Duration Of Injury Research Articles

Experiences with COVID-19 Pandemic in the Spinal Cord Injury Community

<h3>Research Objectives</h3> Document the experiences of people with chronic spinal cord injury (SCI) during the COVID-19 pandemic. <h3>Design</h3> A cross-sectional survey. <h3>Setting</h3> An academic medical center. <h3>Participants</h3> A convenience sample of 35 participants from a local SCI Model Systems Center who completed a survey online or by phone between September 2021 and March 2022. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> A scale "COVID-19: Impact of the pandemic and HRoL in cancer patients and survivors" obtained from NIH PhenX Toolkit was adapted for SCI population that measures personal COVID-19 exposures and experiences, including COVID-19 specific emotional and physical reactions, health care disruption and concerns, disruption to daily activities and social interactions, financial hardship, perceived benefits, functional social support, and perceived stress management. <h3>Results</h3> This sample had a mean age of 51.8 years, a mean duration of injury of 22.2 years, and 55.9 % had paraplegia with American Spinal Injury Association Impairment Scale A, B, or C. 17.1% of participants had COVID-19 infection. Forty percent of participants were fully vaccinated which is lower than that of general population in the state (53.5%). More than half of participants were concerned about family members or close friends getting or dying from COVID-19, had feelings of sadness or depression, and experienced disruptions in day to day social interactions with family and/or friends. The majority reported perceived benefits, had functional social supports, and had ability to manage stress. Participants reported varying COVID-19 related impacts, including employment (eg, 8.5% lost job), health care disruption (eg, 37.1% general care disruption), and financial hardship (eg, 34.3% financial difficulties). <h3>Conclusions</h3> These results provide important markers for developing interventions for SCI population in future crises. <h3>Author(s) Disclosures</h3> No disclosure.

Distal Nerve Transfer to Restore Wrist and Finger Extension - A Systematic Review.

Background: There are numerous options available for restoration of wrist and finger extension following radial nerve palsy. The aim of this study is to conduct a systematic review of the effectiveness of nerve transfer for radial nerve palsy. Methods: Electronic literature research of PubMed, Cochrane, Scopus and Lilacs database was conducted in June 2021 using the terms 'Distal nerve transfer' AND 'Radial nerve injury' 'Radial nerve palsy' OR 'Radial nerve paresis' OR 'Median nerve transfer' OR 'wrist extensor' OR 'finger extension' OR 'thumb extension' OR 'wrist motion'. The data extracted included the study details, demographic data, procedure performed and final functional outcome according to the muscle research council scale. Results: A total of 92.59% and 56.52% had satisfactory outcome following distal nerve transfer of median nerve to restore wrist and finger extension respectively. No significant correlation was found between time to injury duration and satisfactory outcomes. Conclusions: Outcomes of nerve transfers are comparable to tendon transfers. Multi-centric studies are needed to compare the results amongst various surgical procedures described. Level of Evidence: Level III (Therapeutic).

Comparative Outcome of Three Different Approaches for Supracondylar Humeral Fractures in Children in Khyber Pakhtunkhwa, Pakistan

Background: The closed reduction and percutaneous pinning are the min treatment approaches tested in pediatric humerus supracondylar fractures but the treatment approach preferred in fractures without closed reduction is remains unclear. Objectives: The purpose of this study was to compare three common orthopaedic procedures for treating children with supracondylar humerus fractures of the displaced extension type. Methods: The current retrospective analytical study was started in the Department of Orthopedic at Khyber Teaching Medical College from 2015 to 2020, with the approval of the clinical research ethics committee. This analysis was conducted on 64 patients between the ages of 1 and 12 years who underwent hospital surgery for Gartland IIb, Gartland IIb, and Gartland III supracondylar humerus fracture. Results: A total of 64, 22 patients were from group A, in which 18 (81.81%) were male and only 4 (18.18%) were female, while in group B and C were 21 (80.76%), 5 (19.23%) and 14 (87.5%), 2 (12.50%) male and female, respectively. The injury on left elbow and right elbow in group A was recorded 68.18 and 31.81%, respectively. Among the total injured children, the left elbow was fractured in 47 (73.43%) case and the right one in 7 (10.93%). Approximately the duration of injury to therapeutic procedure was recorded 7.53±3.03 hours in the study. When compared to the group of displaced supracondylar humeral fractures that were conservatively handled, the functional and aesthetic treatment outcomes between the closed and open reduction with K-wire fixation groups were significantly different. According to this system, excellent, fair, good and poor functional outcomes were recorded in 10 (45.45%), 6 (27.27%), 4 (18.18%) and 2 (9.09%) patients of A group, respectively, while 13 (50%), 5 (19.23%), 5 (19.235), and 3 (11.50%) patients in group B, respectively. The poor and fair functional outcome was noted in 1 (6.25%) and 3 (18.75%) patients, respectively in group C. Practical implication: This is a critical surgical condition in children and they should be provided with the appropriate treatment to acquire the child's ability of movement. According to our findings among three management techniques, the most favorable was open reduction with K-wire fixation, and therefore was recommended with good success rate. Conclusion: It was thus concluded that open reduction with K-wire fixation is a good alternative to closed reduction with percutaneous pinning for treating displaced pediatric supracondylar humeral fracture. Keywords: Children; Supracondylar humerus fracture; Surgical treatment; Pediatric fractures; Pakistan

