Effects Of Traumatic Injury Research Articles

Automated xeno-free chondrogenic differentiation from human embryonic stem cells: Enhancing efficiency and ensuring high-quality mass production

IntroductionRepairing damaged cartilage poses significant challenges, particularly in cases of congenital cartilage defects such as microtia or congenital tracheal stenosis, or as a consequence of traumatic injury, as the regenerative potential of cartilage is inherently limited. Stem cell therapy and tissue engineering offer promising approaches to overcome these limitations in cartilage healing. However, the challenge lies in the size of cartilage-containing organs, which necessitates a large quantity of cells to fill the damaged areas. Therefore, pluripotent stem cells that can proliferate indefinitely are highly desirable as a cell source. This study aims to delineate the differentiation conditions for cartilage derived from human embryonic stem cells (ESCs) and to develop an automated cell culture system to facilitate mass production for therapeutic applications. MethodsCartilage cell sheets were derived from human ESCs (SEES2, clinical trial-compatible line) by forming embryoid bodies (EBs) with either conventional manual culture or a benchtop multi-pipetter and an automated medium exchange integrated cell incubator, using xeno-free media. Cell sheets were implanted into the subcutaneous tissue of immunodeficient NOG mice to obtain cartilage tissue. The properties of cartilage tissues were examined by histological staining and quantitative PCR analysis. ResultsWe have optimized an efficient xeno-free system for cartilage production with the conventional culture method and successfully transitioned to an automated system. Differentiated cartilage was histologically uniform with cartilage-specific elasticity and strength. The cartilage tissues were stained by Alcian blue, safranin O, and toluidine blue, and quantitative PCR showed an increase in differentiation markers such as ACAN, COL2A1, and Vimentin. Automation significantly enhanced the efficiency of human ESC-derived chondrocyte differentiation. The number of constituent cells within EBs and the seeding density of EBs were identified as key factors influencing chondrogenic differentiation efficiency. By automating the process of chondrogenic differentiation, we achieved scalable production of chondrocytes. ConclusionsBy integrating the differentiation protocol with an automated cell culture system, there is potential to produce cartilage of sufficient size for clinical applications in humans. The resulting cartilage tissue holds promise for clinical use in repairing organs such as the trachea, joints, ears, and nose.

Relationship Between Causes of Amputation with Anxiety and Depression

Objective: To find out relationship between causes of amputation with anxiety and depression. Methodology: Three Main Rehabilitation Centers from Quetta, were involved in 3 month’s cross-sectional research. 54 subjects were included in this research. Inclusion Criteria was “newly amputees to 10years’ time since an amputation, amputees with no psychiatric illness previously, “Upper & lower limb uni-lateral amputees. Exclusion Criteria was amputation because of congenital malformation, amputees from an Afghanistan, amputees with bi-lateral Amputation. Adopted structured questionnaire “Hospital Anxiety and Depression Scale” (HADS) was used. Chi-square test was applied. Results: 47 were men while women were 7. 66.7% amputations were as a consequence of Traumatic injuries whereas 33.3% were as a result of non-traumatic causes. Regarding traumatic causes, major was RTA’s with 46.3% (25), while among non-traumatic, diabetes was the most common cause (24.1%). Tumor along with fall was less common cause for amputation (4%) contribution each. Conclusion: RTA and diabetes were the main reasons of amputation. Causes of amputation have an impact on life of these patients. Outcomes of this study can also be utilized for prevention and treatment due to various causes according to their prevalence .

Application of Hyperpure Chlorine Dioxide for Regenerative Endodontic Treatment of a Root-Canal-Treated Immature Tooth with External Cervical Resorption and Periapical Lesion: A Case Report

The consequences of traumatic injuries are pulp necrosis, periapical inflammation, and possible external cervical resorption (ECR). The concomitant cessation of root maturation and dentinogenesis in premature teeth result in a fragile tooth. Revascularization of the pulp might be an alternative treatment option. A 12-year-old patient was referred for retreatment of chronic apical periodontitis with acute exacerbation after root canal treatment of an upper central incisor. During gutta-percha removal, an ECR was detected. First, it was closed internally with Biodentine, followed by an external composite closure after a cone beam computed tomography evaluation. In the first session, chemomechanical cleaning was aided with sodium hypochlorite and hyperpure chlorine dioxide, and the canal was dressed with Ca(OH)2 until the next session. In the next session, only the low-toxicity, but adequate, bactericide hyperpure chlorine dioxide was applied for irrigation, before the provocation of periapical bleeding into the canal. The blood clots were covered with Biodentine, and the tooth was restored with composite filling. During the 24-month follow-up, clinical signs/symptoms had disappeared, and the periapical lesion was resolved. Increased root thickness in the apical third and decreased size of the apical foramen were detected. In conclusion, regenerative endodontic procedures could potentially be used to retreat immature teeth with persistent apical periodontitis and external cervical resorption.

