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Objective: To analyze the influence of congested and noncongested fixture periods during 2 seasons in a professional male football team on soft-tissue injury incidence and external load. Methods: Thirty-three professional football players from a Portuguese Liga I team participated in this study. Weekly external load and soft-tissue injury rate and burden of 2 consecutive seasons (2021–22 and 2022–23) were analyzed. Results: Total soft-tissue injury rate and burden for the 2 seasons were 3.9 and 3.2 injuries per 1000 hours and 71.8 and 60.5 days per 1000 hours for congested and noncongested periods, respectively. No significant differences were observed between congested and noncongested periods. Total high-speed running, sprint distance, distance above 80% and 90% of maximal velocity, and meters accelerating and decelerating above 2 m/s2 were significantly higher for noncongested weeks. Match accelerations and decelerations above 3 m/s2 were higher during congested periods and training during noncongested periods. No differences between the 2 periods were observed for the total number of accelerations and decelerations above 3 m/s2. Overall, physical outputs per week were higher for training during noncongested weeks, whereas matches during congested periods registered higher external load. Conclusions: No effect of a congested schedule was observed on soft-tissue injury rates and injury burden. Higher match exposure during congested periods increased external load performed per week, and during noncongested periods, training load was superior to congested weeks. [ABSTRACT FROM AUTHOR]

Purpose: To validate an innovative 3D volumetric method of evaluating tissue changes proposed by Lee et al in 2020 by comparing the results of this method--in which the scanned peri-implant surfaces were transformed, visualized, and analyzed as 3D objects--to the results reported by an existing method based on calculation of the mean distance between measured surfaces. The null hypothesis was that there was no statistically significant difference between the two methods. Additionally, the present study evaluated peri-implant tissue changes 5 years after single implant placement in the esthetic zone. Materials and Methods: Both methods were applied to 11 oral implant site casts (6 maxillary central incisor sites, 5 maxillary lateral incisor sites) taken from 11 patients at crown placement and at follow-up examinations 5 years later. The methods are based on digital workflows in which the reference and 5-year casts are scanned and the resulting STL files are superimposed and analyzed for three regions of interest (mesial papilla, central area, and distal papilla). The volumetric changes reported by the Lee et al method and the mean distance method were calculated and compared using the Spearman rank correlation coefficient (P < .01) and the Wilcoxon signed-rank test (P < .05). Results: The correlation between the two sets of measurements was very high (Spearman rank correlation coefficient = 0.885). The new volumetric method indicated a mean volume loss of 2.82 mm3 (SD: 5.06), while the method based on the measurement of mean distance showed a mean volume loss of 2.92 mm3 (SD: 4.43; Wilcoxon signed-rank test result: P = .77). No statistically significant difference was found. The two methods gave equivalent results, and the null hypothesis was accepted. Conclusions: The new volumetric method was validated and can be considered a trustworthy tool. [ABSTRACT FROM AUTHOR]

Context: Contusion and soft tissue injuries are common in sports. Photobiomodultion, light and laser therapy, is an effective aid to increase healing rates and improve function after various injury mechanisms. However, it is unclear how well photobiomodulation improves function after a contusion soft tissue injury. This study aimed to determine the effects of a pulsed red and blue photobiomodulation light patch on muscle function following a human thigh contusion injury. Design: Single-blinded randomized control trial design. Methods: We enrolled 46 healthy participants. Participants completed 5 visits on consecutive days. On the first visit, participants completed a baseline isokinetic quadriceps strength testing protocol at 60°/s and 180°/s. On the second visit, participants were struck in the rectus femoris of the anterior thigh with a tennis ball from a serving machine. Immediately following, participants were treated for 30 minutes with an active or placebo photobiomodulation patch (CareWear light patch system, CareWear Corp). Following the treatment, participants completed the same isokinetic quadriceps strength testing protocol. Participants completed the treatment and isokinetic quadriceps strength test during the following daily visits. We normalized the data by calculating the percent change from baseline. We used a mixed model analysis of covariance, with sex as a covariate, to determine the difference between treatment groups throughout the acute recovery process. Results: We found the active photobiomodulation treatment significantly increased over the placebo group, quadriceps peak torque during the 180°/s test (P =.030), and average power during both the 60°/s (P =.041) and 180°/s (P ≤.001) assessments. The mean peak torque and average power of 180°/s, at day 4, exceeded the baseline levels by 8.9% and 16.8%, respectively. Conclusions: The red and blue photobiomodulation light patch improved muscle strength and power during the acute healing phase of a human thigh contusion injury model. [ABSTRACT FROM AUTHOR]

Vertical ridge augmentation in the anterior mandible is a technically delicate procedure that requires knowledge of some anatomical structures to reduce intra- and postoperative complications. Proper soft tissue management is one of the primary aspects to the success of these techniques, enabling tension-free primary wound closure and preventing membrane exposure. This cadaveric and clinical study provides an anatomical overview of the lingual portion of the anterior mandible. Moreover, there is a description of a novel surgical approach for release of the lingual flap that will help clinicians achieve primary closure without incurring intrasurgical complications. [ABSTRACT FROM AUTHOR]

Purpose: The present study describes a new presurgical soft tissue technique in oral/maxillary bone reconstructive surgery for reducing the risk of soft tissue dehiscence and its related complications. Materials and Methods: Ten consecutive patients with Cawood and Howell type V atrophy were scheduled for CAD/CAM titanium mesh bone reconstructive surgery after applying the vascular delay technique 21 days before regenerative surgery. The surgical and healing complications were clinically assessed at nine time points, ranging from the time of bone regenerative surgery to 9 months after surgery. Surgical complications included flap damage and neurologic and vascular complications. Healing complications were subdivided into four classes. These classes comprised Class I: small membrane exposure (= 3 mm) without purulent exudate; Class II: large membrane exposure (> 3 mm) without purulent exudate; Class III: membrane exposure with purulent exudate; and Class IV: abscess formation without membrane. Results: The study sample included seven men and three women (mean age: 48.2 ± 3.5 years) with seven mandibular cases and three maxillary cases. The defect length ranged from three to six teeth, with a mean mesiodistal distance of 29.9 ± 8.5 mm and a mean volume augmentation of 2.03 ± 0.9 cm3. There were no surgical complications. One patient presented a Class I healing complication that did not affect the regeneration outcome. Conclusions: The vascular delay technique appears to reduce the risk of soft tissue dehiscence and exposure in bone regenerative surgery, though randomized studies involving larger samples and longer follow-up periods are needed in order to draw firm conclusions. [ABSTRACT FROM AUTHOR]

