCA group. Furthermore, DCA treatment reduced mucoid accumulation and ectopic calcification in injured tendons. Conclusion: The findings indicate that injured tendons acutely increase glycolysis and lactate synthesis after injury and that the inhibition of lactate synthesis by DCA is beneficial for tendon healing. Clinical Relevance: Changing metabolism in injured tendons may be a therapeutic target for tendon repair.
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Zhang, Jianying, Feng Li, Tyler Augi, Kelly M. Williamson, Kentaro Onishi, MaCalus V. Hogan, Matthew D. Neal, and James H. C. Wang. "Platelet HMGB1 in Platelet-Rich Plasma (PRP) promotes tendon wound healing." PLOS ONE 16, no. 9 (September 16, 2021): e0251166. http://dx.doi.org/10.1371/journal.pone.0251166.
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Platelet-rich plasma (PRP) is a widely used autologous treatment for tendon injuries in clinics. Platelets (PLTs) are a major source of high mobility group box1 (HMGB1) that is gaining attention as a chemoattractant that can recruit stem cells to the wound area to enhance healing of injured tissues; however, the contribution of PLT HMGB1 in wounded tendon healing remains unexplored. This study investigated the effect of PLT HMGB1 within PRP on tendon healing using PLT HMGB1 knockout (KO) and GFP mice. A window defect was created in the patellar tendons of both groups of mice, and wounds were treated with either saline, PRP isolated from PLT HMGB1-KO mice, or PRP isolated from GFP mice. Seven days post-treatment, animals were sacrificed and analyzed by gross inspection, histology, and immunostaining for characteristic signs of tendon healing and repair. Our results showed that in comparison to mice treated with PRP from PLT HMGB1-KO mice, wounds treated with PRP from GFP mice healed faster and exhibited a better organization in tendon structure. Mice treated with PRP from PLT HMGB1-KO mice produced tendon tissue with large premature wound areas and low cell densities. However, wounds of PLT HMGB1-KO mice showed better healing with PRP from HMGB1-KO mice compared to saline treatment. Moreover, wounds treated with PRP from GFP mice had increased extracellular HMGB1, decreased CD68, increased stem cell markers CD146 and CD73, and increased collagen III protein expression levels compared to those treated with PRP from PLT HMGB1-KO mice. Thus, PLT HMGB1 within PRP plays an important role in tendon wound healing by decreasing inflammation, increasing local HMGB1 levels, and recruiting stem cells to the wound area in the tendon. Our findings also suggest that the efficacy of PRP treatment for tendon injuries in clinics may depend on PLT HMGB1 within PRP preparations.
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Zhang, Ying, Jing Yu, Jiefeng Zhang, and Yongxin Hua. "Simvastatin With PRP Promotes Chondrogenesis of Bone Marrow Stem Cells In Vitro and Wounded Rat Achilles Tendon–Bone Interface Healing In Vivo." American Journal of Sports Medicine 47, no. 3 (January 22, 2019): 729–39. http://dx.doi.org/10.1177/0363546518819108.
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Background: Tendons and ligaments are joined to bone in a specialized interface that transmits force from muscle to bone and permits body movement. Tendon/ligament injuries always occur in the interface areas, and injured tendons/ligaments have a limited healing response because the insertion site is composed of a fibrocartilaginous zone. Purpose: To study the effect of simvastatin with platelet-rich plasma (PRP) on chondrogenesis of rat bone marrow stem cells (BMSCs) in vitro and wounded rat Achilles tendon–bone interface healing in vivo. Study Design: Controlled laboratory study. Methods: The in vitro model was performed by the culture of rat BMSCs with various concentrations of simvastatin (0, 10, 50, 100 nM) for 2 weeks. The effect of simvastatin on the chondrogenic differentiation of the BMSCs was examined by histochemical analysis and real-time quantitative reverse transcription polymerase chain reaction. The in vivo model was carried out by testing the healing effect of simvastatin with PRP on 12 wounded rat Achilles tendon–bone interfaces. Results: Simvastatin induced chondrogenic differentiation of rat BMSCs in a concentration-dependent manner as evidenced by histological staining and real-time quantitative reverse transcription polymerase chain reaction. The wounds treated with simvastatin alone or with simvastatin-containing PRP gel healed much faster than the wounds treated with saline alone or PRP alone. Histological analysis showed that higher percentages of healed tissues were positively stained with safranin O and fast green in wounds treated with simvastatin-containing PRP gel than in the other 3 groups. Immunohistochemical analysis further demonstrated these findings, as evidenced by more positively stained healed tissues with collagen I and II antibodies in the wound areas treated with simvastatin-containing PRP gel than the other 3 groups. Conclusion: The combination of simvastatin with PRP induced chondrogenesis of BMSCs in vitro and enhanced fibrocartilage formation in vivo. The simvastatin–PRP gel treatment promotes wounded tendon-bone interface healing in clinical treatment. Clinical Relevance: The combination of simvastatin with PRP may be a good clinical treatment for wounded tendon/ligament junction healing, especially for acute sports-related tendon/ligament injuries.
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Shafiq, Muhammad. "FREQUENCY, DISTRIBUTION AND TREATMENT OF ACUTE FLEXOR TENDON INJURIES IN ZONE V OF HAND." Gomal Journal of Medical Sciences 17, no. 1 (March 31, 2019): 11–14. http://dx.doi.org/10.46903/gjms/17.01.1857.
