Search

Background: Traumatic brain injury (TBI) is a major medical and social concern in developing countries. TBI-related morbidity and mortality statistics in Egypt are lacking and do not reflect the actual magnitude of the problem. Objectives: To overview the incidence of moderate and severe head trauma in a heavily populated developing country and document the outcome of moderate and severe TBI associated with skull base fracture (SBF). Methodology: Data of patients admitted to our center with moderate and severe TBI associated with skull base fracture (SBF) were reviewed in the period between January 2019 and March 2023. Results: The most common type of trauma was road traffic accidents in 54.2% of the patients; 91.2% had Single SBF (middle cranial fossa fracture was predominant 58.5%). 25.5% had an initial GCS of ≤ 8. Periorbital ecchymosis was the most common presenting sign in 36.3%. The most frequent complication (37.3%) was pneumocephalus. The presence of skull base fracture inversely affected the Glasgow outcome scale extended GOSE (P = 0.001, r = 0.674). Higher initial GCS scores were positively correlated with good GOSE (GOSE) (P = 0.001, r =− 0.222). Conclusions: RTA represents a significant cause for moderate and severe TBI in young male population. SBF is associated with poor outcome in moderate and severe TBI. Higher initial GCS score was positively correlated with good GOSE. It is important to have an overview of different types of TBI in Egypt. [ABSTRACT FROM AUTHOR]

Cerebrospinal fluid (CSF) leak can occur immediately or several years after traumatic skull base injury which may present merely as a CSF leak or may even present with recurrent meningitis. Around 2% of all cases of head trauma, and 12%-30% of all basilar skull fractures may develop CSF leak. Posttraumatic CSF rhinorrhoea usually occurs within the first 48 hours, and the majority of them occur in the first 3 months, whereas delayed CSF leak beyond 3 months is rare. We encountered two such cases of delayed post-traumatic CSF rhinorrhoea about a decade after the head injury. We have reviewed and discussed previous studies on delayed post-traumatic CSF rhinorrhoea which have shown CSF leaks occur after months, years, or even after trauma. Such cases may help clinicians to be aware of the possibility of delayed CSF rhinorrhoea which may occur years after traumatic head injury. [ABSTRACT FROM AUTHOR]

Limited retrospective data suggest that dural venous sinus thrombosis (DVST) in traumatic brain injury (TBI) patients with skull fractures is common and associated with significant morbidity and mortality. Prospective data accurately characterizing the incidence of DVST in patients with high-risk TBI are sparse but are needed to develop evidence-based TBI management guidelines. After obtaining institutional approval, 36 adult patients with TBI with skull fractures admitted to an Australian level III adult intensive care unit between April 2022 and January 2023 were prospectively recruited and underwent computed tomography venography or magnetic resonance venography within 72 hours of injury. When available, daily maximum intracranial pressure was recorded. Dural venous sinus abnormality was common (36.1%, 95% confidence interval 22.5%–52.4%) and strongly associated with DVST (P = 0.003). The incidence of DVST was 13.9% (95% confidence interval 6.1%–28.7%), which was lower than incidence reported in previous retrospective studies. Of DVSTs confirmed by computed tomography venography, 80% occurred in patients with extensive skull fractures including temporal or parietal bone fractures in conjunction with occipital bone fractures (P = 0.006). However, dural venous sinus abnormality and DVST were not associated with an increase in maximum daily intracranial pressure within the first 7 days after injury. Dural venous sinus abnormality was common in TBI patients with skull fractures requiring intensive care unit admission. DVST was confirmed in more than one third of these patients, especially patients with concomitant temporal or parietal and occipital bone fractures. Computed tomography venography is recommended for this subgroup of TBI patients. [ABSTRACT FROM AUTHOR]

The emergence of neurosurgery from the practice of cranial surgery between the eighteenth and the twentieth centuries in London, UK, is well documented, including the role of Sir Victor Horsley, the first neurosurgical appointee at the National Hospital Queen Square in 1886. The process of this transition elsewhere in London and the subsequent foundation of other neurosurgical units are less well described. In East London, the status of St. Bartholomew's Hospital (Barts) as the oldest London hospital still active on its original site and its comprehensive archives allow an unusually long history of surgical practice in the specialty to be studied. Using these archives and other primary and secondary sources, this article describes the transition of cranial surgery in East London from the general surgeons, limited to the treatment of brain and skull injury, to the specialized discipline of neurosurgery. We discuss the culmination of this process in the foundation of three neurosurgical units at London Hospital, Whitechapel, by Sir Hugh B. Cairns from 1927; at Barts Hospital, Smithfield, by John E. A. O'Connell from 1937; and at Oldchurch Hospital, Romford, by Leslie C. Oliver from 1945. Two modern neurosurgical units, in Whitechapel and Romford, have taken forward the work begun by this group. [ABSTRACT FROM AUTHOR]

Context: Penetrating craniocerebral injury associated with depressed skull fracture is an infrequent yet timely neurosurgical emergency. Such injury frequently occurs in the frontal region during traffic accident or stone throw in the civilian setting. As military neurosurgeons, we present our experience in the surgical debridement and reconstruction of this peculiar type of traumatic brain injury. Methods: The patient lies supine, the head in neutral position heal by a Mayfield head clamp. The first step is the debridement of the frontal wound. Then, the depressed skull fracture is operated on using a tailored coronal approach through Merkel dissection plane, in order to keep a free pericranial flap. The bone flap is cut around the depressed skull fracture. Neuronavigation allows to locate the frontal sinus depending on whether it has been breached and thus requires cranialization. Brain and dura mater debridement and plasty are performed. Cranioplasty is performed using either native bone fragments fixed with bone plates or tailored titanium plate if they are too damaged. Conclusion: Performing wounded skin closure first and then a tailored coronal approach with free pericranial flap and a craniotomy encompassing the depressed skull fracture allows to treat frontal penetrating craniocerebral injury in an easy-to-reproduce manner. [ABSTRACT FROM AUTHOR]

Background: Hemorrhage originating from the intercavernous sinuses during transsphenoidal approaches for skull base injury is a common occurrence, but it can be easily controlled. However, in specific cases, it may necessitate suspending the surgery or result in hemodynamic instability. Case Description: We present the case of a 7-year-old female patient who underwent transsphenoidal endoscopic endonasal for craniopharyngioma resection. The patient's parents gave consent for the procedure. During the procedure, significant intraoperative bleeding occurred, which was necessary to stop the resection. After the surgery, cerebral angiography was performed, which identified a prominent anterior intercavernous venous sinus as the source of the bleeding. A successful embolization using onyx was performed, leading to a satisfactory postoperative recovery without any complications. The patient then underwent a second surgical intervention for the resection of the craniopharyngioma through an endoscopic endonasal transsphenoidal approach. This procedure achieved a complete resection of the lesion without complications, and the patient experienced an adequate postoperative recovery. Conclusion: The objective of this case is to describe a previously unreported technique involving onyx embolization for controlling prominent bleeding from the intercavernous sinus and as a presurgical embolization method to reduce the risk of bleeding during endoscopic endonasal surgery for resection of a craniopharyngioma. [ABSTRACT FROM AUTHOR]