Long-Term Effects of Acute Kidney Injury Following Endovascular Femoropopliteal Intervention: Insights From a Multicenter Trial

Purpose: To examine the association between acute kidney injury (AKI) severity and duration with cardiovascular mortality, following endovascular treatment of femoropopliteal disease, and whether it is AKI in itself that confers an increased risk of cardiovascular mortality. Methods: A retrospective analysis of prospectively collected data obtained between 2014 and 2019 from 3 vascular centers. Renal function was followed up for a minimum of 90 days. Electronic records were queried to establish a cause of death, where applicable. Patients were excluded if unable to provide written informed consent or if presenting with acute limb ischemia. Primary outcomes were the hazard ratios for cardiovascular death (AKI patients vs no AKI; no AKI vs stage 1 AKI vs stage 3 AKI; and no AKI vs transient AKI vs established AKI). Propensity score–matched analysis was used to establish whether developing AKI, in patients with similar demographics and procedural characteristics, is associated with a higher risk of cardiovascular death. Results: Overall 239 patients developed AKI, and this was associated with an increased risk of cardiovascular mortality (hazard risk [HR]: 4.3, 95% confidence intervals [CIs]: 2.1–6.8, pairwise comparison p value=0.006]. This was dependent on the severity of the AKI stage (HR 5.4, 95% CI: 2.4–7.3, pairwise comparison p value=0.01) and duration (HR 4.2, 95% CI: 2.3–6.2, pairwise comparison p value=0.04). The propensity score–matched analysis showed that even when patients are matched for comorbidity and procedural characteristics, AKI confers an increased risk of mortality (p=0.04). Conclusions: Acute kidney injury is common after femoropopliteal endovascular therapy. It confers an increased risk of long-term cardiovascular mortality, which is still present when renal decline is transient, and highest for patients with established decline in renal function. Clinical Impact This is the first study in the setting of peripheral arterial disease to show that acute kidney injury has an adverse effect on cardiovascular mortality, in the long-term, that is dependent on its severity, and present even when the AKI is transient. We have also shown that this difference in cardiovascular mortality becomes more pronounced from the medium-term, and thus closer follow-up of these patients is required.

Adherence to and impact of home-based high-intensity IMT in people with spinal cord injury: a pilot study

Study designThe pilot study was completed in 5 phases (Control and 4 phases of IMT) incorporating assessments at Baseline 1 (BL1), BL2, Follow-up 1 (F1), F2, F3, and F4.ObjectiveTo assess the adherence and impact of a daily high-intensity (80% of max) inspiratory muscle training (IMT) home program with once weekly supervision for people with spinal cord injury (SCI).SettingAssessments: research institution or zoom. IMT: participant’s home.MethodsParticipants completed daily IMT in IMT Phase 1 and 2, once weekly in IMT Phase 3, self-selected frequency in IMT Phase 4. All phases had one weekly supervised session except IMT Phase 4. Primary outcomes included adherence and a difficulty score [DS (0- not difficult to 10- the most difficult)]. Secondary outcomes included respiratory function and seated balance.ResultsData from 10 people with chronic SCI (>1 year) (Cervical level of injury: 6, AIS: A-B, injury duration: 10.9 years 95% CI [3.9, 18.1]) were used in the analysis. Participants completed 69% of their training days in IMT Phase 1 and 65% overall reporting an average DS of 7.4 ± 1.4. Only one participant completed training during IMT Phase 4. One participant’s training load was reduced due to suspected overtraining. Maximal inspiratory pressure (MIP), sustained MIP (SMIP), and total power (TP), improved significantly (p < 0.05) from BL2 to F1.ConclusionOur data suggest that people with SCI can perform high-intensity IMT at home to improve inspiratory performance. It is strongly recommended that participants be intermittently monitored for adherence and safety.ClinicalTrials.gov Registration number: NCT04210063.

Chronicity of repeated blast traumatic brain injury associated increase in oxycodone seeking in rats

Numerous epidemiological studies have found co-morbidity between non-severe traumatic brain injury (TBI) and substance misuse in both civilian and military populations. Preclinical studies have also identified this relationship for some misused substances. We have previously demonstrated that repeated blast traumatic brain injury (rbTBI) increased oxycodone seeking without increasing oxycodone self-administration, suggesting that the neurological sequelae of traumatic brain injury can elevate opioid misuse liability. Here, we determined the chronicity of this effect by testing different durations of time between injury and oxycodone self-administration and durations of abstinence. We found that the subchronic (four weeks), but not the acute (three days) or chronic (four months) duration between injury and oxycodone self-administration was associated with increased drug seeking and re-acquisition of self-administration following a 10-day abstinence. Examination of other abstinence durations (two days, four weeks, or four months) revealed no effect of rbTBI on drug seeking at any of the abstinence durations tested. Together, these data indicate that there is a window of vulnerability after TBI when oxycodone self-administration is associated with elevated drug seeking and relapse-related behaviors.