Diode lasers are increasingly being utilized as an alternative to conventional soft tissue surgery. Diode lasers originally referred to wavelengths ranging from 810 to 980 nm, but a visible diode laser with a 445-nm wavelength has emerged as an additional wavelength for soft tissue surgery. The goal of this case series was to demonstrate the clinical results of both visible and nearinfrared (NIR) wavelengths when utilized for stage-two implant surgery. Ten patients with 23 implants were treated at Stony Brook University, Department of Periodontics and Endodontics and Faculty Practice, for implant uncovering using both visible and nonvisible (NIR) diode lasers. The uncovering was performed utilizing 445-, 970-, and 980-nm wavelengths at a power setting of 2 W in either continuous or pulsed modes. The fiberoptic tips were initiated using blue articulating paper. Either topical benzocaine or infiltration anesthesia was utilized prior to soft tissue removal with the initiated tip. All patients healed uneventfully without any postoperative complications. Visible and NIR diode lasers provide an alternative and safe method to uncover submerged implants at stage-two surgery. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective is to compare the imaging and surgical findings in a cohort of patients with suspected penile fracture (PF). Methods: Retrospective cohort study of all patients with suspected PF over an 11-year period at a tertiary referral andrology centre. All dedicated presurgical imaging with ultrasound (US) and MRI was analysed and correlated with intraoperative findings; alternative diagnoses were recorded. Results: One hundred and ninety-three patients were included. One hundred and four (54%) had alternative diagnoses to PF including dorsal vein rupture and haematoma. Ninety-nine (51%) underwent surgical exploration of which 89 (46%) had PF. US correctly confirmed the presence and marked the site of fracture in 92% of cases. MRI was primarily used as a problem-solving tool (13 cases) and demonstrated a more extensive injury than US (12 cases). The reported size of tunical defect on imaging was a median of 7 mm (IQR 4-10) significantly smaller than on exploration (median 20 mm, IQR 10-30; P < .0001). Conclusions: US has a high positive predictive value in the confirmation of PF. MRI improves the detection and characterizing the extent of injury. Imaging marking informs surgical incision but defect size is under appreciated on all imaging modalities. Advances in knowledge: Penile imaging has a high positive predictive value to not only confirm the diagnosis of PF but to stage the extent of injury and mark the skin, which impacts the surgical technique. Alternative diagnoses to fracture are common and imaging could prevent unnecessary surgical exploration. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association, as well as to characterize the associated panel of pro‐ and anti‐inflammatory markers, between the different components of the peri‐implant phenotype and the presence of peri‐implantitis/peri‐implant soft‐tissue dehiscence (PISTD). Materials and Methods: A total of 324 implants in 112 patients were included. The following components of the peri‐implant phenotype were clinically measured through the use of a manual periodontal probe or a digital calliper: keratinized mucosa width (PIKM‐W), mucosal thickness (MT), attached mucosa (AM) and vestibulum depth (VD). The presence of peri‐implantitis and PISTD was assessed through clinical and radiographic examination. Mixed‐models logistic regression analyses were performed to analyse the association between peri‐implant phenotype and the presence of peri‐implantitis or PISTD, adjusting for relevant confounders. Multiplex immunoassays were employed to evaluate the peri‐implant crevicular fluid levels of a panel of pro‐ and anti‐inflammatory markers. Results: Peri‐implant health, peri‐implant mucositis and peri‐implantitis were diagnosed in 36.6%, 21.4% and 42% of the patients (classified according to their worst implant) and 35.2%, 34.3%, and 30.5% of the implants, respectively. In the multi‐level multiple regression model, the absence of PIKM‐W (odds ratio [OR] = 9.24; 95% CI: 2.73–31.28), the absence of attached mucosa (OR = 19.58; 95% CI: 6.12–62.56) and a reduced (<4 mm) vestibulum depth (OR = 2.61; 95% CI: 1.05–6.48) were associated with peri‐implantitis. Similarly, the absence of PIKM‐W (OR = 6.32; 95% CI: 1.67–23.83), a thin (<2 mm) mucosa (OR = 157.75; 95% CI: 14.06–1769.9) and a reduced vestibulum depth (OR = 3.32; 95% CI: 1.02–10.84) were associated with the presence of PISTD. Implants with PIKM‐W = 0 mm showed statistically significantly higher levels of interferon‐γ in both regular (≥2 maintenance/year) and irregular (<2 maintenance/year) compliers (p = 0.046 and p = 0.012). In irregular compliers, the absence of PIKM‐W was also associated with statistically significantly higher levels of interleukin (IL)‐1β and IL‐21 (p = 0.016, p = 0.046). These associations were independent of the effect of relevant confounders (e.g., plaque, compliance with maintenance, etc.). Conclusions: Within their limits, the present findings indicate that (a) peri‐implant soft‐tissue phenotype appears to be associated with the presence of peri‐implantitis and PISTD, and (b) in the absence of PIKM‐W, the inflammatory response seems to be dysregulated and the soft‐tissue remodelling up‐regulated. [ABSTRACT FROM AUTHOR]

Background: This systematic review aggregates the data of studies that include site‐specific analyses of patients undergoing salvage surgery for residual or recurrent hypopharyngeal squamous cell carcinoma. Methods: The primary outcomes are disease‐free, disease‐specific, and overall survival (DFS, DSS, and OS, respectively). Secondary outcomes include complications and postoperative feeding requirements. Results: Fifteen studies met the inclusion criteria with a total of 442 patients. Two‐year DFS is reported from 30.0 to 50.0% and 5‐year DFS ranges from 15.0 to 57.1%. Five‐year DSS ranges from 28.0 to 57.1%. Two‐year OS ranges from 38.8 to 52.0% and 5‐year OS ranges from 15.5 to 57.1%. Complications include pharyngocutaneous fistula (0.0–71.4%), carotid artery rupture (2.9–13.3%), and stomal stenosis (4.2–20.0%). Complete oral feeding achieved following surgery ranges from 61.9 to 100.0%, while complete gastrostomy tube dependence ranges from 0.0 to 28.6%. Conclusions: Salvage surgery for residual or recurrent hypopharyngeal squamous cell carcinoma has a relatively high complication rate and should be offered to patients with the understanding of a guarded prognosis. [ABSTRACT FROM AUTHOR]

Fibrosis, an aberrant reparative response to tissue injury, involves a disruption in the equilibrium between the synthesis and degradation of the extracellular matrix, leading to its excessive accumulation within normal tissues, and culminating in organ dysfunction. Manifesting in the terminal stages of nearly all chronic ailments, fibrosis carries a high mortality rate and poses a significant threat to human health. Heme oxygenase‐1 (HO‐1) emerges as an endogenous protective agent, mitigating tissue damage through its antioxidant, anti‐inflammatory, and antiapoptotic properties. Numerous studies have corroborated HO‐1's potential as a therapeutic target in anti‐fibrosis treatment. This review delves into the structural and functional attributes, and the upstream and downstream pathways of HO‐1. Additionally, the regulatory networks and mechanisms of HO‐1 in cells associated with fibrosis are elucidated. The role of HO‐1 in various fibrosis‐related diseases is also explored. Collectively, this comprehensive information serves as a foundation for future research and augments the viability of HO‐1 as a therapeutic target for fibrosis. [ABSTRACT FROM AUTHOR]