The head is the most vital part of the body among various organs as the injury to the head will result in fatal outcomes compared to injuries sustained to other parts of the body. There has been an increased global incidence of head injuries in case of homicidal deaths. The present study aims to estimate the various patterns of the skull fractures in case of homicidal deaths and also the nature of injury causing such skull fractures in homicidal deaths. The present cross-sectional study revealed that out of 4036 autopsies, there were 74 cases of homicidal deaths with 67 male and 7 female cases. The skull fracture was noticed in 54 cases out of these 74 cases. The maximum number of homicidal deaths were found to be in the age group of 21 to 40 years. Among the different types of skull fractures, the isolated cut fracture contributed to 46.30% of cases followed by isolated fissured fractures and then by the combination of other types of skull fractures. The nature of injury causing skull fractures was blunt force in 51.8% of the cases then by sharp force injuries and then by the combination of these two. To bring down the incidence of homicidal deaths among the younger individuals, strict enforcements of law may be ensued on possession of blunt and sharp force weapons which are used for the brutal attacks. [ABSTRACT FROM AUTHOR]

Eighty percent of cerebrospinal fluid leaks (CSF) occur following trauma and complicate 12 to 13% percent of all basilar skull fractures (Prosser, Vender, and Solares, 2011). An endoscopic endonasal approach (EEA) is often the preferred method of repair with greater than 90% success rates (Prosser, Vender, and Solares, 2011). We report a case of a 37-year-old man who presented to our regional level 1 trauma centre with multiple facial injuries. Initial cross-sectional imaging revealed multiple, continuous anterior skull base fractures with associated pneumocephalus. Though initially managed conservatively, the patient represented five days later with unilateral left-sided rhinorrhoea. An endoscopic endonasal repair with a multilayer fat, tensor fascia lata, free mucosal graft, and vascularised local flap reconstruction was undertaken. This case highlights the importance of maintaining a high level of suspicion for delayed CSF leak in traumatic base of skull injury. The EEA enables meticulous dissection and thorough inspection of the skull base, facilitating multilayered repair and reconstruction of defects. [ABSTRACT FROM AUTHOR]

Efforts to treat epileptic seizures likely date back to primitive, manmade skull openings or trephinations at the site of previous scalp or skull injuries. The purpose may have been the release of "evil spirits," removal of "cerebral excitement," and "restoral of bodily and intellectual functions." With progressive discoveries in brain function over the past 100 to 300 years, the cerebral cortical locations enabling voluntary movements, sensation, and speech have been well delineated. The locations of these functions have become surgical targets for the amelioration of disease processes. Disease entities in particular cerebral-cortical areas may predispose to the onset of focal and or generalized seizures, which secondarily interfere with normal cortical functioning. Modern neuroimaging and electroencephalography usually delineate the location of seizures and often the type of structural pathology. If noneloquent brain regions are involved, open surgical biopsy or removal of only abnormal tissue may be undertaken successfully. A number of the early neurosurgical pioneers in the development of epilepsy surgery are credited and discussed in this article. [ABSTRACT FROM AUTHOR]

This study developed a framework to generate injury prediction functions in order to evaluate the safety of occupants in traffic accidents, using human body model simulations to analyse the influences of crash severity, occupant stature, occupant posture, and restraint stiffness. The THUMS AM50-O Human Body Model (HBM) was used in a sled test setup. Six influencing parameters were included in injury prediction: impact velocity, occupant stature, Body Mass Index (BMI), torso angle, seating position, and seatbelt restraint force. Impact velocity was found as a significant influencing factor on skull injury, while BMI mainly affected chest injury. Sequential sampling method was used for generation of simulation matrix, and high-order interaction terms were identified. As injury prediction functions, quadratic regressions correlate better with the simulation results than other forms of regressions, the combinations of parameters in which also enhanced the robustness of injury prediction when considering uncertainty of input parameters. Using numerical models to generate injury prediction functions can better characterize occupant variations, such as sitting posture, than using traffic accident reconstruction. Such obtained functions can provide reasonable estimation on occupant injury risk based on accident information, and we also hope it may benefit vehicle safety improvement and triage protocol in medical treatments of traffic accident victims. [ABSTRACT FROM AUTHOR]

Although iatrogenic skull base injuries after endoscopic sinus surgery (ESS) are rare (overall complication rate, 0.5%), they can be fatal or cause significant morbidity. Conventionally, skull base injuries were repaired using an external approach. However, in recent years, most skull base injuries after ESS have been repaired using an endoscopic transnasal approach due to its lower morbidity, lower risk of postoperative complications, and shorter hospital stay. We report two cases of iatrogenic skull base injury accompanied by brain injury following ESS and describe the skull base repair techniques employed for each case. In both cases, the skull base defects were successfully repaired using an endoscopic transnasal approach, although craniotomy was also performed in the first case to remove bone fragments from the right frontal base and lateral ventricle. Both patients recovered without residual neurologic deficits. [ABSTRACT FROM AUTHOR]

Migration of mesenchymal stem cells (MSCs) to the site of injury is crucial in transplantation therapy. Studies have shown that cell migration is regulated by the cellular microenvironment and accompanied by changes in cellular metabolism. However, limited information is available about the relationship between MSC migration and cellular metabolism. Here, we show that basic fibroblast growth factor (bFGF) promotes the migration of MSCs with high levels of glycolysis and high expression of hexokinase 2 (HK2), a rate-limiting enzyme in glycolysis. The enhancement of glycolysis via the activation of HK2 expression promoted the migration of MSCs, whereas the inhibition of glycolysis, but not of oxidative phosphorylation, inhibited the bFGF-induced migration of these cells. Furthermore, bFGF enhanced glycolysis by increasing HK2 expression, which consequently promoted β-catenin accumulation, and the inhibition of glycolysis inhibited the bFGF-induced accumulation of β-catenin. When the accumulation of glycolytic intermediates was altered, phosphoenolpyruvate was found to be directly involved in the regulation of β-catenin expression and activation, suggesting that bFGF regulates β-catenin signaling through glycolytic intermediates. Moreover, transplantation with HK2-overexpressing MSCs significantly improved the effect of cell therapy on skull injury in rats. In conclusion, we propose a novel glycolysis-dependent β-catenin signaling regulatory mechanism and provide an experimental and theoretical basis for the clinical application of MSCs. [ABSTRACT FROM AUTHOR]

Objective: To investigate patients presenting to EDs following the recent introduction of a shared electric scooter (e‐scooter) scheme in Northern Territory (NT). Methods: We conducted a prospective observational cohort study in Darwin, a regional city in NT, Australia with a population of approximately 150 000. Any patient who disclosed involvement of an e‐scooter in the reason for their presentation to the ED was included. A descriptive analysis was derived for age, sex, triage time, alcohol level, injury type and the requirement of operating theatre, inpatient stay or ED discharge. Categorical variables were analysed using χ2‐tests, with odds ratios (ORs), 95% confidence intervals (CIs) and P‐values reported. Costing analysis to ED of attendances and inpatient hospital admissions was undertaken. Results: There were 111 presentations over the 8‐month study period (January–September 2021). Forty‐nine percent (n = 51) of patients were male and 51% (n = 54) were female. Extremity (n = 70) and craniofacial (n = 61) injuries were most common and approximately a quarter of patients (n = 24) required operative management for injuries sustained. Approximately half (n = 51) of patients were intoxicated and the average alcohol level of those tested was 0.18% (range 0.05–0.49%). The average cost per ED attendance was AU$777 and total cost of inpatient admissions being AU$352 255. All inpatient admissions were a result of injury while intoxicated. Conclusion: Harm minimisations strategies targeting implementation of alcohol testing and penalties for riders may be able to reduce the effect that the introduction of e‐scooters on the strained health system in the NT. [ABSTRACT FROM AUTHOR]