Transcriptomic Profiling after In Vitro Δ8-THC Exposure Shows Cytoskeletal Remodeling in Trauma-Injured NSC-34 Cell Line.

Neuronal cell death is a physiological process that, when uncontrollable, leads to neurodegenerative disorders like spinal cord injury (SCI). SCI represents one of the major causes of trauma and disabilities worldwide for which no effective pharmacological intervention exists. Herein, we observed the beneficial effects of Δ8-Tetrahydrocannabinol (Δ8-THC) during neuronal cell death recovery. We cultured NSC-34 motoneuron cell line performing three different experiments. A traumatic scratch injury was caused in two experiments. One of the scratched was pretreated with Δ8-THC to observe the role of the cannabinoid following the trauma. An experimental control group was neither scratched nor pretreated. All the experiments underwent RNA-seq analysis. The effects of traumatic injury were observed in scratch against control comparison. Comparison of scratch models with or without pretreatment highlighted how Δ8-THC counteracts the traumatic event. Our results shown that Δ8-THC triggers the cytoskeletal remodeling probably due to the activation of the Janus Kinase Signal Transducer and Activator of Transcription (JAK/STAT) signaling pathway and the signaling cascade operated by the Mitogen-Activated Protein (MAP) Kinase signaling pathway. In light of this evidence, Δ8-THC could be a valid pharmacological approach in the treatment of abnormal neuronal cell death occurring in motoneuron cells.

GENESIS OF AXONAL SWELLINGS IN TRAUMATIC INJURY

AbstractBackgroundAxonal swellings (AxS) are focal enlargements of axons found in a range of biological and pathological settings, including traumatic brain injury. However, the development of AxS and their early effects on axonal homeostasis are poorly understood. Here, we describe the cytoskeletal changes, transport effects and the molecular events that occur in the axon immediately after a traumatic injury.MethodWe developed an in vitro system to study in real‐time the effects of traumatic injury on the axon of mature human neurons. We also generated an algorithm which allowed us to assess the dynamics of the AxS formation in real‐time and examine the role of Ca2+ in the swellings. Through mass spectrometry analysis on isolated axons we described the axonal proteome and identified the immediate phosphorylation changes ocurring in the axon after a traumatic injury. We also used superresolution microscopy to characterize the earliest cytoskeletal changes in the axon and their impact on the movement of several axonal cargoes.ResultAs a result of the mechanical stress we observed the appereance of AxS, which were temporally correlated to Ca2+ levels increase in the axon. Interestingly, by pharmacologically blocking different sources of Ca2+ we observed that Ca2+ plays a role in sustaining the AxS and not in their formation. Proteomic and phosphoproteomic analysis revealed a significant regulation in proteins related to axon development after injury. These proteins were mainly interactors or components of the cytoskeleton, while no association to axonal degeneration or impairment in normal processes was found. We also predicted a general increase in kinases activity after injury, among them ROCK, ERK, JNK, PKC and GSK. A detailed analysis of cytoskeletal arrangement revealed modifications in the actin‐spectrin periodic structure and a mesh‐like organization of microtubules and neurofilaments in the AxS. We finally observed that the structure of swellings allows cargos to cross and that axonal transport of different cargos were not interrupted during mechanical stress.ConclusionThese observations indicate that the mechanical stress to the axon generates segments of cytoskeletal reorganization that result from Ca2+ increase and correlate with regulation through phosphorylation of cytoskeletal and cytoskeletal interacting proteins.

Factors associated with new mental health diagnoses and resource utilization among pediatric patients following trauma admission

PurposeInjured children are at risk for a variety of physical and emotional sequelae that may impair their ability to return to prior function. The effect of traumatic injury on mental health in children is not well characterized or understood. We sought to determine factors associated with new mental health diagnoses and/or mental health resource utilization following admission to a Level 1 pediatric trauma center for traumatic injury. MethodsA retrospective chart review of patients admitted for accidental trauma between 2016 and 2019 was performed. Demographic data, injury characteristics, new mental health diagnoses and/or mental health resource utilization following hospitalization were extracted. Patients with prior mental health diagnosis, psychotropic prescription(s), or resource utilization were excluded from this cohort. A multivariable logistic regression model was used to examine predictors of new mental health diagnoses and/or resource utilization. ResultsThe prevalence of new mental health diagnoses or resources utilization was 9.5% (363/3828). The most common diagnoses were anxiety disorders and nonbipolar depression. The most common psychotropic medication prescribed was antidepressants. Patients with new mental illness were older (odds ratio [OR] 1.1 [95% CI: 1.06, 1.12]), more likely to sustain burn injuries (OR 6.3 [4.2, 9.5]), have non-sports related injuries (OR 3.5 [2.1, 6.0]), and be pedestrian struck (OR 2.7 [1.5, 4.8]). They additionally were more likely to sustain head, neck, and spine injuries (OR 3.8 [2.9, 5.1], 2.4 [1.1, 5.5], and 2.1 [1.3, 3.3], respectively). ConclusionsThere are a variety of demographic and injury specific factors associated with new mental health diagnoses and/or resource utilization in children following admission for trauma. Knowledge of these risk factors may ensure patients are allocated adequate resources to promote timely access to appropriate mental health services after hospitalization. Type of StudyRetrospective comparative study Level of EvidenceIII