Diabetes is a chronic medical condition that disrupts the body's normal blood sugar levels. It is essential to detect this disease at an early stage in order to prevent organ and tissue injury. This study focuses on diagnosing diabetes by leveraging ensemble learning methods, which involve combining various machine learning techniques. The goal is to create an ensemble learning model that achieves the best classification performance by employing different classifiers and combining techniques. The study explores boosting, bagging, voting, and stacking ensemble learning methods, while also introducing an approach called PSO-GWO (Particle Swarm Optimization and Grey Wolf Optimization) hybrid method for optimizing the model's hyperparameters. The model consisting of combining various classifiers in the stacking ensemble learning method provided the highest classification performance in diagnosing diabetes. The 5-fold cross-validation method is used in the study. Within the scope of the study, the highest accuracy with (98.10%) is obtained with the random forest classifier. The results of the study are presented in comparison with other studies in the literature. These findings contribute to the field of diabetes diagnosis and highlight the potential for developing more accurate and reliable diagnostic systems in the future. [ABSTRACT FROM AUTHOR]

The gram-negative bacterium lipopolysaccharide (LPS) is frequently administered to generate models of systemic inflammation. However, there are several side effects and no effective treatment for LPS-induced systemic inflammation. PEGylated PDZ peptide based on zonula occludens-1 (ZO-1) was analyzed for its effects on systemic inflammation induced by LPS. PDZ peptide administration led to the restoration of tissue injuries (kidney, liver, and lung) and prevented alterations in biochemical plasma markers. The production of pro-inflammatory cytokines was significantly decreased in the plasma and lung BALF in the PDZ-administered mice. Flow cytometry analysis revealed the PDZ peptide significantly inhibited inflammation, mainly by decreasing the population of M1 macrophages, and neutrophils (immature and mature), and increasing M2 macrophages. Using RNA sequencing analysis, the expression levels of the NF-κB-related proteins were lower in PDZ-treated cells than in LPS-treated cells. In addition, wild-type PDZ peptide significantly increased mitochondrial membrane integrity and decreased LPS-induced mitochondria fission. Interestingly, PDZ peptide dramatically could reduce LPS-induced NF-κB signaling, ROS production, and the expression of M1 macrophage marker proteins, but increased the expression of M2 macrophage marker proteins. These results indicated that PEGylated PDZ peptide inhibits LPS-induced systemic inflammation, reducing tissue injuries and reestablishing homeostasis, and may be a therapeutic candidate against systemic inflammation. [ABSTRACT FROM AUTHOR]

This paper presents a novel approach to the correction of zygomatic malposition and secondary reconstruction orbital floor fractures, highlighting the use of hydrated acellular dermal matrix (ADM), specifically CGDerm One-Step, in a case where traditional solid implants failed to maintain structural integrity and volume. A 27-year-old woman with persistent facial deformities following a traumatic incident underwent a transformative procedure that utilized ADM for volume correction and structural support, addressing significant challenges such as enophthalmos and facial contour depression. This approach was necessitated by the descent of the entire orbital floor and a previously placed implant (Medpor), leading to unsatisfactory volume correction. By integrating ADM with titanium-reinforced fan plates (Synpor), the surgery successfully restored the patient's facial symmetry and addressed her functional concerns, including diplopia and limited eye movement. Postoperative evaluations demonstrated the long-term effectiveness of this method, with significant improvements in facial contour and eye symmetry. Our findings suggest that ADM, particularly in its hydrated form, offers a reliable alternative to traditional bone grafts and implants for correcting complex craniofacial deformities, providing both aesthetic and functional benefits. This case underscores the importance of adaptable, tissue-mimicking materials in facial reconstructive surgery, offering insights into their potential for broader application in post-traumatic facial corrections. [ABSTRACT FROM AUTHOR]

A comparative analysis of the specific pharmacological activity and wound-healing properties of zinc oxide nanoparticles (ZnO-NPs) was carried out. It has been shown that ZnO-NP forms reduce the severity of formalin paw edema in mice and the exudative reaction in "felt" granuloma in rats. Notably, the effectiveness of the ointment form exceeded the effectiveness of the gel form. The ability of ointment and gel based on ZnO-NPs has been shown to significantly reduce the recovery time of hemorrhagic soft tissue injuries in rats and, unlike medicinal forms of heparin, to increase the blood clotting time of rabbits by 1.25 times and 1.19 times, respectively. Thus, ointment and gel containing ZnO-NPs are potential medicines with anti-inflammatory, anticoagulant properties and the property of shortening the recovery time of hemorrhagic soft tissue injuries. It is concluded that the therapeutic effect of samples containing ZnO-NPs, due to the ability of these nanoparticles to penetrate the skin epithelium, providing regenerating and fibrinolytic activity, blocking the activity of inflammatory mediators and providing, including the systemic effect on blood clotting. [ABSTRACT FROM AUTHOR]

Patients with petrous bone cholesteatoma most commonly present with hearing loss and facial paralysis. Other clinical presentations can include otorrhea, tinnitus, aural fullness, otalgia, and dizziness. Here, we report a patient with petrous bone cholesteatoma who presented with cerebrospinal fluid rhinorrhea. This patient was initially misdiagnosed with rhinogenic cerebrospinal fluid leakage, and was finally diagnosed with the supralabyrinthine type of petrous bone cholesteatoma. During the surgical repair through the transmastoid trans-superior semicircular canal approach, the fistula was found in the superior wall of the internal auditory canal. He had satisfactory outcomes after the surgery, with no recurrent cerebrospinal fluid rhinorrhea. [ABSTRACT FROM AUTHOR]

Digital replantation is a challenging and at-time tedious operation, but if approached thoughtfully and with reasonable expectations can be a reliable and rewarding undertaking. This article summarizes technical considerations for digital replantations involving flexor tendon zone II. The article has been ordered according to the recommended sequence of a structure-by-structure repair in a non-thumb digit. Special considerations are described for thumb, multiple digits, and heterotopic replantation. [ABSTRACT FROM AUTHOR]

This study expands previous work examining the effects on fishes from exposure to a single 4.5 kg underwater explosive detonation. Experiments were done in the field, with fish in cages at different distances from the source. Although our earlier work reported high acoustic dosage levels (e.g. based on peak pressure) correlating with severe injuries, dosage levels that result in moderate, or mild injuries were not clearly established. Thus, in this study, caged Pacific mackerel (Scomber japonicus) were placed at targeted ranges of 150–800 m from the source. All procedures were the same as in the earlier study except that animals were left at depth for ∼3 hours post-exposure to determine immediate effects on survival. Fish were then retrieved and assessed for physical damage. The only statistically significant tissue injuries were swim bladder bruising and in a reduction in inner ear sensory hair cell density that lessened with distance from the source. Still, results must be taken with caution since they may vary with different source levels, water depths, location of the fish in the water column, and by species. [ABSTRACT FROM AUTHOR]

Traumatic heterotopic ossification is a condition in which extraskeletal bone formation occurs in soft tissues after injury. It most commonly occurs in patients who had major orthopedic surgery and in those with severe extremity injuries. The lesion causes local pain and can impair motor function of the affected limb, but there is currently no established prophylaxis or treatment for this condition. In this study, we show that immobilization at an early stage of the inflammatory response after injury can attenuate ossification formation in a murine Achilles tenotomy model. Gene expression analysis revealed a decrease in the expression of Tnf and an increase in the expression of Mkx, which encodes one of the master regulators of tendon differentiation, Mohawk. Notably, we found that TNF‐α suppressed the expression of Mkx transcripts and accelerated the osteogenic differentiation of tendon‐derived mesenchymal stem cells (MSCs), suggesting that TNF‐α acts as a negative regulator of Mkx transcription. Consistent with these findings, pharmaceutical inhibition of TNF‐α increased the expression of Mkx transcripts and suppressed bone formation in this mouse model. These findings reveal the previously unrecognized involvement of TNF‐α in regulating tendon MSC fate through suppression of Mkx expression and suggest that TNF‐α is a potential target for preventing traumatic heterotopic ossification. [ABSTRACT FROM AUTHOR]