Copyright of Forensic Science & Technology is the property of Institute of Forensic Science, Ministry of Public Security and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Simple Summary: Sea turtles are considered an endangered species, largely due to anthropogenic activities. Severe trauma in these species mainly involves the carapace and head. Studies on the incidence of head trauma in sea turtles and analysis of the survival rate after hospitalization performed on many subjects examined over a long period of time were missing in the scientific literature. In this retrospective study, we evaluated 1877 Caretta caretta, 29 of which showed head trauma. The severity of head injuries was assessed clinically and by neurological examination. CT examination was essential to evaluate the impaired central nervous system and sense organs. According to our scoring classification, most head traumatized turtles had severe injuries but in most cases, the animals showed no alteration in mentation state. Only 28% (8/29) of the turtles showed head damage related to severe neurological deficits. Indeed, 21 out of 29 sea turtles were released after a time ranging from a few days to 8 months. To the best of our knowledge, the literature lacks specific data on the incidence, correlations with neurological deficits, complications, and survival rate of traumatic head injuries in loggerhead sea turtles. Sea turtles are considered endangered species, largely due to anthropogenic activities. Much of the trauma in these species involves the carapace and skull, resulting in several degrees of damage to the pulmonary and nervous systems. Among traumatic injuries, those involving the skull can be complicated by brain exposure, and turtles with severe skull injuries that have nervous system impairment, emaciation, and dehydration can often die. Between July 2014 and February 2022, a total of 1877 loggerhead sea turtles (Caretta caretta) were referred for clinical evaluation at the Sea Turtle Clinic (STC) of the Department of Veterinary Medicine of the University of Bari. A retrospective study of 29 consecutive cases of loggerhead sea turtles (Caretta caretta) with skull lesions of different degrees of severity is reported. On admission, physical and neurological evaluations were performed to assess and grade the lesions and neurological deficits. In 20 of the 29 sea turtles with more serious head trauma, computed tomography (CT) findings in combination with physical and neurological assessment enabled the evaluation of the potential correlation between deficits and the extent of head injuries. All sea turtles underwent curettage of the skull wounds, and the treatment protocol included the use of the plant-derived dressing 1 Primary Wound Dressing® (Phytoceutical AG, Endospin Italia) applied on the wound surface as a primary dressing. Out of 29 sea turtles, 21 were released after a time ranging from a few days to 8 months. To the best of our knowledge, the literature lacks specific data on the incidence, correlations with neurological deficits, complications, and survival rate of loggerhead sea turtles with traumatic head injuries. [ABSTRACT FROM AUTHOR]

The increasing popularity of electric scooters in Poland is associated with the growing number of e-scooter-related accidents, which often involve head traumas. Although the most common types of injuries are abrasions and cuts to the skin, they some- times include severe brain injuries. Most e-scooter accidents occur in the warm months. In winter, when there are unfavorable conditions for using this means of transport, e-scooter-related accidents are rare. Described in the text are 2 cases of severe cases of skull and brain injuries which required neurosurgical intervention. In both cases, the riders were under the influence of alcohol and did not use helmets, which had a measurable influence on the profile and the extent of injuries. [ABSTRACT FROM AUTHOR]

Wildlife rehabilitation is a large and internationally known field with thousands of wildlife rehabilitators around the world. Resources, such as time and money, are extremely limited in rehabilitation facilities, and not all animals are candidates for release due to injuries or illnesses that make them unlikely to survive in the wild. Understanding what factors predict release would be useful in focusing limited resources, but there has been little investigation previously. The purpose of this study is to determine what factors affect the survival of mammals and birds at an American Midwest wildlife rehabilitation center. It was found that animals admitted with trauma and fracture or injuries to the skull, hindlimb/pelvis, spine/tail, or nervous system had low rates of release. Weight was also a determining factor for the release of young mammals; animals that were below the average weight for their life stage were less likely to be released. This data may be of use in improving triage techniques in the American Midwest and abroad. [ABSTRACT FROM AUTHOR]

The letter to the editor discusses a research paper titled "The role of secondary imaging in children aged under 24 months with proven skull fracture on initial computed tomography scan." The study examines whether repeat imaging, specifically magnetic resonance imaging (MRI), is necessary and beneficial for young children who have experienced mild blunt force head trauma and have been diagnosed with a skull fracture using computed tomography (CT). The research highlights the importance of careful monitoring in this vulnerable age group, as a significant percentage of patients had new intracranial abnormalities on follow-up MRI. The study suggests that repeat imaging can help identify any missed injuries and prevent major problems such as brain herniation. However, the study's limitations, such as its retrospective methodology and single-center setting, may affect the generalizability of the results. The authors also acknowledge the potential drawbacks of repeat imaging, such as the need for sedation in young children. Overall, the study contributes to the field of pediatric neurosurgery by providing evidence in favor of secondary imaging in certain high-risk situations, leading to better clinical decisions regarding the treatment of head trauma in young children. [Extracted from the article]

Blunt force trauma is a common homicide method, inflicted in three different ways: bodily force, assault with blunt objects of various types and falls from height. The objective of this study is to provide thorough information on blunt force homicides with data on the victims, the offenders, the surrounding circumstances, the injury methods, the extent of injuries, and survival time, which will help inform the inexperienced as well as the seasoned forensic pathologist in their daily work with death investigation and as expert witnesses in court. We have analyzed autopsy reports and available case files of 311 blunt force homicides, making up 21.9% of all homicides in Denmark during 1992–2016. Most victims and offenders were male. Altercation in the setting of nightlife and intoxication was common in male victims, while most female victims were killed in a domestic setting. Bodily force was the most common primary homicide method, followed by assault with a blunt object and fall from height. The head was the region that most often had external injuries, with no noteworthy difference between cases with bodily force and blunt objects. Two out of three victims had one or more lacerations, most often located on the head and more often on the front. Brain injury was the primary cause of death in at least 72.0% victims. Compared to bodily force victims of blunt object assault were especially prone to skull and brain injuries, had a higher trauma score, and more died at the crime scene and had a shorter survival time. [ABSTRACT FROM AUTHOR]