Cranio-Mandibular Disorders after Whiplash Injury: A Mono-Institutional Clinical Study on 31 Patients.

Background: Whiplash is a consequence of traumatic injuries, mostly related to road accidents, with variable clinical manifestations, also known as Whiplash Associated Disorders, such as neck, head and temporo-cranio-mandibular pain. Methods: The current study aims to evaluate the onset and evolution of temporomandibular joint pain in people with whiplash in a study group treated with the use of Zimmer Collars (adjustable rigid cervical collars for neck immobilization), as compared to a control group. This prospective study included 31 patients followed by the Dental Prosthesis Department of the University of Bari “Aldo Moro”: 20 patients with whiplash (age range: 20–39 years) treated with Zimmer collars and 11 patients with whiplash (age range: 20–33 years) who were not. Immediately after the whiplash occurred, a visual analogue scale (VAS) was used to describe the intensity of pain and to complete the chart of the European Academy of Craniomandibular Disorders. Five out of twenty patients, already treated with a Zimmer collar, wore an occlusal splint as well because of persistent pain reported at the 28-day and 60-day follow-up and were supported by pharmacological therapy with analgesics (paracetamol) and muscle relaxants (thiocolchicoside). Results: During the last follow-up (at six months), three out of five patients displayed a residual VAS score of 3, 4, and 5, respectively, while the remaining two displayed a VAS of 0. In the control group, four out of eleven patients needed to wear an occlusal splint but without muscle relaxants and analgesics pharmacological therapy; these four corresponded to the patients showing a residual painful symptomatology, with VAS reaching value of 2, and also were the oldest patients of the group. Data regarding VAS values and Zimmer collar use, both at the first visit and six months later, were statistically analyzed. Conclusion: Our prospective study highlights how whiplash-associated acute disorders are often self-limiting over a period of few months, thus reducing the possibility of symptom chronicity; the latter seems to be strictly related to lesion severity, pre-existence of a craniomandibular dysfunction and patient age, but appears to be independent from Zimmer collar use, as statistically confirmed.

Letter to the editor - The 23-Year Existence of the “Zdrowie” [Eng. Health] Rehabilitation Centre in Kraków – Memories and Summary of Activities

On June 30, 2021, 23 years after its establishment, the activity of "Zdrowie" [Eng. Health] Rehabilitation Centre in Kraków came to an end. At the “Zdrowie” Rehabilitation Centre, this was done through appropriate personalised treatment, mainly rehabilitation, and since its inception, the centre had promoted not only the treatment of diseases, the consequences of traumatic injuries and the resulting disability, but most of all, their prevention. In 1998, as one of the first centres in Poland, the “Zdrowie” Rehabilitation Centre began routinely carrying out pedobarographic examinations, to an extent not found in other places at that time. Since 2006, photogrammetric testing has also been performed. What definitely distinguished the Centre, not only in Kraków, but also on the Polish medical market, was, among others, its scientific activity. Based on the Centre's professional and scientific achievements, sixteen M.A. one B.A, three doctoral dissertations, articles published in reputable journals with the Impact Factor (IF) index and scores from the Ministry of Science and Higher Education (MNiSW) or the Ministry of Science and Education (MNiE) were prepared.