Child physical abuse has significant morbidity and mortality in the pediatric population. There is growing evidence that abusive spinal injury has been under-recognized, changing historical perceptions that these injuries are relatively uncommon. Increased utilization of MRI has been pivotal in recognizing that most abusive spinal injuries involve the soft tissues and ligaments or manifest as intrathecal blood products, which are often undetectable by radiography or CT. Detecting spinal injury in the work-up of non-accidental trauma improves management for abused children and their siblings (defined as siblings or other household members). This review highlights key points in the imaging literature of abusive spinal injury, describes typical patterns of injury, and addresses appropriate imaging practice for work-up. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the use of laser Doppler flowmetry and spectrophotometry (LDFS) for large intestinal viability assessment in horses with naturally occurring large intestinal strangulations. METHODS By use of LDFS, intestinal microperfusion was quantified as tissue oxygen saturation (tSo2), hemoglobin (tHB), and blood flow (tBF) in cases with large colon volvulus and small colon strangulations undergoing colic surgery (n = 17). Intestinal biopsies were taken from the pelvic flexure in all large colon cases and in small colon cases that underwent intraoperative euthanasia. Measurements were compared between survivors and nonsurvivors, and the correlation between LDFS and (immuno)histology was tested (P < .05). RESULTS The tSo2 and tBF were clearly lower and tHB was higher than previously reported in healthy horses. Following correction of the lesion, pelvic flexure tBF was significantly lower than that of the left ventral colon. Prior to correction of the lesion, microperfusion did not differ between survivors and nonsurvivors, but following release of the strangulation the survivors had a significantly higher tSo2 and tBF compared to the nonsurvivors. There was a negative correlation between tBF and interstitium-to-crypt ratio and a positive correlation between tHB and the histological hemorrhage score. There were no significant correlations between LDFS measurements and inflammatory cell counts or hypoxia-inducible factor-1α immunoreactivity. CONCLUSIONS Large intestinal microperfusion was decreased in nonsurvivors compared to survivors and was correlated with histological injury, suggesting that LDFS has the potential to predict tissue injury and postoperative survival. CLINICAL RELEVANCE The use of LDFS as an ancillary diagnostic aid may improve intraoperative viability assessment during colic surgery. [ABSTRACT FROM AUTHOR]

Traumatic upper extremity injuries are a common cause of emergency department visits, comprising between 10-30% of traumatic injury visits. Timely and accurate evaluation is important to prevent severe complications such as permanent deformities, ischemia, or even death. Computed tomography (CT) and CT angiography (CTA) are the favored non-invasive imaging techniques for assessing upper extremity trauma, playing a crucial role in both the treatment planning and decision-making processes for such injuries. In CT postprocessing, a novel 3D rendering method, cinematic rendering (CR), employs sophisticated lighting models that simulate the interaction of multiple photons with the volumetric dataset. This technique produces images with realistic shadows and improved surface detail, surpassing the capabilities of volume rendering (VR) or maximal intensity projection (MIP). Considering the benefits of CR, we demonstrate its use and ability to achieve photorealistic anatomic visualization in a series of 11 cases where patients presented with traumatic upper extremity injuries, including bone, vascular, and skin/soft tissue injuries, adding to diagnostic confidence and intervention planning. [ABSTRACT FROM AUTHOR]

Background and objectives: Although the formation and rupture risk of an anterior communicating artery (ACoA) aneurysm has been the subject of many studies, no previous study has primarily searched for the relationship of the parent and daughter vessels and the impact of their size/diameter ratio on the potential rupture risk of an AcoA aneurysm. The objective of this study is to explore this link and to further analyse the surrounding vasculature of the anterior communicating artery aneurysm. Materials and methods: We conducted a retrospective analysis of 434 patients: 284 patients with an ACoA aneurysm (121 unruptured and 162 ruptured) and 150 control patients without an ΑCoA aneurysm. Radiological angiography investigations were used to assess the diameter ratios of the parent vessels in addition to ACoA aneurysm morphology parameters. Results: When comparing the ruptured to the unruptured cases, we observed no significant difference in the parent or daughter vessel diameter ratios. Younger patient age (OR 0.96, p = 0.00) and a higher aneurysm size ratio (OR 1.10, p = 0.02) were of prognostic importance concerning the rupture risk of the aneurysm. The A1 diameter ratio and the A2 diameter were not statistically significant (OR 1.00, p = 0.99, and OR 3.38, p = 0.25 respectively). Conclusions: In our study, we focused on asymmetry in the parent and daughter vessels as well as traditional ACoA aneurysm morphological characteristics. We were able to label younger patient age and a greater size ratio as independent prognostic factors for ACoA aneurysm rupture. We were unable to label parent and daughter vessel asymmetry as prognostic factors. To validate our findings, parent and daughter vessel asymmetry should be subjected to future prospective studies. [ABSTRACT FROM AUTHOR]

Regnase-1 is an RNase that plays a critical role in negatively regulating immune responses by destabilizing inflammatory messenger RNAs (mRNAs). Dysfunction of Regnase-1 can be a major cause of various inflammatory diseases with tissue injury and immune cell infiltration into organs. This study focuses on the role of the RNase activity of Regnase-1 in developing inflammatory diseases. We have constructed mice with a single point mutation at the catalytic center of the Regnase-1 RNase domain, which lacks endonuclease activity. D141N mutant mice demonstrated systemic inflammation, immune cell infiltration into various organs, and progressive development of lung granuloma. CD4+ T cells, mainly affected by this mutation, upregulated the mTORC1 pathway and facilitated the autoimmune trait in the D141N mutation. Moreover, serine/threonine kinase Pim2 contributed to lung inflammation in this mutation. Inhibition of Pim2 kinase activity ameliorated granulomatous inflammation, immune cell infiltration, and proliferation in the lungs. Additionally, Pim2 inhibition reduced the expression of adhesion molecules on CD4+ T cells, suggesting a role for Pim2 in facilitating leukocyte adhesion and migration to inflamed tissues. Our findings provide new insights into the role of Regnase-1 RNase activity in controlling immune functions and underscore the therapeutic relevance of targeting Pim2 to modulate abnormal immune responses. [ABSTRACT FROM AUTHOR]

Along with clinical and laboratory findings, imaging has a significant role in the initial evaluation and treatment follow-up of a wide variety of infectious and non-infectious musculoskeletal (MSK) conditions. The imaging findings of many non-infectious MSK processes, such as inflammatory, metabolic, and degenerative arthropathies, complications of diabetes mellitus, osseous and soft tissue injuries, osteonecrosis, tumors, and tumor-like lesions may be nonspecific and often overlap with those found in MSK infections. In this article, the authors discuss the imaging findings of both frequent and rare mimickers of MSK infections, including potential distinguishing characteristics. [ABSTRACT FROM AUTHOR]