Acute subdural hematomas (ASDHs) caused by vehicle collisions are common brain injuries that suffers prone to disability and death. However, there is currently no commonly accepted evaluation index for ASDHs, such as the head injury criterion (HIC) for evaluating skull injuries and the brain injury criteria (BrIC, BRIC) for evaluating diffuse axonal injuries. Therefore, we established a set of ASDH indexes (ASDHIs) based on the genetic algorithm for different biomechanical metrics and developed an ASDH prediction model based on an artificial neural network learning (ANN-L). First, simulation models were built using 218 sets of crash test data and the simulated injury monitor model (SIMon). We calculated the correlation coefficients between the kinematic parameters, such as the translational and rotational acceleration, and the biomechanical metrics, such as the intracranial pressure and strain of the bridging vein. The effect of some outlier data is removed using a combination of K-Nearest Neighbor and quadratic regression. We screened some parameters with strong correlations and calculated their weight factors based on the genetic algorithm to establish a set of evaluation indexes for ASDHs. Comparing with 19 existed injury criteria, the results show that each established ASDHI has a higher correlation than these traditional criteria, and also indicate that the evaluation performance of each established ASDHI is advantageous. Finally, on the basis of these established ASDHIs, we built an accurate prediction model of ASDHs using ANN-L, which makes it possible to realize the prediction of ASDHs by only depending on kinematic responses. [ABSTRACT FROM AUTHOR]

BACKGROUND: Local application of bone marrow mesenchymal stem cells has the ability to promote bone tissue regeneration and repair; however, whether it could play a significant role via vein injection and its ability of bone tissue regeneration and repair at different ages still need to be clarified. OBJECTIVE: To explore the effects of bone marrow mesenchymal stem cells on the repair ability of skull injury in young and aging mice via vein injection. METHODS: Totally 40 1-month-old Kunming mice were obtained as young mice, and 40 12-month-old Kunming mice were obtained as aging mice. The mice were divided into young experimental group, young control group, aging experimental group, and aging control group. The bone defect was made in the cranium of the mice. At 1, 8, and 15 days after surgery, 0.2 mL bone marrow mesenchymal stem cell suspension (1×1010 L-1) was injected into the tail vein of mice in the experimental groups; meanwhile, an equal volume of saline was used in the control groups via tail vein. The mice were sacrificed at 1 and 3 weeks after surgery. The specimens were repaired for the following experiments: morphological, histopathological, optical, and immunohistochemical analyses. RESULTS AND CONCLUSION: (1) Micro-CT imaging: At 1 week after surgery, there was no significant difference in the size of bone defect area between the young and aging groups, and the size of the bone defect area was reduced significantly in the experimental groups at 3 weeks after surgery. (2) Hematoxylineosin staining and Masson staining: The collagen fibers appeared at 1 week after surgery; meanwhile, the bone matrix emerged at 3 weeks after surgery in the defect area. The collagen fibers and the bone matrix were significantly more in the experimental groups than those in the control groups. (3) Non-linear light microscopy: At 3 weeks after the operation, the comparison of collagen content in the defect area was as follows: young experimental group > young control group; aging experimental group > aging control group. (4) Immunohistochemical analysis: At 1 and 3 weeks after operation, Sirt1 protein expression was more in the young groups than that in the aging groups. At 1 week, the Sirt1 protein expression was more in the experimental groups than that in the control groups. At 3 weeks, the Sirt1 protein expression was less in the aging experimental group than that in the aging control group. (5) It is concluded that bone marrow mesenchymal stem cells promoted the repair of skull defects in the mice of different ages significantly via the tail vein injection, which mainly promotes bone regeneration by activating Sirt1 expression in mice. [ABSTRACT FROM AUTHOR]

Iatrogenic injury of the internal carotid artery (ICA) is a rare, and probably underreported, complication of transnasal endoscopic skull base surgery. Although treatment algorithms have been suggested, there is no definite consensus or guideline for the management of this severe complication. We describe a case of ICA injury that occurred during a transsphenoidal biopsy of a tumor in the cavernous sinus and we present a treatment algorithm for managing this complication. We reviewed the articles published from 1998 to 2021, reporting on major vascular injury during transnasal endoscopic skull base surgery and endonasal endoscopic surgery, and we compare the methods and results of ICA injury management reported in the literature with the presented case. The most promising treatment for ICA injury might be packing with a muscle graft initially, then performing an endovascular intervention. [ABSTRACT FROM AUTHOR]

Traumatic lesions on human skeletal remains are widely used for reconstructing past accidents or violent encounters and for comparing trauma prevalence across samples over time and space. However, uncertainties in trauma prevalence estimates increase proportionally with decreasing skeletal completeness, as once-present trauma might have gone missing. To account for this bias, samples are typically restricted to skeletal remains meeting a predefined minimum completeness threshold. However, the effect of this common practice on resulting estimates remains unexplored. Here, we test the performance of the conventional frequency approach, which considers only specimens with ≥ 75% completeness, against a recent alternative based on generalized linear models (GLMs), integrating specimen completeness as a covariate. Using a simulation framework grounded on empirical forensic, clinical, and archaeological data, we evaluated how closely frequency- and GLM-based estimates conform to the known trauma prevalence of once-complete cranial samples after introducing increasing levels of missing values. We show that GLM-based estimates were consistently more precise than frequencies across all levels of incompleteness and regardless of sample size. Unlike GLMs, frequencies increasingly produced incorrect relative patterns between samples and occasionally failed to produce estimates as incompleteness increased, particularly in smaller samples. Consequently, we generally recommend using GLMs and their extensions over frequencies, although neither approach is fully reliable when applied to largely incomplete samples., Competing Interests: Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: The process of bone healing is complex and involves the participation of osteogenic stem cells, extracellular matrix, and angiogenesis. The advancement of bone regeneration materials provides a promising opportunity to tackle bone defects. This study introduces a composite hydrogel that can be injected and cured using UV light., Results: Hydrogels comprise bioactive glass (BG) and PCL@GelMA coaxial nanofibers. The addition of BG and PCL@GelMA coaxial nanofibers improves the hydrogel's mechanical capabilities (353.22 ± 36.13 kPa) and stability while decreasing its swelling (258.78 ± 17.56%) and hydration (72.07 ± 1.44%) characteristics. This hydrogel composite demonstrates exceptional biocompatibility and angiogenesis, enhances osteogenic development in bone marrow mesenchymal stem cells (BMSCs), and dramatically increases the expression of critical osteogenic markers such as ALP, RUNX2, and OPN. The composite hydrogel significantly improves bone regeneration (25.08 ± 1.08%) in non-healing calvaria defects and promotes the increased expression of both osteogenic marker (OPN) and angiogenic marker (CD31) in vivo. The expression of OPN and CD31 in the composite hydrogel was up to 5 and 1.87 times higher than that of the control group at 12 weeks., Conclusion: We successfully prepared a novel injectable composite hydrogel, and the design of the composite hydrogels shows significant potential for enhancing biocompatibility, angiogenesis, and improving osteogenic and angiogenic marker expression, and has a beneficial effect on producing an optimal microenvironment that promotes bone repair., Competing Interests: Declarations Ethics approval and consent to participate All animal experiment studies were approved by the animal ethics committee of Qingdao University (No.20210901SD5020231101128, Shandong, China) and conducted in accordance with the National Research Council’s Guide for the Care and Use of Laboratory Animals. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

A PHD (prolyl hydroxylase) inhibitor, 1,4-dihydrophenonthrolin-4-one-3-carboxylic acid (1,4-DPCA), is a drug that can artificially promote tissue regeneration by enhancing metabolic activity through the upregulation of hypoxia inducible factor 1 subunit alpha (Hif-1α) under normoxic conditions. This study presents a novel design methodology for a drug delivery system to maximize the regenerative effect of 1,4-DPCA. Specifically, by encapsulating 1,4-DPCA in polydopamine (PDA) that generates reactive oxygen species (ROS), the combined effects of Hif-1α upregulation and the induction of cellular antioxidant defense mechanisms by localized ROS can significantly enhance tissue regeneration. The study confirmed that each material (PDA and 1,4-DPCA) triggers a positive synergistic effect on the regenerative mechanisms. As a result, the use of a PDA drug delivery system loaded with 1,4-DPCA showed approximately six times greater bone regeneration compared to the control (no treatment) in a mouse calvarial defect model.