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Background: Flexor tendons injuries are common emergency procedures The objectives of this study were to determine the frequency, distribution and results of treatment of acute flexor tendon injuries in zone V of hand in our population. Material and Methods: This descriptive cross-sectional was conducted in the Department of Orthopedic, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2017. Sample size was 30, selected through consecutive technique. Patients having flexor tendon injuries in zone v, admitted through emergency department were included in this study. Demographic variable were sex and age-groups. The research variable were tendon involved, nerves involved, artery involved, mechanism of injury, wound size, duration of injury, season, type of injury, hand involved and results of treatment. All variables, being categorical were analyzed by frequency and percentages using SPSS version 16.0. Results: Out of 30 patients, 22(73.33%) were male. Twenty four (80%) patients were between 21 to 40 years age. Mechanism of injury was glass in 16(53.33%) cases, knife in 10(33.33%) cases. Twenty (66.66%) cases presented in summer. Flexor digitorum sublimus was injured in 21(70.0%), FCR in 11(36.66%), FPL in 8(26.66), FDP in 6(20.0%) and FCU in 4(13.33%) cases. Median nerve was involved in nine (30%) cases. Radial artery was involved in eight (26.66%) cases. Wound size was 2 cm in 24(80%) cases. Sixteen (53.33 %) cases came with self-inflicted injuries. Twenty (66.66 %) cases came after 12 hours. Twenty five (83.33%) patients achieved good to excellent results. Conclusion: Flexor digitorus sublimus was the most common tendon injured in non-dominant hand, especially in young males. Median nerve and radial artery were commonly injured structures mostly with glass. Majority patients presented more than 12 hours after injury, having wound size of 2cm. Mostly the injuries were self-inflicted and occurred in summer season.
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Dinhane, Kandir Genesio Innocenti, Alexandre Leme Godoy-Santos, Alexandre Todorovic Fabro, Maria Regina Moretto, Igor Deprá, and Winston Bonetti Yoshida. "Short-term Changes After Corticosteroid Injections Into the Normal Tendons of Rabbits: A Controlled Randomized Study." American Journal of Sports Medicine 47, no. 3 (January 14, 2019): 721–28. http://dx.doi.org/10.1177/0363546518818819.
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Background: Corticosteroid injections in or around tendons for the treatment of athletic injuries are a common practice among orthopaedic surgeons and are apparently efficacious in the short term, although controversies persist related to local complications. Purpose: This study evaluated short-term (48 hours) biomechanical, biochemical, and histological alterations after a single injection of betamethasone into the normal tendons of rabbits. Study Design: Controlled laboratory study. Methods: A total of 72 New Zealand White rabbits were randomly divided into 2 groups: the test group—in which 36 animals underwent 1 intratendinous injection of betamethasone (1.4 mg / 0.2 mL) in the right calcaneal tendon; the control group—in which the right calcaneal tendon of 36 animals was injected with saline (placebo control group) and the left calcaneal tendon was left untreated for normal standards (normal control). Forty-eight hours later, animals were euthanized and tendons were harvested. Metalloproteinase (MMP1 and MMP2) and interleukin (IL1 and IL6) expression levels, biomechanical resistance (load × elongation parameters), and histomorphometry (hematoxylin and eosin and picrosirius red stains for collagen fibers, tenocytes, and inflammatory cells) were analyzed in the tendons. Results: The test group had a significant reduction in MMP2 expression as compared with the control groups ( P = .027). Regarding the other parameters, there were no additional significant differences between the groups. Conclusion: A single injection of corticosteroid into normal calcaneal tendons did not trigger acute local morphological, structural, or biomechanical injuries at 48 hours, but it did promote a significant decrease in MMP2 levels. Additional studies are needed with increased duration of follow-up, various doses, and multiple injections and in tendinopathic models. Clinical Relevance: Some previous studies demonstrated early structural changes in tendons after a single corticosteroid injection, which was not corroborated by the present study. Metalloproteinase decrease is usually associated with a reduction in collagen degradation, which would be protective for the healing process. More studies are necessary to confirm the possible beneficial effect of these results in the long term and for tendinopathies.
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Sung, Kun Yong, Seung Je Lee, and Hong Sil Joo. "Treatment Strategy for an Electrical Burn Patient with Multiple Fourth-Degree Wounds." Journal of Wound Management and Research 16, no. 2 (June 30, 2020): 121–24. http://dx.doi.org/10.22467/jwmr.2020.01032.
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Electrical burns, especially high-voltage burns, usually cause necrosis of the subcutaneous fat, fascia, muscle, and bone. The reconstruction of electrical injuries often involves multiple surgeries. We present the case of a 56-year-old man who was injured by a high-voltage current resulting in multiple soft tissue defects on the left ankle and plantar area. The wounds on the malleolar and lateral plantar areas had burned the muscle, tendon, and bone. Because the patient had multiple wounds and unstable vessels, we took the strategy of operating in stages. The primary aim of treatment was wound healing and maintaining the support structure for mobility. Several rounds of wide debridement and negative-pressure wound therapy, followed by application of acellular dermal matrix and split-thickness skin graft were performed as part of the first stage. At the 1-year follow-up, the patient could walk independently wearing a splint to prevent foot drop. A second reconstructive surgery is possible, if necessary.
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Khvisyuk, O. M., V. V. Pastukh, M. Yu Karpinsky, O. D. Karpinska, and I. A. Subbota. "An experimental study of the mechanical properties of the Achilles tendon in rabbits during its recovery after injury." TRAUMA 22, no. 1 (April 9, 2021): 12–19. http://dx.doi.org/10.22141/1608-1706.1.22.2021.226392.