Penile skin zipper entrapment is an emergent medical condition in which the penile skin, scrotal skin, or foreskin gets caught within the teeth of a zipper or the slider itself. This can lead to complications such as urethral involvement, skin loss, or tissue necrosis. We propose a novel technique to aid in the release of entrapped skin utilizing wire cutters directed at the inferior portion of the zipper pull. To describe a novel technique to free entrapped penile skin and compare its performance to the well-established median bar technique in a simulated setting. A randomized cross-over design was used to compare techniques on successful release, time to release and tissue injury using an animal model of raw chicken skin entrapped in a zipper. Statistical significance was assessed at p < 0.05. Twenty-two participants were included. There was no statistically significant difference between the novel technique and the median bar technique regarding successful release (100% vs 95.5%, respectively), median time to release (29.1 vs 26.4 seconds, respectively), or frequency of tissue injury (22.7% vs 27.3%). Performance using our novel technique for removal of penile skin from a zipper is similar to the median bar release technique regarding. Our novel technique may be a valid treatment option for the release of entrapped penile skin in a zipper mechanism in the emergency department setting. [ABSTRACT FROM AUTHOR]

Mesenchymal stem cell (MSC)-based therapies have emerged as promising methods for regenerative medicine; however, how to precisely enhance their tissue repair effects is still a major question in the field. Circulating extracellular vesicles (EVs) from diseased states carry diverse pathological information and affect the functions of recipient cells. Based on this unique property, we report that disease-derived circulating EV (disease-EV) preconditioning is a potent strategy for precisely enhancing the tissue repair potency of MSCs in diverse disease models. Briefly, plasma EVs from lung or kidney tissue injuries were shown to contain distinctly enriched molecules and were shown to induce tissue injury-specific gene expression responses in cultured MSCs. Disease-EV preconditioning improved the performance (including proliferation, migration, and growth factor production) of MSCs through metabolic reprogramming (such as via enhanced oxidative phosphorylation and lipid metabolism) without inducing an adverse immune response. Consequently, compared with normal MSCs, disease-EV-preconditioned MSCs exhibited superior tissue repair effects (including anti-inflammatory and antiapoptotic effects) in diverse types of tissue injury (such as acute lung or kidney injury). Disease-derived EVs may serve as a type of "off-the-shelf" product due to multiple advantages, such as flexibility, stability, long-term storage, and ease of shipment and use. This study highlights the idea that disease-EV preconditioning is a robust strategy for precisely enhancing the regenerative capacity of MSC-based therapies. Disease-derived circulating extracellular vesicles preconditioning enables the transferring of various disease-specific information to mesenchymal stem cells (MSCs) and thus precisely enhances their therapeutic effects. [Display omitted] [ABSTRACT FROM AUTHOR]

It was the aim of the study to analyze the distribution and pattern of facial fractures following e-scooter trauma. Prospective audit data of facial fractures were retrospectively collected to investigate the impact of e-scooter hire, specifically in the form of facial fractures associated with their use. Data collected included patient demographics, mode of injury, date of injury, facial bones involved, presence of soft tissue injury, and factors associated with injury, including intoxication and helmet use. A total of 849 patients were treated for facial fractures during the study period, of which 34 were attributed to e-scooter use. One-half of those injured riding e-scooters were intoxicated, and one-quarter were wearing helmets. There have been an increasing number of facial fractures associated with e-scooter use following the start of the shared e-scooter trial. Zygomaticomaxillary complex fractures were the most common pattern of facial fracture seen. Most patients required surgical management of their injuries. Policymakers should consider how to improve the enforcement of current regulations, given the healthcare cost associated with the management of these preventable injuries. [ABSTRACT FROM AUTHOR]

The interface between dental restorations and the neighbouring soft tissue is of key significance for restorative success and longevity. Trauma-related enamel–dentine fractures are frequently present with the restorative challenge of subgingival margins and little remaining tooth structure. This report looks at two paediatric dental trauma patients with extensive crown fractures resulting in subgingival margins, which posed a poor long-term tooth survival. Electrosurgery was used before definitive composite restorations to allow for supragingival margins and access. Each patient attended the Child Dental Health Department at the University of Manchester Dental Hospital for assessment and treatment provision. CPD/Clinical Relevance: This article identifies electrosurgery as an increasingly useful adjunct to restorative management of traumatized permanent incisor teeth in paediatric patients. [ABSTRACT FROM AUTHOR]

Oral focal mucinosis (OFM) is a rare lesion first described in 1974, but the aetiology remains unknown. Clinically, OFM presents as an asymptomatic nodular lesion and the similarity of clinical features to other soft tissue injuries makes the diagnosis difficult. The aim of this study was to integrate the demographic, clinical, and histopathological characteristics from previously published cases of OFM into a systematic review. Electronic searches without publication date restriction were performed in the following databases: Embase, PubMed, Medline, Web of Science, and Scopus. Case reports or case series of OFM published in English and presenting enough clinical and histopathological information were included. This systematic review identified 42 studies from 12 countries, comprising 113 cases of OFM. This lesion affected more females than males, usually in the fourth decade of life. The gingiva was the most common anatomical location, followed by the palate. Clinical presentation was most often an asymptomatic nodule. Imaging exams revealed that most cases did not have bone involvement. Surgical removal was the treatment of choice for most cases and only one recurrent case was reported. In conclusion, OFM is an uncommon pathology, and its diagnosis depends on histopathological analysis. The lesion could be included as a differential diagnosis of benign soft tissue lesions of the oral cavity, especially those affecting the gingiva. [ABSTRACT FROM AUTHOR]