The cell (plasma) membrane is enriched with numerous receptors, ligands, enzymes, and phospholipids that play important roles in cell-cell and cell-extracellular matrix interactions governing, for instance, tissue development and repair. We previously showed that plasma membrane nanofragments (PMNFs) act as nucleation sites for bone formation in vivo, and induce in vitro mineralization within 1 day. In this study, we optimized the methods for generating, isolating, and applying PMNFs as a cell-free therapeutic to expedite bone defect repair. The PMNFs were isolated from different mouse cell lines (chondrocytes, osteoblasts, and fibroblasts), pre-conditioned, lyophilized, and subsequently transplanted into 2 mm critical-sized calvarial defects in mice (n = 75). The PMNFs from chondrocytes, following a 3-day pre-incubation, significantly accelerated bone repair within 2 weeks, through a coordinated attraction of macrophages, endothelial cells, and osteoblasts to the healing site. In vitro experiments confirmed that PMNFs enhanced cell adhesion. Comparison of the PMNF efficacy with phosphatidylserine, amorphous calcium phosphate (ACP), and living cells confirmed the unique ability of PMNFs to promote accelerated bone repair. Importantly, PMNFs promoted nearly complete integration of the regenerated bone with native tissue after 6 weeks (% non-integrated bone area = 15.02), contrasting with the partial integration (% non-integrated bone area = 56.10; p < 0.01, Student's test) with transplantation of ACP. Vickers microhardness tests demonstrated that the regenerated bone after 6 weeks (30.10 ± 1.75) exhibited hardness similar to native bone (31.07 ± 2.46). In conclusion, this is the first study to demonstrate that cell membrane can be a promising cell-free material with multifaceted biofunctional properties that promote accelerated bone repair. STATEMENT OF SIGNIFICANCE., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

Mobilizing endogenous progenitor cells to repair damaged tissue in situ has the potential to revolutionize the field of regenerative medicine, while the early establishment of a vascular network will ensure survival of newly generated tissue. In this study, a gene-activated scaffold containing a stromal derived factor 1α plasmid (pSDF1α), a pro-angiogenic gene that is also thought to be involved in the recruitment of mesenchymal stromal cells (MSCs) to sites of injury is described. It is shown that over-expression of SDF1α protein enhanced MSC recruitment and induced vessel-like structure formation by endothelial cells in vitro. When implanted subcutaneously, transcriptomic analysis reveals that endogenous MSCs are recruited and significant angiogenesis is stimulated. Just 1-week after implantation into a calvarial critical-sized bone defect, pSDF1α-activated scaffolds are recruited MSCs and rapidly activate angiogenic and osteogenic programs, upregulating Runx2, Dlx5, and Sp7. At the same time-point, pVEGF-activated scaffolds are recruited a variety of cell types, activating endochondral ossification. The early response induced by both scaffolds leads to complete bridging of the critical-sized bone defects within 4-weeks. The versatile cell-free gene-activated scaffold described in this study is capable of harnessing and enhancing the body's own regenerative capacity and has immense potential in a myriad of applications., (© 2024 The Author(s). Advanced Healthcare Materials published by Wiley‐VCH GmbH.)

Background. This study is designed to assess the variations of the ethmoid roof through the Keros, Gera, and Thailand-Malaysia-Singapore (TMS) classifications by means of Cone-Beam Computed Tomography (CBCT). Materials and Methods. 372 CBCT scans were reviewed. The depth of the olfactory fossa (OF) was defined by the height of the lateral lamella (LL). The degree of the angle formed by the LL and the continuation of the horizontal plane passing through the cribriform plate was calculated. The risk of injury to the skull base was assessed by TMS classification. Results. The distribution of Keros types 1, 2, and 3 was 20.43%, 66.26%, and 13.31%, respectively. No significant difference was seen in the Keros classification among males and females, and asymmetry in the depth of the cribriform plate was seen in 33.3% of patients. 29.57% of the cases had type I, 61.42% had type II, and 9.01% had type III of Gera classification. 33.9% of the patients had asymmetry in the Gera classification. There was not significant difference in the Gera classification among males and females. 95.43%, 4.17%, and 0.40% of patients were of types 1, 2, and 3 of TMS classification, respectively. Conclusion. The most prevalent variations of the ethmoid roof were Keros type II, Gera type II, and TMS type 1. Although the prevalence of the dangerous types (Keros type 3, Gera type III, and TMS type 3) was low, preoperative assessment is essential in reducing surgical complications. CBCT is beneficial in evaluating these variations due to its low radiation dose. [ABSTRACT FROM AUTHOR]

Background: Penetrating skull injuries in pediatrics (TPC) occupy a special place due to their rarity. The aim is to provide an overview of the current evidence on decompressive craniectomy in children, to describe the indications and to detail the complications. Reporte case: We present the case of a 12-year-old boy who suffered a TPC by a projectile that perforated his head, causing multiple brain injuries, and underwent early bilateral decompressive craniectomy, presenting the complications and neurological disabilities typical of the injury and surgery, with a reserved evolution and prognosis. Conclusions: Pediatric penetrating skull injuries should be of individualized management, type of injury and disease, experience of the treatment team, and the decision should always be consensual in front of the benefits and risks in the short and long term. [ABSTRACT FROM AUTHOR]

A correct assessment on the position, path, and direction of fracture lines is crucial when the sequence of different injuries on the skull has to be ascertained. In this context, the so-called Puppe's rule on intersecting fracture lines has always been considered a cornerstone of such an investigation. However, there is one factor that has never been previously considered: how do fracture lines behave when they reach the edges of an old and remodeled hole from a previous craniotomy? Two peculiar cases are presented of subjects undergoing cranial fractures due to blunt force trauma (case 1) and gunshot (case 2). Both previously underwent neurosurgical operations with persistence of the burr holes produced by the craniotomy drill (15 and 20 years before death). What was arguable, according to Puppe's rule, was that the fracture lines, when at the edge of the craniotomy hole, stopped. However, what has been detected was different than what expected: fracture lines continued exactly in the opposite direction, as though they were "skipping" the hole, following the same direction and the same axis and stopping a few centimeters over on the opposite side of the craniotomy hole. Puppe's rule has never been refuted, but these cases are the closest to an exception ever seen in forensic anthropology. [ABSTRACT FROM AUTHOR]

We present the forensic anthropological study of the relic of the skull of James Alphaeus, which was preserved in the Chapel of the Relics of the Cathedral of Santiago de Compostela (Spain). The remains consist of skull fragments and another few bones, which are in a state of carbonization and highly fragmented. The results show that the remains belong to a mature adult male individual, and the injuries to the skull were probably produced by a cutting blunt instrument such as a sword. These results lead us to doubt the identity of the remains. [ABSTRACT FROM AUTHOR]