VAPING-INDUCED ALVEOLAR RUPTURE LEADING TO PNEUMOMEDIASTINUM IN A YOUNG FEMALE

TOPIC: Disorders of the Mediastinum TYPE: Medical Student/Resident Case Reports INTRODUCTION: Electronic cigarette use or "vaping" has been on the rise in America over the last decade. Literature shows that approximately 8.1 million Americans admitted to vaping in 2018. Vaping is when one inhales and exhales an aerosolized solution (Vaper) through a cigarette-like electrical device. Some chemicals found in vapers have been linked to disease processes. While using E-cigarettes, the participant inhales a large amount of vaper, exaggerating the Valsalva maneuver, subsequently increasing intra-thoracic pressure. This increase in thoracic pressure places the participant at risk for spontaneous pneumomediastinum. We present a case of a 19-year-old female diagnosed with spontaneous pneumomediastinum. The only risk factor, the use of electric cigarettes. CASE PRESENTATION: A 19-year-old female with a history of type 1 diabetes mellitus and vape dependence presents with a 3-day history of abdominal pain, chest pain, and retching. She admitted to vaping daily for one year before the presentation. Physical examination revealed no evidence of respiratory distress along with slight crepitus tracheal area at the level above the clavicle. She was found to be in diabetic ketoacidosis (DKA), which was also treated. She continued to have epigastric burning along with chest pain. For this reason, computed tomography (CT) of the chest was performed and showed pneumomediastinum. She did not meet the Pittsburg criteria for esophageal rupture. Barium swallow eventually ruled out esophageal rupture. The pneumomediastinum likely occurred secondary to vape-induced alveolar rupture. She was treated with supplemental oxygen, and serial chest radiograph showed gradual resolution of pneumomediastinum. DISCUSSION: Laennec first described pneumomediastinum (PM) in 1819 as a consequence of traumatic injury. The clinical presentation could be very vague, ranging from classic chest pain to unspecific symptoms, which lead to delayed diagnosis. The pathophysiology of can be described by the Macklin effect as follows: (a) alveolar rupture, (b) air dissection along the bronchovascular sheath, and (c) free air reaching the mediastinum. Chest radiography, the standard diagnostic procedure, diagnosis can be confirmed by chest computed tomography scan. Once the diagnosis is approved, the patient should be admitted for monitoring and treatment consisting of avoidance of the trigger factors, oxygen, and bed rest. CONCLUSIONS: Spontaneous pneumomediastinum secondary to vaping is on the rise. The diagnosis of vaping-induced lung injury continues to be a dilemma among physicians. A high index of suspicion is necessary for early detection and treatment. Although most cases are benign, it will be prudent for health care providers to actively query patients about their use and educate patients on their potential severe side effects. REFERENCE #1: Pneumomediastinum: Practice Essentials, Pathophysiology, Epidemiology. Accessed April 28, 2021. https://emedicine.medscape.com/article/1003409-overview REFERENCE #2: Marasco RD, Loizzi D, Ard NP, Fatone FN, Sollitto F. Spontaneous Pneumomediastinum After Electronic Cigarette Use. Ann Thorac Surg. 2018;105:e269-e271. doi:10.1016/j.athoracsur.2017.12.037 REFERENCE #3: Panacek EA, Singer AJ, Sherman BW, Prescott A, Rutherford WF. Spontaneous pneumomediastinum: Clinical and natural history. Ann Emerg Med. 1992;21(10):1222-1227. doi:10.1016/S0196-0644(05)81750-0 DISCLOSURES: No relevant relationships by Esiemoghie Akhigbe, source=Web Response No relevant relationships by Ebubechukwu Ezeh, source=Web Response No relevant relationships by Mackenzie Hamilton, source=Web Response No relevant relationships by Mohamed Suliman, source=Web Response

Neuropathy of the peroneal nerve as a complication after total knee arthroplasty: characteristics of rehabilitation

Knee arthroplasty is recognized as the gold standard in the treatment of stage IIIIV degenerative diseases and the consequences of traumatic injuries. The number of surgeries is growing, and the number of complications after considered interventions is growing as well. Frequency of peripheral nerve neuropathies is not high, but damage to the peroneal nerve after total arthroplasty of the knee joint can lead to severe dysfunction of the lower limb, decrease in daily activity and the patients quality of life. The article analyzes the treatment results of 254 patients after primary and secondary knee arthroplasty. Signs of damage to the peroneal nerve upon admission to the second stage of rehabilitation were identified in 3.9% of cases. The clinical and functional examination performed in dynamics showed that the presence of neuropathy of the peroneal nerve aggravated the severity of the existing functional disorders in patients after knee arthroplasty. It has been established that complex intensive rehabilitation treatment, which should begin immediately after the diagnosis is made and be carried out intermittently for at least six months, restore the function of the affected nerve in 75% of cases.

Cerebrospinal fluid replacement solutions promote neuroglia migratory behaviors and spinal explant outgrowth in microfluidic culture.