Vertebral compression fractures (VCFs) affect 1.4 million patients every year, especially among the globally aging population, leading to increased morbidity and mortality. Often characterized with symptoms of sudden onset back pain, decreased vertebral height, progressive kyphosis, and limited mobility, VCFs can significantly impact a patient's quality of life and are a significant public health concern. Imaging modalities in radiology, including radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) studies and bone scans, play crucial and evolving roles in the diagnosis, assessment, and management of VCFs. An understanding of anatomy, and the extent to which each imaging modality serves to elucidate that anatomy, is crucial in understanding and providing guidance on fracture severity, classification, associated soft tissue injuries, underlying pathologies, and bone mineral density, ultimately guiding treatment decisions, monitoring treatment response, and predicting prognosis and long-term outcomes. This article thus explores the important role of radiology in illuminating the underlying anatomy and pathophysiology, classification, diagnosis, treatment, and management of patients with VCFs. Continued research and advancements in imaging technologies will further enhance our understanding of VCFs and pave the way for personalized and effective management strategies. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive plate osteosynthesis (MIPO) for clavicular shaft fracture yields favorable functional outcomes and results in less surgery-related soft tissue injury than other techniques. Anterior chest and shoulder skin numbness, a common complication after open reduction and plate fixation, is related to injury to the supraclavicular nerves. We propose MIPO combined with a mini-open approach without fluoroscopy for nerve preservation to minimize the risk of postoperative numbness compared with traditional open plating without nerve preservation. Methods: A total of 59 patients were retrospectively identified, with a follow-up period of 6 months. Thirty-two patients underwent MIPO with mini-open and nerve preservation technique (MIPO group), and 27 patients underwent traditional open plating without nerve preservation (open group). Constant–Murley shoulder outcome score, operation time, wound length, skin numbness, and number of implant removals were compared between the groups. Results: The MIPO group had significantly lower rates of anterior chest and shoulder skin numbness than the open group (MIPO: 12.5% vs. open: 55.6%; p < 0.001). Operation time was significantly longer in the MIPO group than in the open group (MIPO: 109.38 ± 18.83 vs. open: 81.48 ± 18.85; p < 0.001). Wound length was significantly shorter in the MIPO group than in the open group (MIPO: 4.73 ± 0.79 vs. open: 9.76 ± 1.64; p < 0.001). Both groups had similarly excellent Constant–Murley shoulder scores. There were significantly fewer implant removals in the MIPO group than in the open group (MIPO: 6.3% vs. open: 25.9%; p = 0.036). Neither group experienced any infection, implant failure, or nonunion. Conclusions: Our technique combining MIPO with the mini-open approach and supraclavicular nerve preservation yields a lower incidence of skin numbness than traditional open plating without nerve preservation. [ABSTRACT FROM AUTHOR]

Radiation‐induced tissue injury (RITI) is the most common complication in clinical tumor radiotherapy. Due to the heterogeneity in the response of different tissues to radiation (IR), radiotherapy will cause different types and degrees of RITI, which greatly limits the clinical application of radiotherapy. Efforts are continuously ongoing to elucidate the molecular mechanism of RITI and develop corresponding prevention and treatment drugs for RITI. Single‐cell sequencing (Sc‐seq) has emerged as a powerful tool in uncovering the molecular mechanisms of RITI and for identifying potential prevention targets by enhancing our understanding of the complex intercellular relationships, facilitating the identification of novel cell phenotypes, and allowing for the assessment of cell heterogeneity and spatiotemporal developmental trajectories. Based on a comprehensive review of the molecular mechanisms of RITI, we analyzed the molecular mechanisms and regulatory networks of different types of RITI in combination with Sc‐seq and summarized the targeted intervention pathways and therapeutic drugs for RITI. Deciphering the diverse mechanisms underlying RITI can shed light on its pathogenesis and unveil new therapeutic avenues to potentially facilitate the repair or regeneration of currently irreversible RITI. Furthermore, we discuss how personalized therapeutic strategies based on Sc‐seq offer clinical promise in mitigating RITI. [ABSTRACT FROM AUTHOR]

Acute lung injury (ALI) is a severe pulmonary condition with high mortality and morbidity, lacking effective pharmacotherapeutic options. Rosa roxburghii Tratt, a unique fruit from southwestern China, is valued for its rich nutritional content and functional properties. Fermentation is known to enhance the nutritional value, flavor, and shelf life of foods. In this study, we investigated the effects of fermented Rosa roxburghii juice (RRFJ) on gut microbiota, metabolites, and the levels of short-chain fatty acids in the intestines, as well as its impact on lung tissue and intestine tissue injury, inflammation, and oxidative stress in murine models. The results showed that RRFJ modulated gut microbiota and metabolites, increased short-chain fatty acid levels, and consequently reduced lung tissue injury, inflammation, and oxidative stress in mice with ALI. These findings suggest that RRFJ has the potential to serve as a functional dietary adjunct in the management of acute lung injury, providing a scientific basis for its therapeutic role. [ABSTRACT FROM AUTHOR]

Introduction: Maxillofacial injuries are a common finding among the patients reporting to the Emergency Department. Aim: This study was conducted to evaluate the occurrence and characteristics of Oral and Maxillofacial injuries among the patients who reported to the Emergency Department at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. Materials and Method: The study was carried out retrospectively by analysing the medical records of patients who were presented with maxillofacial injuries, under the Department of Oral and Maxillofacial Surgery over a period of nine years. A total of 2831 patients were evaluated and segregated into different age groups. Standardized data was gathered on the number and location of lacerations, abrasions, fractures of facial bones, associated head injuries and treatment done. Result: It was found that the majority of the maxillofacial injuries reported to the emergency department are soft tissue injuries comprising of 71.49% of total cases among which 55.77% cases were with single or multiple lacerations and 15.72% cases with abrasions alone. The most common cause of facial injuries is road traffic accidents 56.8% followed by self-fall (33.8%) and assault (5.837%). The most common site of occurrence of laceration was noted to be forehead laceration (13.2%) followed by chin (10.97%), supraorbital (9.44%), upper lip (8.1%) and lower lip (5.97%). Among the fracture cases, Mid-facial fracture occurred in 58.84%, followed by mandibular fractures at 20.86% being the next most common occurrence. Conclusion: The results and understanding obtained from this study will be utilized to develop focused treatments for reducing the severity and frequency of maxillofacial trauma. Further, we believe that public awareness campaigns about enhanced safety measures can reduce the occurrence of maxillofacial injuries. [ABSTRACT FROM AUTHOR]

Introduction: Therapeutic plasma exchange (TPE), an effective method to eliminate harmful soluble mediators associated with tissue injury, serves as a crucial intervention for systemic rheumatologic diseases (SRDs). However, its value in critically ill SRDs remains uncertain. This retrospective study aims to evaluate the efficacy of TPE in SRDs. Methods: Critically ill SRD patients admitted to the department of intensive care unit of a large tertiary hospital receiving TPE from January 2011 to December 2019 were included. Results: A total of 91 critically ill SRD patients received TPE were enrolled. Their mean age was 47.67 ± 16.35 years with a female predominance (n = 68). Significant decrease in SOFA score post‐TPE treatment was observed (p < 0.05). There were no TPE‐related fatalities. Improvement was observed in 64 (70.32%) patients. Conclusion: This study shows favorable clinical outcomes. TPE may be an acceptable treatment option for critically ill SRD patients. [ABSTRACT FROM AUTHOR]

Mechanotherapy has emerged as a promising treatment for tissue injury. However, existing robots for mechanotherapy are often designed on intuition, lack remote and wireless control, and have limited motion modes. Herein, through topology optimization and hybrid fabrication, wireless magneto‐active soft robots are created that can achieve various modes of programmatic deformations under remote magnetic actuation and apply mechanical forces to tissues in a precise and predictable manner. These soft robots can quickly and wirelessly deform under magnetic actuation and are able to deliver compressing, stretching, shearing, and multimodal forces to the surrounding tissues. The design framework considers the hierarchical tissue‐robot interaction and, therefore, can design customized soft robots for different types of tissues with varied mechanical properties. It is shown that these customized robots with different programmable motions can induce precise deformations of porcine muscle, liver, and heart tissues with excellent durability. The soft robots, the underlying design principles, and the fabrication approach provide a new avenue for developing next‐generation mechanotherapy. [ABSTRACT FROM AUTHOR]