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Background. The problem of treating patients with tendon injuries remains unresolved. Unsatisfactory results after surgical treatment, according to different authors, range from 15 to 62 %. The functional outcome after surgical repair of damaged tendons is difficult to predict because of the high risk of scar block formation, which prevents them from sliding freely. Adhesions compromise the extensibility of the tendons, which in turn affects their strength. The purpose was to experimentally investigate the strength properties of the Achilles tendons after their surgical restoration with the further use of various medications. Materials and methods. The mechanical properties of the Achilles tendons of rabbits were investigated, on which a model of their partial damage was created by crossing by 1/2 the diameter. The injured tendon was sutured with a tendon suture. Within the experiment, 5 groups of preparations of the Achilles tendons of rabbits with a heel bone were studied, 3 preparations in each group. Group 1 was a control one. After performing the tendon suture, the wound was sutured. The rabbits of group 2 were administered Noltrex around the tendon suture. Group 3 included the animals who were injected with a preparation of hyaluronic acid. Group 4 consisted of the animals who were injected with lidase. Group 5 included the animals with the normal values, preparations of non-operated Achilles tendons of intact animals. All animals were withdrawn from the experiment on day 60. According to the test results, the value of the elastic modulus and the ultimate strength of the preparation was calculated. Results. The greatest elongation under a tensile load of 30 N was achieved on preparations of unoperated Achilles tendons of rabbits — 2.96 ± 0.22 mm. The smallest elongation was obtained for the preparations of the control group — 0.83 ± 0.37 mm. The rest of the drug groups showed intermediate values. The Achilles tendon preparations of rabbits from the control group (0.216 ± 0.123 MPa) have the highest value of the elastic modulus. The smallest value of the modulus of elasticity was found in the study of non-injured preparations of the Achilles tendon (0.051 ± 0.004 MPa). The drugs of the control group had the greatest strength (the value of the maximum permissible load was 81.81 ± 0.34 N). The least strength was demonstrated by preparations of non-traumatized Achilles tendons of rabbits (the value of the maximum permissible load was 69.72 ± 0.18 N). Conclusions. Within the recovery of the Achilles tendon in rabbits after injury, an increase in the values of indicators characterizing the strength properties of tissues is observed — elastic modulus, maximum permissible load, and ultimate strength. The values of indicators characterizing the plastic properties of tissues decrease, which can be one of the reasons for the development of post-traumatic contractures. The best indicators in terms of tissue plasticity were observed in the group of preparations of the Achilles tendon of rabbits treated with hyaluronic acid. The worst ones were registered in the control group.
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Wang, Hai, and Ningning Liu. "Research on the Examination Value of High-Frequency Ultrasound in the Postoperative Rehabilitation Treatment of Sports Injury Achilles Tendon Rupture." Journal of Medical Imaging and Health Informatics 10, no. 4 (April 1, 2020): 918–22. http://dx.doi.org/10.1166/jmihi.2020.2954.
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The objective of the paper is to explore the examination value of high-frequency ultrasonography in the postoperative rehabilitation treatment of Achilles tendon injury occurred during sports events. The high-frequency ultrasound imaging technique was applied to examine the Achilles tendon injuries of patients. After the patients accepted Achilles tendon rupture repair surgeries, ultrasound imaging was applied to detect the rehabilitation conditions during the recovery processes. The diagnosis was mainly performed through the Achilles tendon sonograms examined 4 weeks, 6 weeks, 12 weeks, 24 weeks after the surgeries respectively; in addition, the changes in the American Orthopedic Foot and Ankle Score (AOFAS) and the elasticity modulus of repaired Achilles tendons were observed 8 weeks, 12 weeks, 24 weeks, and 48 weeks after the surgeries respectively. The results showed that the Achilles tendon was significantly improved after the postoperative rehabilitation, and the average AOFAS score was positively correlated with the elasticity modulus of the repaired Achilles tendon. In addition, the research results also indicated that the high-frequency ultrasound technology could accurately observe the thickness, area, and internal echo of the Achilles tendons of patients dynamically in real-time, which was convenient and quick. After the patient had undergone rehabilitation training, high-frequency ultrasound could be used to detect the postoperative rehabilitation conditions of patients, thereby the real-time rehabilitation conditions of the patients would be obtained.
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ANGERMANN, P., and M. LOHMANN. "Injuries to the Hand and Wrist. A Study of 50,272 Injuries." Journal of Hand Surgery 18, no. 5 (October 1993): 642–44. http://dx.doi.org/10.1016/0266-7681(93)90024-a.
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This study reports the causes, characteristics and treatment of injuries to the hand and wrist presented to five accident and emergency departments in a 2-year survey of 13% of the Danish population. The rate of injury to the hand or wrist was 28.6% of all injuries, or 3.7 per 100,000 inhabitants per year. 34% of the accidents were domestic, 35% were leisure accidents, 26% were occupational and 5% were traffic accidents. Only 2% of the patients were admitted to hospital for further treatment or observation and 13% were referred to a hospital as outpatients. The most frequent causes for admission were fractures (42%), tendon lesions (29%) and wounds (12%).
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Esquivel, Esteban, Cameron Cox, Amanda Purcell, and Brendan MacKay. "Zone V Extensor Tendon Repair with a Palmaris Longus Tendon Autograft and Human Umbilical Membrane." Case Reports in Orthopedics 2020 (January 4, 2020): 1–5. http://dx.doi.org/10.1155/2020/2759281.
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Extensor tendon repairs, although common, can be difficult injuries to treat. Their treatment is tailored to the zone of the hand that is affected since varying biomechanical forces are applied to the tendon at each zone. Prompt treatment is necessary to prevent potential complications associated with these injuries. This is particularly true of Zone V extensor tendon injuries, as their mechanism is commonly a highly infectious human bite. We present the case of a human fight bite resulting in a Zone V extensor tendon injury. The delayed presentation of this case resulted in an untreated infection that caused an abscess with associated extensor tendon necrosis and rupture. Given the large gap length between the ends of the tendons, tendon repair was performed using a palmaris longus autograft. Even when these are done in a controlled setting, adhesions are common. The compromised wound bed caused irritation, erosion, and subsequent rupture of the extensor tendon of the hand. In an effort to avoid common complications such as adhesion, the repair was then wrapped with human umbilical membrane (AVIVE® Soft Tissue Membrane, AxoGen Inc., Alachua, FL) to separate adjacent tissue and reduce inflammation. Even without access to formal physical therapy, our patient had excellent functional outcomes at his final follow-up visit. The patient was able to make a loose composite fist, had no extensor lag at the MCP joints, and had extensor lag of 15 degrees at the PIP joints of digits 4-5.
Dissertations / Theses on the topic "Tendons – wounds and injuries – treatment"
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Kelly, Patricia J. "Morphological changes of collagenase induced tendinitis of achilles rat tendons utilizing augmented soft tissue mobilization." Virtual Press, 1999. http://liblink.bsu.edu/uhtbin/catkey/1129629.