Introduction  The risk of skull base injury during choanal atresia repair can be mitigated via thorough understanding of skull base anatomy. There is a paucity of data describing differences in skull base anatomy between patients with coloboma, heart defects, atresia choanae, growth retardation, genital abnormalities, and ear abnormalities (CHARGE) syndrome and those without. Objectives  The aim of this study was to measure nasal and skull base anatomy in patients with isolated bilateral choanal atresia (BCA), CHARGE syndrome, and other syndromic congenital anomalies. Methods  Retrospective chart review of patients with bilateral choanal atresia and computed tomography of the face between 2001 and 2019 were evaluated. Choanal width, height, mid-nasal height, and skull base slope were measured radiographically. Differences in anatomy between healthy patients, those with CHARGE syndrome, and those with other congenital anomalies were compared. Results  Twenty-one patients with BCA and relevant imaging were identified: 7 with isolated BCA, 6 with CHARGE syndrome, and 8 with other congenital anomalies. A t -test indicated insignificant difference in skull base slope, choanal height, choanal width, or mid-nasal skull base height between isolate BCA cases and patients with any congenital anomaly. When comparing CHARGE to isolated BCA cases, mid-nasal height was shorter in CHARGE patients (p  = 0.03). There were no differences in measurements between patients with congenital anomalies excluding CHARGE (p  > 0.05). Two patients in the congenital anomaly group were found to have bony skull base defects preoperatively. Conclusion  This study represents the largest description of skull base and nasal anatomy in patients with CHARGE syndrome and BCA. Surgeons should be aware of the lower skull base in CHARGE patients to avoid inadvertent skull base injury. [ABSTRACT FROM AUTHOR]

Objective: To report our experience on the complications of primary pediatric endoscopic sinus surgery (ESS). Methods: Case series of pediatric ESS performed from 1991 to 2016 on children who failed maximal medical therapy and/or adenoidectomy. Inclusion criteria were children (age <12 years old) who underwent primary ESS with or without adenoidectomy for chronic rhinosinusitis (CRS) after failed maximal medical therapy and/or adenoidectomy. All patients underwent maxillary antrostomy ± partial or total ethmoidectomy. Patients with complicated acute rhinosinusitis were excluded. Complications reviewed included: skull base injury and CSF leak, orbital injuries (blindness, orbital hemorrhage, emphysema, periorbital swelling and bruising, fat exposure), and bleeding requiring intervention. Results: A total of 352 patients underwent ESS between 1991 and 2016. There were no blindness or orbital hematoma reported, and no major nasal bleeding requiring intervention. The total number of complications was 31 (8.8%): 1 (0.3%) CSF leak, 3 (0.85%) orbital emphysema, 5 (1.4%) periorbital ecchymosis, and 22 (6.3%) lamina papyracea violation with orbital fat exposure. Conclusions: Complications of primary pediatric ESS can be rare dependent on surgeon's experience, the most common being orbital injury. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

In the context of further impact tests with various striking weapons against the skull, it turned out that the manufacturer had incorrectly calibrated the force measuring plate, which was used in our earlier experiments. When the tests were carried out again under the same conditions, the measurement results were significantly higher. [ABSTRACT FROM AUTHOR]

• Depressed skull fractures (DSF) depend on kinetic energy and affect a small impact area. • In the present case, a DSF was detected in a man kicked once from an assailant wearing sneakers. • An extraordinarily thin cranial vault (0.2 cm frontal, 0.3 cm occipital) was detected. • 3D CT-reconstruction was diriment in forensic assessment of the case. • The intensity of the force has to be related to the resistance offered by the surface. Depressed skull fractures occur when broken bones displace inward, meaning that a portion of the outer table of the fracture line lies below the normal anatomical position of the inner table. They typically result from force trauma, when the skull is struck by an object with a moderately large amount of kinetic energy but a small surface area, or when an object with a large amount of kinetic energy impacts only a small area of the skull. In the present case, a depressed fracture of the frontal bone was detected at the autopsy of a 52-year-old man who, according to the belated confession of the assailant, was kicked in the head. The assailant was wearing sneakers. Could such a fracture be caused "just" by a kick? In this case it was possible due to an extraordinarily thin cranial vault (0.2 cm frontal, 0.3 cm occipital), which allowed the fractures to occur from a kinetic force that might not have been sufficient with a normal cranial vault thickness. An important role in the forensic analysis of the case was played by the 3D CT reconstruction. [ABSTRACT FROM AUTHOR]

Background: Traumatic atlanto-occipital dislocation is an unstable injury of the craniocervical junction. For pediatric patients, surgical arthrodesis of the occipitocervical junction is the recommended management. While having a high success rate for stabilization, the fusion comes with obvious morbidity of limitation in cervical spine flexion, extension, and rotation. An alternative is external immobilization with a conventional halo. Case Description: We describe the case of a 10-year-old boy who was treated successfully for traumatic AOD with a noninvasive pinless halo. Following initial brain trauma management, we immobilized the craniocervical junction with a pinless halo after reducing the atlanto-occipital dislocation. The pinless halo was kept on at all times for the next 3 months. The craniocervical junction alignment was monitored with weekly cervical spine X-rays and CT craniocervical junction on day 15th, day 30th, and day 70th. A follow-up MRI C-spine 3 months from presentation confirmed resolution of the soft-tissue injury and the pinless halo was removed. Dynamic cervical spine X-rays revealed satisfactory alignment in both flexion and extension views. The patient has been followed up for 2 years postinjury and no issues were identified. Conclusion: Noninvasive pinless halo is a potential treatment option for traumatic pediatric atlanto-occipital dislocation. This should be considered bearing in mind multiple factors including age and weight of the patient, severity of the atlanto-occipital dislocation (Grade I vs. Grade II and incomplete vs. complete), concomitant skull and scalp injury, and patient's ability to tolerate the halo. It is vital to emphasize that this necessitates close clinicoradiological monitoring. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is a major public health issue that causes significant morbidity and mortality in the pediatric population. Pediatric minor TBIs are the most common and are widely underreported because not all patients seek medical attention. The specific management of these patients is distinct from that of adult patients because of the different physiologies in these age groups. This article focuses on minor TBIs, particularly growing skull fractures, traumatic cerebrospinal fluid leakage, and concussion. [ABSTRACT FROM AUTHOR]

Background: Removal of the surrounding bone during dacryocystorhinostomy may present a higher risk of skull base injury in patients with frontal sinus aplasia. We used sinus plain films to predict cases with a greater risk of a reduced skull base distance in dacryocystorhinostomy. Methods: Sinus plain films and computed tomography data from patients were retrospectively evaluated. The frontal sinus was classified as normal, hypoplastic, or aplastic according to Waters' view. Correlations of the frontal sinus roof-supraorbital margin (F-O) and the frontal sinus roof-nasion (F-N) distances on plain film with the closest lacrimal sac-anterior skull base (LS-ASB) distance measured on computed tomography images were assessed. Results: We evaluated 110 patients. In total, 16 (11.8%) patients had frontal sinus aplasia, of whom 6 (2.7%) had bilateral and 10 (9.1%) had unilateral aplasia. Sides with frontal sinus aplasia based on Waters' view had a shorter median LS-ASB distance than normal or hypoplastic sides. The F-O and F-N distances in Waters' view were significantly positively correlated with the computed tomographic LS-ASB distance. The F-O margin and F-N distance thresholds for predicting an LS-ASB distance < 10 mm, considered a risky distance, were 11.6 and 14.4 mm, respectively, with sensitivities of 100% and 91.7%, and specificities of 76% and 82.7%, respectively. Conclusions: The LS-ASB distance is closer on aplastic frontal sinus sides. Waters' view on plain sinus films can provide a fast and inexpensive method for evaluating the skull base distance and sinonasal condition during planning for dacryocystorhinostomy. [ABSTRACT FROM AUTHOR]