ABSTRACT Background/Aim Methods Results Conclusion The association between ear problems and traumatic dental injuries (TDIs) has not been examined in longitudinal cohort studies. The study aimed to estimate the effect of ear problems on TDIs in primary and permanent teeth among Australian Indigenous children.The Longitudinal Study of Indigenous Children is a study of two representative cohorts of Indigenous Australian children, aged from 6 months to 2 years (baby cohort) or from 3.5 to 5 years (child cohort) at baseline (2008). The children's mother/primary carer undertook a face‐to‐face interview in 2008, repeated annually for the next 9 years. Ear problems included runny ears, perforated eardrum, total deafness, deaf in one ear, hearing loss/partially deaf, and other ear problems. TDIs were teeth and oral soft and hard tissue injuries. Multivariate survival analysis using Cox proportional regression models estimated hazards ratio (HR) were used in the analysis.A total of 870 from baby cohort and 668 from child cohort Indigenous children, who had no TDIs at baseline were included in the analysis. The prevalence of TDIs was 9.2%, 11.1%, and 6.6% in the total, baby, and child cohorts, respectively. Multivariable models for TDIs indicate children with ear problems had nearly four times (total: HR = 3.72, 95% CI: 1.82–6.77), five times (baby cohort: HR = 4.76, 95% CI: 1.59–11.63), and more than 15 times (child cohort: HR = 16.2, 95% CI: 4.78–49.28) the average hazard over time, than those without ear problems. After adjusting for all covariates, children with ear problems had more than 22 times (HR = 22.03, 95% CI: 4.50–87.07) TDIs than those without ear problems in the child cohort. Mothers/primary carers with lower educational level was positively associated with the incidence of TDIs.Ear problems were a risk indicator for the increased incidence of TDIs in two large cohorts of Indigenous Australian children. Mothers/primary carers' educational level was a significant risk factor for TDIs. [ABSTRACT FROM AUTHOR]

AbstractBackgroundAimMethodologyResultsConclusionOne of the most popular chemotherapy medications is doxorubicin (DOX), however it can have non-negligible damage. When the underlying mechanisms of damage are investigated, the most prominent pathways are oxidative stress, inflammation and apoptosis.We investigated the NF-κB/MAPK inflammatory pathway and cellular apoptosis to determine the efficacy of trigonelline alkaloid (TRIG) in preventing DOX-induced lung injury.The study consisted of C, TRIG, DOX and TRIG+DOX groups. TRIG and TRIG+DOX groups received 50 mg/kg TRIG for 7 days. On day 8, DOX and TRIG+DOX groups received a single dose of 15 mg/kg DOX.Our results showed that apoptosis markers and inflammation were higher in the DOX group. In contrast, TRIG pretreatment partially suppressed apoptosis and decreased inflammation by blocking the activation of the MAPK/NF-κB pathway, lowering IL-6 levels, and protecting the lung from apoptotic cell death.Assessing TRIG’s effectiveness in lung tissue injury, this study may be a crucial first step. [ABSTRACT FROM AUTHOR]

Fibrosis is an abnormal tissue healing process characterized by the excessive accumulation of ECM components, such as COL I and COL III, in response to tissue injury or chronic inflammation. Recent advances in epitranscriptomics have underscored the importance of m6A modification in fibrosis. m6A, the most prevalent modification in eukaryotic RNA, is catalyzed by methyltransferases (e.g., METTL3), removed by demethylases (e.g., FTO), and recognized by reader proteins (e.g., YTHDF1/2). These modifications are crucial in regulating collagen metabolism and associated diseases. Understanding the role of m6A modification in fibrosis and other collagen-related conditions holds promise for developing targeted therapies. This review highlights the latest progress in this area. [ABSTRACT FROM AUTHOR]

Background: The thresholds of mechanical inputs for bruising caused by blunt impact are important in the fields of machine safety and forensics. However, reliable data on these thresholds remain inadequate owing to a lack of in vivo experiments, which are crucial for investigating the occurrence of bruising. Since experiments involving live human participants are limited owing to ethical concerns, finite-element method (FEM) simulations of the bruising mechanism should be used to compensate for the lack of experimental data by estimating the thresholds under various conditions, which requires clarifying the mechanism of formation of actual bruises. Therefore, this study aimed to visualize the mechanism underlying the formation of bruises caused by blunt impact to enable FEM simulations to estimate the thresholds of mechanical inputs for bruising. Methods: In vivo microscopy of a transparent glass catfish subjected to blunt contact with an indenter was performed. The fish were anesthetized by immersing them in buffered MS-222 (75–100 mg/L) and then fixed on a subject tray. The indenter, made of transparent acrylic and having a rectangular contact area with dimensions of 1.0 mm × 1.5 mm, was loaded onto the lateral side of the caudal region of the fish. Blood vessels and surrounding tissues were examined through the transparent indenter using a microscope equipped with a video camera. The contact force was measured using a force-sensing table. Results: One of the processes of rupturing thin blood vessels, which are an essential component of the bruising mechanism, was observed and recorded as a movie. The soft tissue surrounding the thin blood vessel extended in a plane perpendicular to the compressive contact force. Subsequently, the thin blood vessel was pulled into a straight configuration. Next, it was stretched in the axial direction and finally ruptured. Conclusion: The results obtained indicate that the extension of the surrounding tissue in the direction perpendicular to the contact force as well as the extension of the thin blood vessels are important factors in the bruising mechanism, which must be reproduced by FEM simulation to estimate the thresholds. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to retrospect and summarize clinical efficiency and experience of the free superficial palmar branch of radial artery (SPBRA) flap for soft-tissue reconstruction in distal digital injury. Method: 13 patients with soft-tissue defect of finger, reconstructed by the free superficial palmar branch of radial artery (SPBRA) flap in our department from January 2020 to January 2022, were reviewed. After 6–12 months of follow-up, evaluated the treatment effect of the fingers reconstructed by SPBRA flap. Results: All the flaps in our series application were survival uneventful, and all the donor sites were closed primarily without complications or obvious scarring. The flaps were soft in texture and satisfactory in appearance and function. The flaps with the median nerve palmar cutaneous branch had a good sensation recovery. Measurement of two-point discrimination (TPD) ranged from 6 to 10 mm. All patients were satisfied with the aesthetic appearance. According to the Evaluation Trial Standards of Upper Limb Partial Function of Hand Surgery of Chinese Medical Association, the results were graded as excellent in 11 cases and good in 2 cases. Conclusion: The SPBRA perforator flap has the advantages of simple operation, soft texture, good appearance and function, and is credible and useful for reconstructing various finger injuries. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Radial head subluxation, known as pulled elbow or nursemaid's elbow, is a common presentation to the Paediatric Emergency Department (PED). Fifty per cent of children present following an unwitnessed injury or with an atypical history. Furthermore, examination can be difficult in an upset or frightened child meaning the precise location of the injury is not always easily identifiable. Many children receive upper limb x‐rays unnecessarily and others undergo attempted reduction for suspected pulled elbow when a fracture is the cause of their pain.To evaluate the ability of point‐of‐care ultrasound (POCUS) to correctly identify cases of suspected pulled elbow.A retrospective review of patients aged 0–5 years presenting to the PED of our large District General Hospital from November 2020 to November 2022. We reviewed the electronic medical records of all patients presenting with a triage category of ‘elbow Injury’. We excluded patients presenting with obvious deformity, significant swelling and history of road traffic collision or other major trauma mechanism such as a fall from a height. POCUS was carried out by the authors according to pre‐existing clinical protocols.Thirty‐seven patients underwent POCUS. Twenty‐nine had a typical history and all had a positive POCUS for pulled elbow. Of the remaining eight patients with an atypical history, three were found to have a positive POCUS compared to unaffected elbow. Five patients with an atypical history had negative POCUS findings and were diagnosed as soft tissue injuries after further assessment. All 32 with positive sonographic signs had a final diagnosis of pulled elbow, meaning the specificity was 100% (47.8–100) (P = 0.00003). The sensitivity was 100%.Use of POCUS by appropriately trained clinicians, as an extension of a clinical examination, in this retrospective study reliably confirmed pulled elbow. This has the potential to reduce both unnecessary radiation as well as the time in the emergency department for the child and their carers. [ABSTRACT FROM AUTHOR]