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Augmented Soft Tissue Mobilization (ASTM) is a new noninvasive technique utilized to treat chronic musculoskeletal injuries. The purpose of this study was to trace the morphological events in collagenase injured rat Achilles tendons during ASTM treatment and to observe passive occurrence of post treatment remodeling in tendons. Twelve groups of rats were divided into the following categories, A) control, B) sham surgery, C) ASTM only, D) ASTM/sham , E) tendinitis, F) ASTM/tendinitis 1 week, G) ASTM/tendinits 2 weeks H) ASTM/tendinits 3 weeks I) ASTM/tendinits 4 weeks, J) Post ASTM 5 weeks, K) Post ASTM 10 weeks, L) Post ASTM 15 weeks. One week after the last designated treatment, the Achilles tendons were harvested and then prepared for light microscopy, electron microscopy, and bifringence polarizing microscopy. An increase in fibroblast activation and proliferation was noted with the tendinitis, ASTM/tendinitis, and post groups. Ossification occurred in the core of the Achilles tendon in all of the ASTM groups. The presence of inflammatory cells was observed in the tendons and longitudinal remodeling of the collagen fibers did not occur.Department of Biology
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Murrell, George Anthony Calvert St George Clinical School UNSW. "Nitric oxide and tendon healing." Awarded by:University of New South Wales. St George Clinical School, 2006. http://handle.unsw.edu.au/1959.4/31887.
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Nitric oxide is a small free radical generated by family of enzymes, the nitric oxide synthases. In a series of experiments performed over the last 15 years we showed that nitric oxide is induced by all three isoforms of nitric oxide synthase during tendon healing and that it plays a crucial beneficial role in restoring tendon function. In normal tendon we found very little nitric oxide synthase activity while in injured rat and human tendons nitric oxide synthase activity was expressed in healing fibroblasts in a temporal fashion. In healing rat Achilles tendon fibroblasts the first isoform to be expressed was endothelial nitric oxide synthase (eNOS), followed by inducible nitric oxide synthase (iNOS), and then brain or neuronal nitric oxide synthase (bNOS). Systemic inhibition of nitric oxide synthase activity decreased the cross sectional area and mechanical properties of the healing rodent Achilles tendons. Addition of nitric oxide via NO-flurbiprofen or NO-paracetamol enhanced rat Achilles tendon healing. Addition of nitric oxide to cultured human tendon cells via chemical means and via adenoviral transfection enhanced collagen synthesis, suggesting that one mechanism for the beneficial of nitric oxide on tendon healing might be via matrix synthesis. The final part of the work involved three randomized, double-blind clinical trials which evaluated the efficacy of nitric oxide donation via a patch in the management of the tendinopathy. In all three clinical trials there was a significant positive beneficial effect of nitric oxide donation to the clinical symptoms and function of patients with Achilles tendinopathy, tennis elbow and Achilles tendonitis.
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Myers, Kimberly S. "Rat tendon morphological changes due to augmented soft tissue mobilization at various pressures." Virtual Press, 1997. http://liblink.bsu.edu/uhtbin/catkey/1041917.
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Augmented soft tissue mobilization therapy (ASTM) is a newly developed massage technique. ASTM is applied with the aid of specifically designed, solid instruments and has been successfully used in the treatment of chronic tendinitis patients. In a study on collage nase -injure d rat Achilles tendons treated with ASTM, Davidson et. al (1997) reported gait improvement as well as fibroblasts proliferation and suggested ASTM may augment healing by the recruitment of fibroblast. The present study examined the morphological response of enzyme-induced rat Achilles tendons to 3 different ASTM pressure application: 1 newton; 2 newtons and 3 newtons. Collagenase-injured tendons exhibited disrupted and randomly arranged collagen fibers. Treatment applications were performed for 4 days for a total of 4 treatments. Morphological differences were demonstrated between groups in proportion to the ASTM treatment pressure application. The ASTM group treated with 3 newtons demonstrated the greatest mean fibroblast count (370.3 +/- 51.6). Further, electron microscopy revealed the presence of activated fibroblasts in the tendons of the 3 newtons, ASTM group. However, immunochemical staining comparisons of Type I and III collagen, fibroblast growth factor receptor, and insulin-like growth factor between groups were not remarkable.Department of Physiology and Health Science
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Leaman, Jason. "Morphological changes of native rat achilles tendons following augmented soft tissue mobilization." Virtual Press, 1999. http://liblink.bsu.edu/uhtbin/catkey/1117857.
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Augmented Soft Tissue Mobilization, a massage therapy which uses a solid instrument rather than human fingers to treat musculoskeletal injuries, has been successful in treating tendinitis. Davidson et al. studied the functional and morphological affects of ASTM on collagenase induced Achilles tendinitis in Sprague-Dawley rats. Morphological observations showed a significant increase in the number and activation of fibroblasts in the ASTM treated Groups. The authors suggested that the physical force of ASTM may promote tendon healing via increased fibroblast recruitment. An important, but unexplained, question is how ASTM would affect the fibroblasts of native, noncollagenase injured, tendons. Studies have shown that mechanical forces can alter cellular functions. The purpose of this study was to examine the morphological changes in native Sprague-Dawley rat Achilles tendons after ASTM therapy using different application pressures.Three animal Groups were randomly established: A) control Group with no ASTM; B) light ASTM with 1 Newton of pressure; and C) heavy ASTM with 3 Newtons of pressure. Upon completion of the therapy, the Achilles tendons of each Group were examined with light and electron microscopy techniques to assess fibroblast number, tendon morphology, and the presence of type I and type III collagen. Fibroblast counts from each Group were compared using a two-way ANOVA, multiple regression, and curvilinear regression analysis. Morphological differences were shown between the three Groups, especially between the non force Group and the two force Groups. The ASTM Group treated with one Newton demonstrated the greatest mean fibroblast count (165.1+/-55.8&160.7+/-49.8). Electron microscopy revealed the presence of activated fibroblasts in the tendons of the two force Groups, ASTM Groups. Polarizing microscopy showed a dramatic increase in the amount of Type III collagen in the two force Groups compared to the non force Group.Ball State UniversityMuncie, IN 47306
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Strydom, Aliki Veruschka. "Extraction and biomedical application of peripheral blood stem cells in sheep and horses." Thesis, Stellenbosch : University of Stellenbosch, 2007. http://hdl.handle.net/10019.1/1146.