Disorders of the nervous system (NS) impact millions of adults, worldwide, as a consequence of traumatic injury, genetic illness, or chronic health conditions. Contemporary studies have begun to incorporate neuroglia into emerging NS therapies to harness the regenerative potential of glial-mediated synapses in the brain and spinal cord. However, the role of cerebrospinal fluid (CSF) that surrounds neuroglia and interfaces with their associated synapses remains only partially explored. The flow of CSF within subarachnoid spaces (SAS) circulates essential polypeptides, metabolites, and growth factors that directly impact neural response and recovery via signaling with healthy glia. Despite the availability of artificial CSF solutions used in neurosurgery and NS treatments, tissue engineering projects continue to use cell culture media, such as Neurobasal (NB) and Dulbecco's Modified Eagle Medium (DMEM), for development and characterization of many transplantable cells, matrixes, and integrated cellular systems. The current study examined in vitro behaviors of glial Schwann cells (ShC) and spinal cord explants (SCE) within a CSF replacement solution, Elliott's B Solution (EBS), used widely in the treatment of NS disorders. Our tests used EBS to create defined chemical microenvironments of extracellular factors within a glial line (gLL) microfluidic device, previously described by our group. The gLL is comparable in scale to the in vivo SAS that envelopes endogenous CSF and enables molecular transport via mechanisms of convective diffusion. Our results illustrate that EBS solutions facilitate ShC survival, morphology, and proliferation similar to those measured in traditional DMEM, and additionally support glial chemotactic behaviors in response to brain-derived growth factor (BDNF). Our data indicates that ShC undergo significant chemotaxis toward high and low concentration gradients of BDNF with statistical differences between gradients formed within diluents of EBS and DMEM solutions. Moreover, SCE cultured with EBS solutions facilitated measurement of neurite explant extension commensurate with reported in vivo measurements. This data highlights the translational significance and advantages of incorporating CSF replacement fluids to interrogate cellular behaviors and advance regenerative NS therapies.

Reabilitação protética após fratura dento-alveolar extensa – relato de caso

Bucco-sinus communications are common incidences and may be associated with posterior superior tooth extraction. In large maxillary losses, repairing prostheses have a categorical or essential indication. Thus, the objective of this study is to report a clinical case of prosthetic rehabilitation using a removable partial denture (RPD) due to absence of teeth in the posterior maxilla region resulting from a dento-alveolar fracture as consequence of traumatic injury. A 21-year-old male patient attended the dental clinic at Nilton Lins University, reporting masticatory failure, discomfort and sensitivity when eating cold foods in the right upper molars region. After clinical and radiographic examination, it was observed that in addition to the absence of teeth 16, 17 and 18, there was an extensive bone loss in the right posterior hemiarch, with surgically sealed bucosinusal communication. As treatment plan, rehabilitation using a removable partial prosthesis modified and adapted to the acquired defect was proposed. In the consultations, the stages of study model manufacturing, assemble in a semi-adjustable articulator and delineation. The modification of the metallic frame consisted of a larger connector, like a wide palatal plate 10 mm long without relief on the palate, complemented by indirect twinned clamps and direct “T” type on tooth 15. The case was concluded with the steps of metal frame test, teeth assembly, teeth testing, acrylization and installation. The rehabilitation treatment by means of restorative PPR was satisfactory, as it was observed that after its installation, the patient showed extreme satisfaction with the result obtained, with an explicit improvement in chewing and swallowing.

Prolonged Circulation of Ultra-Large Von Willebrand Factor and a Reduction in ADAMTS13 Activity Promotes Microvascular Disease Following Traumatic Injury