Objectives To introduce and evaluate a simple method for assessing joint inflammation and structural damage on whole-body MRI (WBMRI) in juvenile idiopathic arthritis (JIA), which is usable in clinical practice. Methods The proposed system utilizes post-contrast Dixon WBMRI scans. Joints are assessed for synovitis (grade 0–2) and structural damage (present/absent) at 81 sites. The synovitis grading is based on features including above-normal intensity synovial enhancement, synovial hypertrophy, joint effusion, subarticular bone marrow oedema and peri-articular soft tissue oedema. This system was evaluated in a prospective study of 60 young people (47 patients with JIA and 13 controls with non-inflammatory musculoskeletal pain) who underwent a WBMRI. Three readers (blinded to diagnosis) independently reviewed all images and re-reviewed 20 individual scans. The intra- and inter-reader overall agreement (OA) and the intra- and inter-reader Gwet's agreement coefficients 2 (GAC2) were measured for the detection of a) participants with ≥1 joint with inflammation or structural damage and b) joint inflammation or structural damage for each joint. Results The inter-reader OA for detecting patients with ≥1 joint with inflammation, defined as grade 2 synovitis (G2), and ≥1 joint with structural damage were 80% and 73%, respectively. The intra-reader OA for readers 1–3 was 80–90% and 75–90%, respectively. The inter-reader OA and GAC2 for joint inflammation (G2) at each joint were both ≥85% for all joints but were lower if grade 1 synovitis was included as positive. Conclusion The intra- and inter-reader agreements of this WBMRI assessment system are adequate for assessing objective joint inflammation and damage in JIA. [ABSTRACT FROM AUTHOR]

Introduction With similar prevalence to injuries from fires, stings, and natural disasters, soft tissue injuries may occur from fireworks, industrial accidents, or other explosives. Surgeons are less familiar with treating high-velocity penetration from small debris, which may increase the chance of infection and subsequent fatality. Penetration risk curves have been developed to predict V50, the velocity with 50% probability of penetration, for various sized projectiles. However, there has been limited research using nonmetallic materials to achieve lower density projectiles less than 1 g cm−2, such as sand or rocks. Material and Methods To emulate the size and density of these energized particles, 14 ball bearings of stainless steel, silicon nitride, or Delrin acetal plastic ranging from 1.59 mm (1/16") to 9.53 mm (3/8") with sectional densities between 0.3 g cm−2 and 5  g cm−2 were launched toward porcine legs at a range of velocities to determine the penetration thresholds. High-speed videography was captured laterally at 40 kHz and impact velocity was captured using a physics-based tracking software. A generalized linear model with repeated measures and a logit link function was used to predict probability of penetration for each projectile. A total of 600 impacts were conducted to achieve at least 15 penetrating impacts for each projectile over a range of velocities. Results Higher impact velocities were required to penetrate the skin as sectional density of the projectile decreased, and the relationship between velocity and sectional density exhibited an exponential relationship (V 50, |$ = 184.6*S{D^{ - 0.385}}$|⁠ , R 2 = 0.95) with substantial change for nonlinearity in sectional densities ranging from 0.3 g cm−2 to 1  g cm−2. Compared to previous studies, the empirical relationship was consistent in the linear region (2-5  g cm−2), and novel experimentation filled in the gaps for sectional densities less than 1  g cm−2, which expressed more nonlinearity than previously estimated. For low-density projectiles with diameters of 1.59 (1/16") or 3.18 (1/8"), 32 impacts were lodged into the epidermis but did not penetrate through the dermis; however, penetration was defined as displacement into or through the dermis. Conclusions These experimental results may be used to develop and validate finite element simulations of low-density projectile impacts to address complex, multivariate loading conditions for the development of protective clothing to reduce wounding and subsequent infection rates. [ABSTRACT FROM AUTHOR]

Several barriers exist in Alberta, Canada to providing accurate and accessible diagnoses for patients presenting with acute knee injuries and chronic knee problems. In efforts to improve quality of care for these patients, an evidence-informed clinical decision-making tool was developed. Forty-five expert panelists were purposively chosen to represent stakeholder groups, various expertise, and each of Alberta Health Services' 5 geographical health regions. A systematic rapid review and modified Delphi approach were executed with the intention of developing standardized clinical decision-making processes for acute knee injuries, atraumatic/overuse conditions, knee arthritis, and degenerative meniscus. Standardized criteria for screening, history-taking, physical examination, diagnostic imaging, timelines, and treatment were developed. This tool standardizes and optimizes assessment and diagnosis of acute knee injuries and chronic knee problems in Alberta. This project was a highly collaborative, province-wide effort led by Alberta Health Services' Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI). [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation (CPR) is performed in cardiac arrests. There exist life support guidelines for individuals in performing effective CPR. CPR-related bleeding and hemothoraces are rare. Intercostal artery rupture leading up to shock and respiratory compromise in such situations is rare. Here, we present a unique case with a management dilemma while discussing challenges and guidance to regional centers. Case presentation: A 49-year-old Caucasian male experienced an out-of-hospital cardiac arrest which required bystander cardiopulmonary resuscitation from a colleague prior to commencement of lysis protocol at the local hospital. Transfer was later arranged to the nearest cardiac catheterization laboratory where a rescue percutaneous coronary intervention was performed in the left anterior descending artery that required strict dual antiplatelet use. Beneath the shroud of these events was a life-threatening right-sided hemothorax from rupture of intercostal arteries that occurred during initial resuscitation. Astute recognition of this post-percutaneous coronary intervention resulted in eventual transfer of the patient to a tertiary center where the source and the collection of the bleed was addressed. The patient's took a great trajectory to improvement. Conclusions: A regional center poses many challenges and limitations. Massive bleeding from intercostal arteries leading to hemorrhagic shock and respiratory compromise from an expanding hemothorax post-CPR is rare. Post-percutaneous coronary intervention use of dual antiplatelets posed a management dilemma that prompted assistance from tertiary counterparts. Clinicians should be astute and quick in assessing and providing care. [ABSTRACT FROM AUTHOR]