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Thesis (PhD (Physiological Sciences))--University of Stellenbosch, 2007.SUPERFICIAL digital flexor tendon injury has a serious negative impact on the competitive horse industry. Injured horses require up to a year of rest for recovery and likelihood of re-injury upon return to normal activity is as high as 80 %. Tendon healing requires (a) production of collagen by fibroblasts, to provide tensile strength and elasticity to the tendon, (b) minimisation of restrictive fibrosis, which compromises tendon gliding function and (c) minimisation of peritendinous adhesions. We review conventional treatments for tendon healing before exploring stem cell application as a therapeutic alternative. We promote the use of hematopoietic and mesenchymal stem cells derived from adult peripheral blood - as opposed to bone marrow-derived stem cells or embryonic stem cell sources - and review published research output in this regard. In conclusion, we outline our research objectives and present and discuss our results in the chapters that follow. Mononuclear cells - consisting of hematopoietic stem cells, mesenchymal stem cells and leucocytes – were isolated from the peripheral blood of sheep and horses through red blood cell lysis and blood plasma extraction. Cell counts and propidium iodide dye exclusion viability tests were conducted on the cell pellets. Sheep sub samples were tested for CD45 expression and horse sub samples for CD4 and CD11a/18 cell surface markers by flow cytometry for characterisation purposes. In both cases, separate sub samples were incubated with matched immunoglobulin (IgG) isotypes, conjugated to fluorescein isothiocyanate (FITC), to serve as controls. For the culture of mononuclear cells, 4.5 x 106 cells were selected for autologous sheep injections, 3 x 106 CD45- cells for allogeneic sheep injections (the latter excluding leucocytes that may induce an immune response) and 72 x 106 cells for horse injections. These cells were incubated with bromo-deoxyuridine (BrdU), cultured and subsets were extracted for a second round of cell counts and viability tests before being resuspended in blood plasma. For the horse samples an additional 1 x 106 mononuclear cells were incubated until reaching 60 % confluence and tested for myogenic differentiation. Low cell mortality and lack of fluorescence from IgG-FITC controls reflected effective protocols and a lack of false positive results. The fact that the equine cell population differentiated into myotubes verified the presence of mesenchymal stem cells in injections. We tested whether surgical incisions or collagenase injections best mimicked naturally occurring tendon injuries and compiled macroscopic and microscopic descriptions of tendon injury sites at seven weeks post-injury. The superficial digital flexor tendons of 27 sheep received an incision, a collagenase injection or a saline control injection. After one week a number of sheep were sacrificed while the remainder received further saline treatment and were sacrificed after another seven weeks. Tendons were examined through clinical observations, image analysis of maximum tendon diameter, mechanical testing and histological sectioning of affected tissues. Collagenase-induced injury resembled tendonitis more closely than surgically-induced injury. Collagenase-injured tendons (a) induced lengthier lameness in affected limbs, (b) were more swollen and difficult to palpate, (c) assumed the bow appearance characteristic of natural injury, (d) experienced extensive haemorrhage due to collagen lysis, (e) had decreased elasticity and capacity to carry loads and stress, (f) displayed decreased stiffness due to collagen fibre disruption and (g) developed severe inflammation. After seven weeks injured tendons displayed increased vascularisation in the areas of haemorrhage and in the adjacent collagen matrix. High inflammation rates and low collagen levels however still persisted. Collagenase injections were used to induce tendonitis in the superficial digital flexor tendons of 27 sheep. After one week these tendons received treatment with a control saline solution, autologous peripheral blood mononuclear cells (MNCs) or allogeneic peripheral blood CD45- MNCs. Healing rates were compared after a further seven week period by conducting ultrasonographic evaluations, clinical observations, image analyses of maximum tendon diameter, mechanical tests and histological investigations. Tendons treated with MNCs displayed an improvement in echogenicity and fibre linearity, higher and more organised collagen levels, stronger mechanical properties and less swelling. Although these improvements were not always significant, they provided strong evidence to suggest marked healing benefits over a longer time period. Collagenase injections were used to induce tendonitis in the superficial digital flexor tendons of four horses. After one week these tendons received treatment with either a control saline solution or autologous peripheral blood mononuclear cells (MNCs). Healing rates were compared after a further seven week period by conducting ultrasonographic evaluations, clinical observations, image analysis of maximum tendon diameter and histological investigations. Tendons treated with MNCs displayed significant improvements in fibre linearity in the direct vicinity of the lesion, as well as recovery rate thereof, and experienced less swelling when compared with their untreated counterparts. Healing trends suggested that, given a longer period of observation post-injury, more significant improvements may become apparent. Human adipose tissue is known be an easily accessible and high yielding source of multipotent mesenchymal stem cells. These stem cells could potentially be used for therapeutic advancement of tendon regeneration. Our first goal was to examine the in vitro myogenic differentiation potential of adipose-derived, adherent mononuclear cells (MNCs) from six adult sheep. The second goal was to characterise the population of cells isolated through various available ovine specific, non-mesenchymal stem cell surface markers, namely, CD1, CD31, CD34 and CD45. After incubation, only four of the six MNC cultures started to proliferate. These four cultures all exhibited high myogenic differentiation ability. The isolated cell populations did not express any of the non-mesenchymal stem cell specific cell surface markers. In conclusion, our data suggests that peripheral blood stem cells and adipose-derived stem cells are important candidate cell types for therapeutic application to improve tendon repair in horses and sheep. Sufficient time must be allowed following injury and prior to stem cell treatment (at least one month) and a controlled exercise program should be followed posttreatment. A larger sample size is required and at least six months of recovery before macroscopic and histological repair can be analysed more accurately and conclusively. Ultrasonography should be carried out on a continuous basis, as it is a non-invasive method of monitoring change over time.