Introduction: Increases in plasma von Willebrand Factor (vWF) levels, accompanied by decreases in its respective metalloprotease, ADAMTS13, have been demonstrated in diseases of microvascular injury. We hypothesized that following severe trauma, a burst of ultra-large vWF (UL-vWF) is released into the bloodstream by damaged endothelium, resulting in increased thrombogenicity due to circulating vWF multimers. We further hypothesized that traumatic injury would lead to a deficit of ADAMTS13, promoting the accumulation of UL-vWF forms and, ultimately, the increased risk of microvascular disease, such as acute kidney injury (AKI). Methods: A cohort of 37 severely injured trauma patients was analyzed for antigen levels of plasma vWF and ADAMTS13 at 0- and 24-hours after admission. Circulating vWF multimeric composition from both time points was determined by vertical agarose gel electrophoresis. Multivariate analyses were performed with data abstracted from the electronic medical records to identify further dependences. A similar analysis was also performed on plasma from a cohort of 8 patients with trauma induced AKI at 0-, 24-, and 72-hours after admission; these patients were well matched against trauma patients without AKI. Finally, we utilized a murine model of polytrauma and hemorrhage, in conjunction with qRT-PCR of ADAMTS13 in total liver RNA, to specifically address how the expression of ADAMTS13 is altered by the systemic effects of traumatic injury. Results: Circulating vWF levels were increased in severe trauma patients when compared to healthy controls at presentation (189% (110-263) vs. 95% (74-120)) and persisted through 24-hours (213% (146-257) vs. 132% (57-160)). Ultra-large vWF forms were elevated at both 0- and 24-hours when compared to pooled normal plasma ((10.0% (8.9-14.3) and 11.3% (9.1-21.2), respectively, vs 0.6%). The largest vWF forms within trauma patient plasma circulated at 33±4 dimers vs 18±1 dimer in length within pooled normal plasma. Severe trauma patient ADAMTS13 activity was decreased at 0-hours (66% (47-86) vs. 100% (98-100)) and at 24-hours (72.5% (56-87.3) vs 103% (103-103)) when compared to healthy patients. Furthermore, the proportion of circulating low molecular weight multimeric (LMWM) vWF to total circulating vWF forms was directly dependent upon ADAMTS13 activity at 24-hours (Decreased ADAMTS13 Activity: 20.4% (15.0-22.7) LMWM vWF vs Normal Activity: 25.8% (22.7-35.2) LMWM vWF). Strikingly, ADAMTS13 activity independently predicted the development of coagulopathy, correlating with presentation INR (ρ =-0.63), activated clotting time of thromboelastography (TEG) (ρ=-0.36), and TEG maximum amplitude (ρ=0.36). ADAMTS13 activity also closely correlated with injury severity (ISS) (ρ=-0.34) and blood product transfusion (ρ =-.45). The cohort of 8 trauma patients who went on to develop AKI showed a 1.54-fold (1.02-2.05) increase in plasma vWF antigen levels between 0 and 72 hours, while those who did not develop AKI showed no change in vWF levels over this time period. Furthermore, those who developed AKI demonstrated a smaller proportion of LMWM vWF in plasma than those who did not (25.4% (23.4-28.0) vs 31.2% (27.2-35.6)), suggesting the increased thrombogenicity of their circulating vWF forms. Finally, qRT-PCR of total liver RNA in 6 mice demonstrated a 2-fold decrease in ADAMTS13 RNA expression levels between the times immediately before and 24-hours after trauma. Altogether, these data indicate that both circulating ADAMTS13 and its production are deficient in the days following severe injury. Conclusions: Severe traumatic injury alters the circulating composition of ADAMTS13 and its target, vWF, shifting their equilibrium to one that promotes thrombosis. Not only is the concentration of circulating ADAMTS13 decreased following traumatic injury, but hepatic expression of the enzyme is lacking as well. In the immediate moments following injury, these mechanisms contribute to life-saving hemostasis; however, as these changes extend into the following days, the early hemostatic benefit quickly shifts to burden that may exacerbate microvascular disease. Disclosures Ragni: Bioverativ/Sanofi: Consultancy, Research Funding; Sangamo: Research Funding; Shire/Takeda: Consultancy, Other: Study drug; Alnylam/Sanofi: Consultancy, Research Funding; Bayer: Consultancy; Spark Therapeutics: Consultancy, Research Funding; ICER: Consultancy; OPKO: Research Funding; Biomarin: Consultancy, Research Funding. Rollins-Raval:Bayer, Inc: Membership on an entity's Board of Directors or advisory committees. Raval:Sanofi: Membership on an entity's Board of Directors or advisory committees; Bayer, Inc: Research Funding. Neal:Janssen Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; CSL Behring: Membership on an entity's Board of Directors or advisory committees.

The problem of continuity in the provision of medical care as an element of a violation of the rights of the patient with trauma pathology

This article is devoted to the disclosure of the key legislative problems in the implementation of the legal rights of certain categories of citizens – patients with traumatic pathology in obtaining qualified medical care. The choice of the category of patients in this work is not accidental and is due to the fact that today traumatism is one of the main causes of mortality. Disability associated with the consequences of traumatic injuries ranks third in the overall structure of the causes of persistent disability in the Russian Federation and is one of the most important indicators characterizing the quality of medical care to this population. The quality of medical care provided to the population, guaranteed by the Constitution of the Russian Federation, is affected by the observance and implementation of the rights of patients enshrined in the Federal law «on the basis of public health protection», first of all, the right to access to the required medical care. As a result of the study of this problem, a number of shortcomings of the current legal regulation of certain areas of domestic health care have been identified, which in our opinion significantly reduces the effectiveness of the state policy in the field of health protection of the population of Russia, including in ensuring the implementation of effective medical care for injuries, especially in terms of medical rehabilitation at the post-hospital stage of medical care. The methodological basis of this work was a set of methods of scientific knowledge, social processes and facts, dialectical method of knowledge, involving the study of legal and social phenomena, the method of system analysis, the method of analysis of literary, including st atistical data.

