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The external popliteal sciatic nerve (EPSN) is the nerve of the lower extremity most frequently affected by compressive etiology. Its superficial and sinuous anatomical course is closely related to other rigid anatomical structures and has an important dynamic neural component. Therefore, this circumstance means that this nerve is exposed to multiple causes of compressive etiology. Despite this fact, there are few publications with extensive case studies dealing with treatment. In this review, we propose to carry out a narrative review of the neuropathy of the EPSN, including an anatomical reminder, its clinical presentation and diagnosis, as well as its surgical and biological approach. The most novel aspect we propose is the review of the possible role of biological factors in the reversal of this situation.

Our research group has been developing a series of biological drugs produced by coculture techniques with M2-polarized macrophages with different primary tissue cells and/or mesenchymal stromal cells (MSC), generally from fat, to produce anti-inflammatory and anti-fibrotic effects, avoiding the overexpression of pro-inflammatory cytokines by the innate immune system at a given time. One of these products is the drug PRS CK STORM, a medium conditioned by allogenic M2-polarized macrophages, from coculture, with those macrophages M2 with MSC from fat, whose composition, in vitro safety, and efficacy we studied. In the present work, we publish the results obtained in terms of safety (pharmacodynamics and pharmacokinetics) and efficacy of the intravenous application of this biological drug in a murine model of cytokine storm associated with severe infectious processes, including those associated with COVID-19. The results demonstrate the safety and high efficacy of PRS CK STORM as an intravenous drug to prevent and treat the cytokine storm associated with infectious processes, including COVID-19.

Intercellular communication between monocytes/macrophages and cells involved in tissue regeneration, such as mesenchymal stromal cells (MSCs) and primary tissue cells, is essential for tissue regeneration and recovery of homeostasis. Typically, in the final phase of the inflammation-resolving process, this intercellular communication drives an anti-inflammatory immunomodulatory response. To obtain a safe and effective treatment to counteract the cytokine storm associated with a disproportionate immune response to severe infections, including that associated with COVID-19, by means of naturally balanced immunomodulation, our group has standardized the production under GMP-like conditions of a secretome by coculture of macrophages and MSCs. To characterize this proteome, we determined the expression of molecules related to cellular immune response and tissue regeneration, as well as its possible toxicity and anti-inflammatory potency. The results show a specific molecular pattern of interaction between the two cell types studied, with an anti-inflammatory and regenerative profile. In addition, the secretome is not toxic by itself on human PBMC or on THP-1 monocytes and prevents lipopolysaccharide (LPS)-induced growth effects on those cell types. Finally, PRS CK STORM prevents LPS-induced TNF-A and IL-1Β secretion from PBMC and from THP-1 cells at the same level as hydrocortisone, demonstrating its anti-inflammatory potency.

Background: The infiltration of the stromal vascular fraction (SVF) of autologous adipose tissue to treat osteoarthritis has been used for several years demonstrating its safety and noticeable efficacy. This article presents clinical data from patients afftected by moderate and severe knee osteoarthritis demonstrating safety and clinical efficacy of the treatment when this autologous cell product is injected in the knee joint and patients evaluated post-operatively after 1 year. However, what do we know about the mechanism that underlies this clinical improvement? This article proposes, for the first time in our opinion, a hypothesis of the mode of action that involves structural and molecular interactions between SVF and infrapatellar fat pad (IFP). As consequence, there would be a re-education of intra-articular adipose tissue, which we consider a key player for the clinical effect observed in the mid and long term mainly due to immuno-regulatory mechanisms., Methods: This is a retrospective and not controlled study that evaluated 50 patients (100 joints) ranging from 50 to 89 years old, separated by age cohorts. Clinical efficacy was assessed using the Lequesne, WOMAC, and VAS scales, by ultrasound control and quantification of the biochemical profiles of synovial fluid., Results: There were no serious adverse effects. All the indexes studied showed a significant clinical improvement after 1-year follow-up for all ages and OA degree groups. This finding was correlated with the ultrasound observations and biochemical data, which show a marked decrease in catabolic and pro-inflammatory molecules (MMP-2, IL-1B, IL-6, and IL-8) and significant increase for anabolic and anti-inflammatory molecules (IGF-1 and IL-10)., Conclusions: We conclude that intra-articular SVF infiltration for knee OA treatment is safe and effective during 1 year. We propose that applied SVF cells cause a cascade of molecular and structural events that, through complex interactions between IFP and SVF, re-educating the intra-articular fatty tissue towards a homeostatic, protective, and anti-inflammatory function, which will ultimately promote the restructuring and regeneration of damaged tissues.