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Dakin, Stephanie Georgina. "The role of prostaglandins in equine tendinopathy." Thesis, Royal Veterinary College (University of London), 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.572458.
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Chow, Ching-san Esther, and 周靜珊. "Functional absence of flexor digitorum superficialis to the little finger and its effects on functional status: a study in the Hong Kong Chinese population." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B45011199.
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Brown, Lisa Gill. "Effect of repeated eccentric demands placed on the lower limb musculature during simulated Rugby Union play." Thesis, Rhodes University, 2010. http://hdl.handle.net/10962/d1005192.
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Epidemiological studies consistently report that muscular strains are a primary injury type in rugby union with the majority of the strains occurring to the quadricep and hamstring musculature. Recently it has been suggested that poor eccentric muscular strength is a precursor to hamstring and quadriceps strains during intermittent sports that require rapid acceleration and deceleration. Despite the high incidence of these muscle injuries in Rugby Union there has been little research into the possible mechanisms involved. Thus, the purpose of this study was to measure the physiological and perceptual responses during a simulated Rugby Union laboratory protocol and further, to identify changes in muscle recruitment patterns and muscle strength over time by comparing this protocol to a continuous, constant load protocol covering the same distance. The experimental condition (EXP) required university level players to perform 80 minutes of simulated rugby union play in a laboratory setting (on a walkway of 22m) which was compared to that of a control condition (CON) which involved subjects covering the same distance, at a constant speed of 4.2km.h-1 on a treadmill. Physiological, biophysical and perceptual responses were measured pre-, at half-time and post-protocol. Heart rate was significantly (p<0.01) greater as a result of EXP in comparison to the CON. Electromyography (EMG) of the vastus medialis was significantly (p<0.01) greater during the CON protocol. The EXP condition elicited higher iEMG activity in the hamstring musculature at all time intervals. In addition the iEMG of the semitendinosus decreased significantly (p<0.01) as a result of the EXP protocol. Peak eccentric knee extensors (EXT) (-13.19%) and flexors (FLEX) (-12.81%) torque decreased significantly during the experimental protocol. After passive half-time (236.67 + 56.27Nm (EXT) and 173.89 + 33.3NM (FLEX)) and at the end of the protocol (220.39 + 55.16Nm and 162.89 + 30.66Nm) reduced relative to pre protocol (253.89 + 54.54Nm and 186.83 + 33.3Nm). Peak eccentric knee extensors did not change during the control protocol. „Central‟ and ‟Local” Rating of Perceived Exertion values were significantly (P<0.01) greater during the EXP protocol with an increased incidence of hamstring discomfort and perceived pain (5 out of 10). The EXP protocol resulted in significantly (p<0.01) increased incidence of delayed onset muscle soreness (DOMS). In conclusion, a stop-start laboratory protocol elicited increased heart rate, negatively impacted on muscle activity of the hamstrings, decreased eccentric strength in the lower limb musculature, resulted in increased ratings of „Central‟ and „Local‟ exertion and increased pain perception and increased incidence of DOMS. Thus, a stop-start rugby specific laboratory protocol has a negative impact on performance. Due to the specificity of the protocol being designed to match the demands of competitive match play it is expected that these changes in heart rate, muscle activity and strength, particularly eccentric strength, will impact negativity on performance during rugby match play and increase the likelihood of injury
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Watts, Russell Edward. "Evaluation of DETA as a surface treatment to enhance neuronal attachment to a silicone-based substrate." Thesis, Georgia Institute of Technology, 2001. http://hdl.handle.net/1853/16905.
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Granger, Nicolas. "Effects of intraspinal transplantation of mucosal olfactory ensheathing cells in chronic spinal cord injury in domestic dogs." Thesis, University of Cambridge, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.608161.
Full textBooks on the topic "Tendons – wounds and injuries – treatment"
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Association, American Occupational Therapy, ed. Occupational therapy practice guidelines for tendon injuries. Bethesda, Md: American Occupational Therapy Association, 1997.
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service), SpringerLink (Online, ed. The Achilles Tendon: Treatment and Rehabilitation. New York, NY: Springer-Verlag New York, 2009.
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Sports injuries sourcebook: Basic consumer health information about sprains, fractures, tendon injuries, overuse injuries, and injuries to the head, spine, shoulders, arms, hands, trunk, legs, knees, and feet, and facts about sports- specific injuries, injury prevention, protective equipment, children and sports, and the diagnosis, treatment, and rehabilitation of sports injuries ... 4th ed. Detroit, MI: Omnigraphics, 2012.
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Hamil, Douglas P. Effectiveness of nonoperative and operative treatments for rotator cuff tears. Hauppauge, N.Y: Nova Science Publishers, 2011.
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Arno, Lindner, ed. Management of lameness causes in sport horses: Muscle, tendon, joint and bone disorders. Essen: Arbeitsgruppe Pferd, 2006.
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Flexor tendon injuries. Boston: Little, Brown, 1985.
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1959-, Kannus Pekka, ed. Human tendons: Anatomy, physiology, and pathology. Champaign, IL: Human Kinetics, 1997.
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Concise guide to tendon and ligament injuries in the horse. New York: Howell Book House, 1996.
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Consensus Development Conference on the Treatment of Radiation Injuries (1st 1989 Washington, D.C.). Treatment of radiation injuries. New York: Plenum Press, 1990.
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Garde, Louis Anatole Le. Gunshot injuries: How they are inflicted, their complications and treatment. 2nd ed. Mt. Ida, Ark: Lancer Militaria, 1991.
Find full textBook chapters on the topic "Tendons – wounds and injuries – treatment"
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Folmar, Eric, and Michael Gans. "Conservative Treatment of Peroneal Tendon Injuries: Rehabilitation." In The Peroneal Tendons, 143–71. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-46646-6_7.
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Orgill, Dennis P. "Operative Management of Pressure Injuries." In Interventional Treatment of Wounds, 75–84. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-66990-8_5.