Intraoperative internal carotid artery (ICA) injury during open skull base surgery is a catastrophic complication. Multiple techniques and management strategies have been reported for endoscopic skull base surgery; however, the literature on managing this complication in open skull base surgery is limited. To perform a systematic review and give an overview of the different techniques described to manage this complication intraoperatively, a systematic review was conducted in PubMed, Ovid Medline, Ovid Embase and Scopus for literature published until July 2021. Titles and abstracts were screened. Studies meeting prespecified inclusion criteria were reviewed in full. PRISMA guidelines were strictly adhered to. Out of 4492 articles, only 12 articles could be included, reflecting an underreporting of open skull base ICA injuries. Multiple techniques can be used depending on the location and size of the injury as well as the surgeon's experience. Described techniques include the following: a primary repair via a micro-suture or nonpenetrating clips; wrapping or plugging; coating; occlusion of the parent artery with or without a bypass; packing with further endovascular management. A treatment algorithm is proposed. [ABSTRACT FROM AUTHOR]

Introduction. A transorbital intracranial injury with a foreign body can be a very complex and controversial therapeutic problem. The orbit's content is susceptible to penetrating trauma, and neurovascular skull base structures are at high risk from injury. There are some traditional cranial surgical approaches and more recently reported different endoscopic approaches for treating this kind of injury. Case report. We presented a case of a 30-year-old male who had an accident at work when a piece of wood hit him in his head and entered through the medial aspect of his left orbit with skull base and cavernous sinus injury. Rapid and complete radiological and clinical assessments were performed, and the patient was treated in a minimally invasive manner. The foreign body was manually extracted with an endoscopic and endovascular team ready to treat adverse events. No postoperative complications w ere r eported, a nd v isual a cuity i ncreased at the one-month follow-up. Conclusion. Penetrating wounds of the orbit represent a challenge that requires a multidisciplinary assessment and well-organized management. Combined endoscopic minimally invasive approaches should be considered during the treatment of this kind of injury. [ABSTRACT FROM AUTHOR]

In this paper, the authors give a new insight to the indication and preparation of trepanations through the analysis of a newly discovered case of 10th‐century‐CE surgical trepanation found in the material of Sárrétudvari‐Poroshalom. We also intend to outline the implications of this particular case to the general methodology of trepanation research. We estimated basic anthropological data (sex and age‐at‐death) and performed analyses of paleopathological and activity‐related lesions. Computed tomography, radiocarbon, and genetic analyses were also conduced. Beside other prior traumas, two codependent lesions were detected on the right parietal bone with no sign of healing. In this lesion complex, an original sharp force trauma was observable surrounded by two curved, intentionally created furrows, which can be interpreted as attempted surgical trepanation presumably performed with a U‐shaped gouge. The results of the analysis of activity‐related changes and archeological examination corroborate the assumption that the injuries described on the skull may have been, indeed, acquired during activities connected to military lifestyle, and the individual may have been a high‐ranking military leader in his community. This unique case has paramount importance providing more detailed knowledge of past medical practices. The application of U‐shaped gouge has not been formerly documented in the literature, which opens a new perspective both in the osteological investigation of these interventions and the archeological research concerning ancient medical technology. Our results may suggest a possible mode of tool use, and aid future reconstruction attempts concerning the hypothesized 10th‐century‐CE trepan from Tiszaeszlár–Bashalom. [ABSTRACT FROM AUTHOR]

Successful bone fragment fixation is a crucial factor in bone fracture healing, the fixation of crushed bone fragments could hinder bone fracture healing. Thus, ideal bone glues to effectively adhere and splice comminuted bone fragments are needed in clinical. Herein, an osteoinductive and biodegradable double cross-linked bone glue (GelMA-oDex-AMBGN) was constructed through Schiff's base reaction between commercial GelMA (with different substitution degrees of amino groups) and Odex mixed with amine-modified mesoporous bioactive glass nanoparticles (AMBGN), followed by crosslink with blue light irradiation. The GelMA-oDex-AMBGN bone glue successfully adhered and spliced the comminuted bone fragments of isolated rat skulls. GelMA-oDex-AMBGN promoted the proliferation of 3T3 cells and enhanced the expression of osteogenic proteins Runx2 and OCN in vitro. In rat cranial critical-sized defect models, GelMA-oDex-AMBGNs with different substitution degrees significantly increased the new bone contents at the fracture defect sites and promoted bone tissue regeneration in vivo. In conclusion, the double cross-linked bone glue (GelMA-oDex-AMBGN) was successfully constructed and can induce bone regeneration. Additionally, there was no significant difference in osteogenic activity among GelMA-oDex-AMBGNs with different substitution degrees and the equal content of AMBGN.

Background: Low-energy penetrating brain injuries are rarely encountered in neurosurgical practice. Immediate surgical management remains the primary treatment strategy to control potential bleeding and prevents infectious complications. Case Description: A 28-year-old man presented with an orbital injury with left-sided chemosis, amaurosis, and ophthalmoplegia following an assault. Cranial CT revealed an industrial drill bit causing a penetrating injury to the skull base. The tip of the object reached the petrous apex. CT angiography showed no signs of cerebrovascular damage. The drill bit was visualized through a frontotemporal craniotomy. It was then carefully removed under direct microscopic vision. Postoperative ceftriaxone was administered. The patient was discharged in good condition on postoperative day 6. His vision impairment remained. Conclusion: Timely access to neuroimaging diagnostics and microneurosurgical facilities allows for good outcomes in the surgical treatment of low-velocity penetrating brain injuries. [ABSTRACT FROM AUTHOR]