Problem Addressed: Scheuermann's disease or deforming vertebral osteochondritis affects about 5% of the population. These patients become permanent users of rehabilitation services due to their discomfort. In periods of acute pain patients can only receive palliative and not very effective treatment., Purpose of the Work: In this study 30 patients who fulfil the criteria for diagnosis of Scheuermann's disease were treated with the F.E.D. device. By using this method, a back pressure of up to 100 kg can be applied at the apex of the kyphosis, stretching the anterior common vertebral ligament in an attempt to diminish complaint., Research Method: There were 14 men and 16 women with ages ranging from 15 to 35 years old. The mean kyphotic angle was 53 degrees (range, 45-65). Patients had an average Risser of 4.75 (range, 3-5). Schöber's test disclosed a range of values from 0 to 2.5 cm (mean, 0.78). The average period of treatment was 4 months (80 sessions of treatment). SUMMARY OF RESULTS AND FINDINGS: All the 30 patients referred disappearance of thoracic back pain after treatment. This pain relief effect was permanent for the time of follow-up. Kyphotic angle decreased from a mean of 30 degrees Cobb to 45 degrees (16% correction). A home physiotherapy program was recommended to all the patients in order to maintain dorsal elasticity as measured by Schöber's test. After treatment, the mean Schöber test value was 2.92. In cases treated during the growing period, where alterations in the spine were minimal or did not show radiographic alterations, progression of the kyphotic deformity was stopped., Conclusion: The F.E.D. device has shown to be a promising method both for the treatment of complaints in stabilised Scheuermann's disease and control of the progression of kyphotic deformity in the growing spine.

Introduction: One of the most important sequels of scoliosis in adults is pain, caused either by muscular overuse and imbalance or by nerve root compression. This is a very difficult sequel to treat because of the failure of the common analgesic drugs and physiotherapy treatments., Material and Method: We studied 30 patients with degenerative scoliosis of different origins. There were 24 women and 6 men. Patient age ranged from 25 to 55 years old. The initial Cobb angle ranged from 25 degrees to 65 degrees with a mean of 35 degrees. The mean Schöber back score* at the beginning of treatment was 1.32. The number of sessions with the F.E.D. method were between 20 and 60 with a mean of 45 sessions. All the patients had a case history of NSAIDs, muscle relaxants and physiotherapy., Results: The final average Cobb angle was 33 degrees and Schöber score* 2.88. After treatment, only two cases required NSAIDs, muscle relaxants and physiotherapy., Conclusions: The F.E.D. method seems to be a promising alternative for treatment of painful sequels in adult scoliosis, since in our study disappearance of symptomatology was seen in the majority of cases. The F.E.D. method also had a permanent effect over time if patients followed a home physiotherapy program. This analgesic effect has a direct relation with the improvement achieved in the flexibility index.

Problem Addressed: Treatment of scoliosis under 30 degrees Cobb in growing patients remains controversial. Different orthopaedic devices have been developed and used with satisfactory results, alone or in combination with a variety of physiotherapy programs. The F.E.D. method is a dynamic three-dimensional therapy consisting in the application of derotational forces under spine stretching. This method offers some advantages over conventional conservative treatment for scoliosis: shorter treatment period, no use of plasters in many cases, better psychological tolerance, etc., Purpose of the Work: In this work, the results of the F.E.D. method were compared to other conservative treatment techniques in scoliosis under 30 degrees Cobb angle and Risser 3 or less., Research Method: Both the F.E.D. group and the group of patients treated by traditional orthopaedic methods included 30 children. Patients were divided on the basis of the type of scoliotic deformity: thoracic, thoracolumbar or lumbar. SUMMARY OF RESULTS AND FINDINGS: The results obtained showed that patients treated with the F.E.D. method had a significantly better outcome than the other methods in terms of angle correction and shorter period of treatment necessary to reach correction., Conclusion: The F.E.D. method can be considered as the elective treatment in growing adolescents with scoliosis under 30 degrees.