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Garrison, Glenn. "Conservative Treatment of Peroneal Tendon Injuries: Immobilization/Bracing/Orthotics." In The Peroneal Tendons, 125–42. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-46646-6_6.
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Pedowitz, David I., Rachel Shakked, Daniel J. Fuchs, and Johannes B. Roedl. "Conservative Treatment of Peroneal Tendon Injuries: Peroneal Tendon Sheath Ultrasound-Guided Corticosteroid Injection." In The Peroneal Tendons, 173–81. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-46646-6_8.
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Hanson, R. Reid, and Amelia S. Munsterman. "Treatment of Burn Injuries, Gunshot Wounds, and Dog-Bite Wounds." In Equine Wound Management, 476–89. Hoboken, NJ, USA: John Wiley & Sons, Inc., 2016. http://dx.doi.org/10.1002/9781118999219.ch20.
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van Baar, Margriet E. "Epidemiology of Scars and Their Consequences: Burn Scars." In Textbook on Scar Management, 37–43. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-44766-3_5.
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AbstractPathological scarring in burn wounds can result in hypertrophic scars and/or contractures. Prevalences of hypertrophic scarring after burn injuries between 8% and 67% are reported. A recent prospective study revealed a prevalence of 8%. Data on prevalence of burn scar contractures are limited; reported prevalence at discharge varied between 38 and 54% and decreased with an increasing time post burn. About 5–20% of the people who suffered from burn injuries received reconstructive surgery after burns, up to 10 years post injury.Factors predicting pathological scar formation after burn injuries include patient, injury and treatment characteristics. Injury- and treatment-related characteristics are the main predictors of scar outcomes after burn injury. These characteristics are related to burn size (total body surface area burned) and burn depth (number or type of surgery) or the overall healing process in general (length of stay, wound healing complications). Intrinsic patient-related risk factors seem to play a role as well but are less consistent predictors of scar outcome. This includes the risk factors like the female gender and also a younger age and darker skin.Knowledge on risk factors for poor scar outcome can be used to tailor treatment, aftercare and scar prevention to these patients with a high-risk profile.
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Majumder, Sanjib. "The extensor tendons." In Oxford Textbook of Plastic and Reconstructive Surgery, edited by Vivien Lees and James Haeney, 495–500. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780199682874.003.0154.
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The extensor tendon system of the hand includes the forearm-based extrinsic extensors that power wrist and finger extension as well as the hand-based intrinsic extensors that stabilize the digits in extension. The anatomy and interaction of these tendons are described with reference to the topographic classification system of Verdan’s zones. The injuries of the extensors can be either closed or open and the treatment is injury and site specific. The approaches to the individual injuries and treatment are described.
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MAKINS, GEORGE HENRY. "SYMPTOMS AND SIGNS OF GUNSHOT WOUNDS OF THE BLOOD-VESSELS, AND THE TREATMENT OF HÆMORRHAGE." In On Gunshot Injuries to the Blood-Vessels, 30–56. Elsevier, 2013. http://dx.doi.org/10.1016/b978-1-4831-6686-5.50008-2.
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Grocott, Patricia. "Managing Wounds." In Adult Nursing Practice. Oxford University Press, 2012. http://dx.doi.org/10.1093/oso/9780199697410.003.0039.
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This chapter addresses the vital area of wound care, including the impact that wounds can have upon patients and their families, and the nursing management challenges that they present. As a registered nurse caring for patients with wounds, you will be responsible for making a clinical assessment of the patient with a wound, making clinical decisions based on the most appropriate evidence-based, nurse-led interventions, and, crucially, measuring patient outcomes. The latter involves continuous monitoring of how both the patient and his or her wound is responding, or not, to the treatment and care that you give. This chapter presents a generic approach to wound management, and this should help you to deliver high-quality, safe wound care for patients with wounds of differing aetiologies. This includes core components of interventions for acute, chronic, and palliative wound care. Importantly, the chapter has been designed to help you to make the links between assessment, clinical decision-making, nursing interventions, and patient care. Nurses play a key role in the multidisciplinary team in the delivery of wound care, and frequently act as the ‘point of contact’ for the manufacturers and suppliers of wound care products. The approach advocated in this chapter will equip you to make informed assessments and clinical decisions. Wounds are injuries to the body, the skin in particular, causing a breach of the layers of skin (see Chapter 12 Understanding Skin Conditions) and the body boundary. The term ‘wound’ also defines the act of injuring a person’s skin. This may be deliberate, e.g. during a surgical procedure, or deliberate to cause harm, e.g. during warfare, terrorist attacks, or domestic and street violence. Wounding can also occur with accidents (a cut from a kitchen knife), natural disasters (earthquake), and exposure to environmental stresses such as extreme heat (burns, skin cancers), extreme cold (frostbite), excessive pressure, and excessive exposure to water and moisture (trench foot). Wounds also develop because of diseases and conditions such as diabetes, which disrupt the structures of the skin and the normal metabolic processes that maintain skin health (see Chapter 9 Understanding Diabetes Mellitus).
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Oates, Scott D. "Extensor Tendon Repair." In Operative Plastic Surgery, edited by Gregory R. D. Evans, 931–38. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190499075.003.0091.
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Because of their location on the dorsum of the hand, the extensor tendons are particularly vulnerable to injury. This is even more likely over the joints since the dorsal skin is particularly thin there. Injuries can occur from both sharp and blunt trauma. Untreated extensor tendon injuries can result in significant functional impairment and potential long-term permanent deformities of the hand. There are significant differences in treatment for extensor tendon injuries involving the finger zones versus the hand. This chapter will describe the most common treatment modalities for extensor tendon injuries to the hand and forearm.
Conference papers on the topic "Tendons – wounds and injuries – treatment"
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Frybarger, Michelle R., and Karim H. Muci-Küchler. "Distribution of Bacterial Contamination in Partial Penetration Surrogate Ballistic Wounds." In ASME 2020 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2020. http://dx.doi.org/10.1115/imece2020-23897.