BACKGROUND: Polyetheretherketone and titanium mesh are commonly used in skull repair, but there is no clinical trial evidence of long-term (such as 2 years after operation) repair effect and safety comparison between the two materials. OBJECTIVE: To evaluate the long-term effect and adverse events of polyetheretherketone and titanium mesh in repairing skull defects. METHODS: This is a prospective, single-center, non-randomized controlled, 2-year follow-up clinical trial. Sixty inpatients scheduled for skull repair in the Fourth Affiliated Hospital of China Medical University will be enrolled and divided into two groups according to different intraoperative skull repair materials. Polyetheretherketone and titanium mesh materials will be used in the trial and control groups, respectively (n=30 per group). All patients will be followed up for 6, 12, and 24 months. This trial was approved by the Medical Ethics Committee of the Fourth Affiliated Hospital of China Medical University on February 1, 2021 (approval No. EC-2021-HS-002). This trial meets the requirements of the Declaration of Helsinki formulated by the World Medical Association. All patients are required to sign an informed consent form. The recruitment time will be from August 1, 2021 to August 1, 2022. Result analysis time will be from September 1, 2024 to September 30, 2024. Completion time will be October 31, 2024. RESULTS AND CONCLUSION: Primary outcome measure is rate of failure in skull repair at 24 months after surgery. Secondary outcome measures are rate of failure in skull repair at 6 and 12 months after surgery; the incidence of adverse events to assess safety of implant materials; Glasgow Outcome Scale scores to evaluate the recovery of neurological function; satisfaction score for body shaping to assess skull shaping effect; and head CT imaging to assess skull injury healing at 6, 12, and 24 months after surgery. Cost-effectiveness ratio and incremental cost-effectiveness ratio will be used to assess the difference in cost effectiveness of the two materials at 6, 12, and 24 months after surgery. The trial hopes to prove that compared with titanium mesh, the use of polyetheretherketone for skull repair has a better repair effect for 2 years, a lower incidence of adverse events, better biocompatibility, and obvious advantages in long-term efficacy and security. This study was registered with the Chinese Clinical Trial Registry on February 27, 2021 (registration number: ChiCTR2100043703). Study protocol version is 1.0. [ABSTRACT FROM AUTHOR]

Platelet-derived growth factor receptor α (PDGFRα) is often considered as a general marker of mesenchymal cells and fibroblasts, but also shows expression in a portion of osteoprogenitor cells. Within the skeleton, Pdgfrα+ mesenchymal cells have been identified in bone marrow and periosteum of long bones, where they play a crucial role in participating in fracture repair. A similar examination of Pdgfrα+ cells in calvarial bone healing has not been examined. Here, we utilize Pdgfrα-CreERTM;mT/mG reporter animals to examine the contribution of Pdgfrα+ mesenchymal cells to calvarial bone repair through histology and single-cell RNA sequencing (scRNA-Seq). Results showed that Pdgfrα+ mesenchymal cells are present in several cell clusters by scRNA-Seq, and by histology a dramatic increase in Pdgfrα+ cells populated the defect site at early timepoints to give rise to healed bone tissue overtime. Notably, diphtheria toxin-mediated ablation of Pdgfrα reporter+ cells resulted in significantly impaired calvarial bone healing. Our findings suggest that Pdgfrα-expressing cells within the calvarial niche play a critical role in the process of calvarial bone repair., (© The Author(s) 2024. Published by Oxford University Press.)

Purpose: The treatment of craniofacial bone defects caused by trauma, tumors, and infectious and degenerative diseases is a significant issue in current clinical practice. Following the rapid development of bone tissue engineering (BTE) in the last decade, bioactive scaffolds coupled with multifunctional properties are in high demand with regard to effective therapy for bone defects. Herein, an innovative bone scaffold consisting of GO/Cu nanoderivatives and GelMA-based organic-inorganic hybrids was reported for repairing full-thickness calvarial bone defect., Methods: In this study, motivated by the versatile biological functions of nanomaterials and synthetic hydrogels, copper nanoparticle (CuNP)-decorated graphene oxide (GO) nanosheets (GO/Cu) were combined with methacrylated gelatin (GelMA)-based organic-inorganic hybrids to construct porous bone scaffolds that mimic the extracellular matrix (ECM) of bone tissues by photocrosslinking. The material characterizations, in vitro cytocompatibility, macrophage polarization and osteogenesis of the biohybrid hydrogel scaffolds were investigated, and two different animal models (BALB/c mice and SD rats) were established to further confirm the in vivo neovascularization, macrophage recruitment, biocompatibility, biosafety and bone regenerative potential., Results: We found that GO/Cu-functionalized GelMA/β-TCP hydrogel scaffolds exhibited evidently promoted osteogenic activities, M2 type macrophage polarization, increased secretion of anti-inflammatory factors and excellent cytocompatibility, with favorable surface characteristics and sustainable release of Cu 2+ . Additionally, improved neovascularization, macrophage recruitment and tissue integration were found in mice implanted with the bioactive hydrogels. More importantly, the observations of microCT reconstruction and histological analysis in a calvarial bone defect model in rats treated with GO/Cu-incorporated hydrogel scaffolds demonstrated significantly increased bone morphometric values and newly formed bone tissues, indicating accelerated bone healing., Conclusion: Taken together, this BTE-based bone repair strategy provides a promising and feasible method for constructing multifunctional GO/Cu nanocomposite-incorporated biohybrid hydrogel scaffolds with facilitated osteogenesis, angiogenesis and immunoregulation in one system, with the optimization of material properties and biosafety, it thereby demonstrates great application potential for correcting craniofacial bone defects in future clinical scenarios., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Yang et al.)

Objectives : The technique of guided bone regeneration (GBR) has been widely used in the field of reconstructive dentistry to address hard tissue deficiency. The objective of this research was to manufacture a novel bi-layered asymmetric membrane that incorporates demineralized dentin matrix (DDM), a bioactive bone replacement derived from dentin, in order to achieve both soft tissue isolation and hard tissue regeneration simultaneously. Methods : DDM particles were harvested from healthy, caries-free permanent teeth. The electrospinning technique was utilized to synthesize bi-layered DDM-loaded PLGA/PLA (DPP) membranes. We analyzed the DPP bilayer membranes' surface topography, physicochemical properties and degradation ability. Rat skull critical size defects (CSDs) were constructed to investigate in vivo bone regeneration. Results : The synthesized DPP bilayer membranes possessed suitable surface characteristics, acceptable mechanical properties, good hydrophilicity, favorable apatite forming ability and suitable degradability. Micro-computed tomography (CT) showed significantly more new bone formation in the rat skull defects implanted with the DPP bilayer membranes. Histological evaluation further revealed that the bone was more mature with denser bone trabeculae. In addition, the DPP bilayer membrane significantly promoted the expression of the OCN matrix protein in vivo . Conclusions : The DPP bilayer membranes exhibited remarkable biological safety and osteogenic activity in vivo and showed potential as a prospective candidate for GBR applications in the future.

Given the widespread clinical demand, addressing irregular cranial bone defects poses a significant challenge following surgical procedures and traumatic events. In situ-formed injectable hydrogels are attractive for irregular bone defects due to their ease of administration and the ability to incorporate ceramics, ions, and proteins into the hydrogel. In this study, a multifunctional hydrogel composed of oxidized sodium alginate (OSA)-grafted dopamine (DO), carboxymethyl chitosan (CMCS), calcium ions (Ca 2+ ), nanohydroxyapatite (nHA), and magnesium oxide (MgO) (DOCMCHM) was prepared to address irregular cranial bone defects via dynamic Schiff base and chelation reactions. DOCMCHM hydrogel exhibits strong adhesion to wet tissues, self-healing properties, and antibacterial characteristics. Biological evaluations indicate that DOCMCHM hydrogel has good biocompatibility, in vivo degradability, and the ability to promote cell proliferation. Importantly, DOCMCHM hydrogel, containing MgO, promotes the expression of osteogenic protein markers COL-1, OCN, and RUNX2, and stimulates the formation of new blood vessels by upregulating CD31. This study could provide meaningful insights into ion therapy for the repair of cranial bone defects.