Effects of an acidic environment on coagulation dynamics

Background Disruption of hydrogen ion homeostasis is a consequence of traumatic injury often associated with clinical coagulopathy. Mechanisms by which acidification of the blood leads to aberrant coagulation require further elucidation. Objective To examine the effects of acidified conditions on coagulation dynamics using in vitro models of increasing complexity. Methods Coagulation dynamics were assessed at pH 7.4 and 7.0 as follows: (i) tissue factor (TF)-initiated coagulation proteome mixtures (±factor [F]XI, ±fibrinogen/FXIII), with reaction progress monitored as thrombin generation or fibrin formation; (ii) enzyme/inhibitor reactions; and (iii) TF-dependent or independent clot dynamics in contact pathway-inhibited blood via viscoelastometry. Results Rate constants for antithrombin inhibition of FXa and thrombin were reduced by ~ 25-30% at pH 7.0. At pH 7.0 (+FXI), TF-initiated thrombin generation showed a 20% increase in maximum thrombin levels and diminished thrombin clearance rates. Viscoelastic analyses showed a 25% increase in clot time and a 25% reduction in maximum clot firmness (MCF). A similar MCF reduction was observed at pH 7.0 when fibrinogen/FXIII were reacted with thrombin. In contrast, in contact pathway-inhibited blood (n = 6) at pH 7.0, MCF values were elevated 6% (95% confidence interval [CI]: 1%-11%) in TF-initiated blood and 15% (95% CI: 1%- 29%) in the absence of TF. Clot times at pH 7.0 decreased 32% (95% CI: 15%-49%) in TF-initiated blood and 51% (95% CI: 35%-68%) in the absence of TF. Conclusions Despite reported decreased procoagulant catalysis at pH 7.0, clot formation dynamics are slightly enhanced in blood ex vivo and suppression of thrombin generation is not observed. A decrease in antithrombin reactivity is one potential mechanism contributing to these outcomes.

A Pneumomediastinum with Diffuse Subcutaneous Emphysema

A 65-year-old man presented to the Emergency Department with facial angioedema. It occurred just after an intramuscular morphine injection in the shoulder for a minor chest trauma from falling off a chair. On physical examination, he had right chest pain, a pulse of 90 beats/min, blood pressure of 140/80 mm Hg, respiratory rate of 35 breaths/min, and room air oxygen saturation of 88%. Diffuse wheezes were detectable in both lungs. He was provided with supplemental oxygen, salbutamol aerosol, and corticosteroid treatment. After initial stabilization, subcutaneous emphysema developed suddenly over his chest. Chest radiography revealed a right lucency, some mediastinal radiolucent streaks, and subcutaneous emphysema (Figure 1). Chest computed tomography scan with intravenous contrast confirmed the right pneumothorax and the pneumomediastinum (Figure 2, Figure 3), and revealed a rib fracture (Figure 4). A chest drain was inserted and the patient’s condition improved.Figure 2Chest computed tomography scan (tissue window). Right pneumothorax (arrow) and pneumomediastinum (arrow) are visible.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Chest computed tomography scan (tissue window) reveals right and left pneumothoraces and pneumomediastinum with dissection of bronchovascular sheaths (arrows).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4Chest computed tomography scan (bone window) shows a rib fracture (arrow).Used with permission of Emilie Dehours, MD, Department of Emergency Medicine, Purpan, Toulouse, France.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The term pneumothorax was first coined in 1803 by Itard, and its clinical features were described by Laennec in 1819. More than half of pneumothoraces are traumatic (accidental or iatrogenic); the others occur without any preceding trauma and are labeled spontaneous (1Schramel F.M.N.H. Postmus P.E. Vanderschueren R.G.J.R.A. Current aspects of spontaneous pneumothorax.Eur Respir J. 1997; 10: 1372-1379Crossref PubMed Scopus (257) Google Scholar). Traumatic pneumothoraces result from penetrating or nonpenetrating chest injuries (2Gupta D. Hansell A. Nichols T. et al.Epidemiology of pneumothorax in England.Thorax. 2000; 55: 666-671Crossref PubMed Scopus (259) Google Scholar). It is noteworthy that, in the literature, there is a strong association between rib fractures and pneumothoraces (3Bridges K.G. Welch G. Silver M. et al.CT detection of occult pneumothorax in multiple trauma patients.J Emerg Med. 1993; 11: 179-186Abstract Full Text PDF PubMed Scopus (90) Google Scholar). On the other hand, pneumomediastinum, reported in 1939 by Hamman, is an uncommon clinical entity (4Chalumeau M. Clainche L. Sayeg N. et al.Spontaneous pneumomediastinum in children.Pediatr Pulmunol. 2001; 31: 67-75Crossref PubMed Scopus (147) Google Scholar). The first described pneumomediastinum by Laennec in 1819 was a consequence of traumatic injury. The most widely accepted explanation for the development of pneumomediastium is a sudden rupture of distended alveoli under high-pressure gradient between the alveoli and the surrounding interstitial space. The free air then dissects from the ruptured alveoli along the bronchovascular sheaths toward the mediastinum. This sequence of events is known as the “Macklin Effect” (5Macklin M.T. Macklin C.C. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory diseases and other conditions.Medicine. 1994; 23: 281-352Crossref Scopus (604) Google Scholar). Gas can also escape retroperitoneally through periaortic and periesophageal planes (6Zylak C.M. Standen J.R. Barnes G.R. et al.Pneumomediastinum revisited.Radiographics. 2000; 20: 1043-1057Crossref PubMed Scopus (164) Google Scholar). As a result, the air within the mediastinum can further dissect through these planes, causing pneumopericardium, pneumoretroperitoneum, and pneumoperitoneum. As a consequence of our finding, early incorporation of a routine chest computed tomography scan in all patients with rib fractures might be required to successfully diagnose pneumothoraces and pneumomediastinum.