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Abstract With the rise in use of IEDs during armed conflicts, there has been an increase in the number of injuries to the extremities. Shrapnel and debris ejected during the explosion become high-speed projectiles capable of penetrating soft tissues, bringing bacterial contamination into the wound. If not properly treated, that contamination could lead to infection. Studies aimed at understanding the distribution of bacterial contamination along the permanent cavity could provide useful information to improve treatment protocols for these types of injuries. In this paper, a lower extremity surrogate model was used to investigate bacterial distribution in partial penetration ballistic wounds. The targets used were ballistic gelatin blocks that had an Escherichia coli-laden filter paper placed on their front face. Spherical projectiles were fired into the targets adjusting their speed to obtain three different partial penetration depths. After each shot, a gelatin strip containing the permanent cavity was extracted and segmented. The permanent cavity was removed from each segment, placed in a test tube with buffer solution, and heated in a water bath to melt the gelatin. Standard microbiology protocols were followed to determine the number of colony forming units (CFUs) in each segment. The bacteria distribution was represented by percent of total CFU in the permanent cavity versus segment number. In addition, bacterial contamination as a function of projectile penetration depth was explored. For the cases considered, most of the bacterial contamination occurred in the segments closer to the projectile entry point.
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Wang, James H.-C. "Tendon Stem Cells and Platelet-Rich Plasma for Repair of Injured Tendons." In ASME 2011 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2011. http://dx.doi.org/10.1115/sbc2011-53204.
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Tendon injuries, including acute tendon injuries and tendinopathy, are common in both occupational and athletic settings. However, current treatments for tendon injury are largely ineffective, as they cannot restore normal structure and function to injured tendons. This challenge mainly stems from our incomplete understanding of tendon cell properties and responses to biomechanical and biochemical environments surrounding the cells. In recent years, however, significant progress has been made on two fronts. First, tendon stem cells (TSCs) have been recently identified. The tendon-specific stem cells can self-renew and posses multi-differentiation potential and as such, may be used to repair injured tendons more effectively. Second, platelet-rich plasma (PRP) has now been widely used in orthopaedics and sports medicine to treat injured tendons. In this presentation, I will present data on TSCs, in terms of their differential properties with respect to tenocytes and their differential mechano-responses when subjected to small and large mechanical loading conditions. I will also discuss the basic scientific studies on PRP regarding its effects on TSCs, particularly on their differentiation, which is a critical issue related to the safety and efficacy of PRP treatment in clinics (Fig. 1).
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Woo, Savio L. Y., Matthew B. Fisher, and Alejandro J. Almarza. "Regeneration of Ligaments and Tendons With ECM Bioscaffolds." In ASME 2008 International Mechanical Engineering Congress and Exposition. ASMEDC, 2008. http://dx.doi.org/10.1115/imece2008-68870.
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Ligaments and tendons of the knee are subjected to large loads during sports and work related activities, and thus, are frequently injured. For the anterior cruciate ligament (ACL) and medial collateral ligament (MCL), there are over 100,000 and 50,000 annual tears, respectively, in the United States alone. As a torn ACL has limited healing potential, surgical reconstruction using autograft replacements, such as the bone-patellar tendon-bone (BPTB) as well as the quadrupled semitendinosus and gracilis tendons, are performed in a large number of patients to restore knee stability. In spite of the over 25 years of experience, knee extension deficits and many long term complications associated with the BPTB autograft, including the progression of osteoarthritis, are serious post-surgical problems. Additionally, there are complications associated with donor site morbidity, anterior knee pain, arthrofibrosis, and inferior biomechanical properties of the patellar tendon (PT). In the case of MCL injuries, functional treatment is sufficient for rapid tissue healing; however, the neo-MCL is known to have significantly inferior tissue quality compared to the intact MCL, and the remodeling process can take years. Thus, it presents an increased chance for reinjury.
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Izmailov, Sergey, Julia Perevezentseva, Andrey Rotkov, Vladimir Beschastnov, Evgeniy Popov, and Egor Lukoyanychev. "Mathematical Justification of the Wound suturing by Wound Contractors of new Generation." In International Conference "Computing for Physics and Technology - CPT2020". Bryansk State Technical University, 2020. http://dx.doi.org/10.30987/conferencearticle_5fce2772128d09.10616351.
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Frequent cases of man-made disasters, terrorist attacks and military conflicts lead to an increase in the number of victims. Significant soft tissue defects are known to result from gunshot wounds. So, as a result of mine-blasting injuries, defects in the skin and underlying tissues more than 10 cm in diameter are formed in 71.1% of cases. The prerequisite for the uncomplicated course of the wound process is to achieve an adequate comparison of the edges of the wound without excessive tension. To close such extensive wounds, various technical means are used: sutures on pads, various types of dermatotension. We have developed various models of wound contractors (RC) for treatment of wounds. With the help of the RC, a complete reposition and good adaptation of the edges of the wound is created. The wound closure method using these RC almost completely eliminates tissue cutting and limits the sawing effect to a minimum. This is explained by the effects of elastic forces reducing to zero when matching soft tissues and suturing. The use of hardware methods for suturing wounds requires the development of mathematical models of various types of wounds and surgical sutures. These models should provide a simulation of living tissues of the wound edges behavior to achieve the best results in the treatment of wounds by RC advanced technologies. The purpose of this study is to mathematically justify RC with the parallel holding of spokes. Another purpose is to develop a mathematical model of the wounds suturing by hardware technology.
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CHIRVA, Y. V., and M. I. BABICH. "TREATMENT OF DEFECTS IN BONES AND SOFT TISSUE WOUNDS IN VICTIMS WITH INJURIES OF THE LOWER EXTREMITIES BY THE METHOD OF SEQUENTIAL OSTEOSYNTHESIS." In Проблемы и вопросы современной науки. Научно-Издательский Центр Международной Объединенной Академии Наук (НИЦ МОАН), 2018. http://dx.doi.org/10.18411/pivsn-18.
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