“Our Culture Is Medicine”: Perspectives of Native Healers on Posttrauma Recovery Among American Indian and Alaska Native Patients

American Indian and Alaska Native (Native) people experience more traumatic events and are at higher risk for developing posttraumatic stress disorder compared with the general population. We conducted in-depth interviews with six Native healers about their perspectives on traumatic injury and healing. We analyzed the interviews using an inductive approach to identify common themes. We categorized these themes into four categories: causes and consequences of traumatic injury, risk factors, protective factors, and barriers to care. The implications of our study include a need for improving cultural competence among health care and social services personnel working with Native trauma patients. Additional cumulative analyses of Native healers and trauma patients would contribute to a much-needed body of knowledge on improving recovery and promoting healing among Native trauma patients.

World Trauma Congress: when dreams come true

World Trauma Congress: when dreams come true

Distal Tibiofibular Bone-Bridging in Transtibial Amputation

The creation of a bone bridge between the residual tibia and fibula is a controversial surgical technique used in the performance of transtibial amputation. Twenty consecutive patients who underwent a unilateral transtibial amputation, as a consequence of traumatic injury, had distal tibiofibular bone-bridging performed by a single surgeon. Eight completed the Prosthesis Evaluation Questionnaire (PEQ), a validated outcomes instrument designed to measure patient self-reported health-related quality of life after a lower-extremity amputation. Their responses were compared with those of a previously reported control group of nondiabetic patients who had undergone transtibial amputation with the use of a traditional technique and with those of a previously reported consecutive group of Brazilian patients, including twelve who were diabetic, who had undergone a similar bone-bridge procedure. The scores in the American bone-bridge group were similar to those in the control group and not as good as those in the Brazilian bone-bridge group. The American bone-bridge and control groups scored lower in the Social Burden, Ambulation, Frustration, Sounds, Utility, and Well-Being domains of the PEQ. While many experts in the care of amputees believe that the distal tibiofibular bone-bridge technique improves patient functional outcomes, our small group of patients treated with this procedure did not appear to have better outcomes than a group of patients treated successfully with a standard surgical technique. More information is needed before the bone-bridge technique can be recommended as an important component of standard transtibial amputation surgery.

Reduced PMN beta 2 integrins after trauma: a possible role for colony-stimulating factors.

The beta 2 integrins are composed of a common 95-kD beta-subunit (CD18) and one of three possible alpha-subunits: CD11a, CD11b, or CD11c. These molecules are involved in neutrophil adhesion, diapodesis, chemotaxis and phagocytosis. In this study, the effects of traumatic injury on neutrophil expression of these alpha-subunits were investigated. Neutrophils from patients with severe trauma (n = 30) were stained with fluorescent anti-CD11a, -CD11b, or -CD11c. The percentage of positive neutrophils and the mean channel fluorescence were assayed by flow cytometry. In 10 patients and 10 normals, the effects of granulocyte-colony stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) on alpha-subunit expression were evaluated. Ninety-four +/- 2% (s.e.m.) of normal neutrophils were CD11a+, 89 +/- 1% were CD11b+ and 89 +/- 8% were CD11c+. Only 65 +/- 2% of patient neutrophils were CD11a+, 45 +/- 5% were CD11b+ and 8 +/- 1% were CD11c+. Culture of normal neutrophils without colony-stimulating factors resulted in reduced expression of CD11a and CD11c, but up-regulation of CD11b. Down-regulation of CD11a and CD11c was partially reversed by colony-stimulating factors (30 U/ml). CD11b receptor density was further up-regulated by GM-CSF and G-CSF. Treatment of patient neutrophils with colony-stimulating factors in culture resulted in up-regulation of alpha-subunits as well. GM-CSF appeared to have the greater effect. These results indicate that colony-stimulating factors may have a clinical role in improving beta 2 integrin expression, and suggest a use in these infection-prone patients.