COMPARISON OF HEART RATE VARIABILITY OF CHRONIC SPINAL CORD INJURY PATIENTS IN SUPINE AND SITTING POSITIONS

Background: Sympathetic and parasympathetic activity shift in response to body position changing. Spinal cord injury (SCI) patients have problems controlling autonomic functions occurs as a result of an imbalance between the sympathetic and parasympathetic nervous systems. Despite the fact that changing body position is often used in SCI rehabilitation, few studies have compared the autonomic activity of SCI patients at different body positions. Heart rate variability (HRV) can be used to invasively assess cardiac autonomic modulation. This study aims to obtain information about the autonomic modulation features of SCI patients in supine and sitting positions using HRV measurements. Methods: This study was a cross-sectional study approach. Participants of this study were 14 chronic SCI patients with injury durations more than a year. Measurement of HRV is using Polar H10 (1B56EB2E). HRV measurements in the subjects of this study were Root Mean Square of the Successive Differences (RMSSD) and Low Frequency/High Frequency (LF/HF) ratio in supine and sitting positions. Results: There was a significant difference in the value of RMSSD in chronic SCI patients from supine to sitting position (p 0.019). There was no significant difference in the value of LF/HF ratio in chronic SCI patients from supine to sitting position (p 0.408). Conclusions: Parasympathetic activity (RMSSD) decreased significantly in chronic SCI patients due to postural changing from supine to sitting position. Despite the fact that sympathetic activity is disrupted in SCI patients, the sympathovagal balance can still be maintained with changes in body position.

S3114 Painless Jaundice With a Significantly Elevated CA 19-9: It Is Not Always Pancreaticobiliary Cancer

Introduction: Carbohydrate antigen 19-9 (CA 19-9) is often very high in pancreaticobiliary cancers but can be substantially elevated in benign diseases too. We present a case of painless jaundice with a significantly elevated CA 19-9 from vanishing bile duct syndrome (VBDS). Case Description/Methods: 65-year-old white male with history of obesity, hypertension, hyperlipidemia, prior cholecystectomy and no family history of pancreatic cancer presented with two weeks of painless jaundice and 10 pounds unintentional weight loss. Physical exam noted scleral icterus and jaundice with a T.Bili of 23 mg/dL (Table 1). CT scan showed intrahepatic bile duct dilation and a 10 mm common bile duct without a discrete mass. CA 19-9 was elevated to 1,480 U/mL, concerning for malignancy. ERCP found a low-grade main bile duct stricture which was stented. Bile duct brushings and fine needle aspiration of the pancreas were negative for malignancy. Biliary dilation was resolved on follow-up MRCP but his bilirubin remained high. Infectious and autoimmune workup was unremarkable. Repeat cholangiography and brushings confirmed no obstruction or malignancy (Fig. 1a). An infiltrative versus drug induced liver injury was suspected. EUS-guided liver biopsies revealed cholestasis with dilated bile canaliculi, hepatocytes with ballooning degeneration and a paucity of bile ductules. Cytokeratin-7 immunostaining demonstrated >50% ductopenia, confirming VBDS (Fig. 1b and c). Follow up at hepatology clinic determined triamterene-HCTZ, atorvastatin or omeprazole stopped during hospitalization to be the likely culprit. His CA 19-9, LFTs and symptoms improved over the following weeks (Table 1). Discussion: VBDS is an acquired cholestatic liver disease that may mimic the presentation of pancreatic cancer. CA 19-9 can be substantially elevated through T-cell mediated destruction of small bile ducts causing impaired excretion, inflammatory production, and decreased clearance. Severity of liver damage depends on the duration of injury and degree of bile duct loss at the time of diagnosis. Prompt diagnosis is important to prevent cirrhotic progression, improve outcomes, and avoid unnecessary treatments. Recognizing its association with an elevated CA 19-9 may help with this, but is scarcely reported in the literature. CA 19-9 is not typically checked in cases of VBDS but is likely commonly elevated. Providers should be aware of this association when faced with a patient with painless jaundice and a significantly elevated CA 19-9 but no obvious malignancy. Table 1. - LFT Trends During the Course of Presentation Normal Range Hospital Admission * 2 weeks 3 weeks ** 4 weeks *** 7 weeks 13 weeks Total bilirubin 0.2-1.3 mg/dL 23 22.7 22 19.7 4.7 1.3 Direct bilirubin 0.0-0.2 mg/dL >13 n/a 14.9 14.6 4.2 0.6 AST 0-45 U/L 107 134 172 200 121 27 ALT 0-50 U/L 190 130 163 182 120 35 ALP 40-150 U/L 267 179 187 168 132 109 CA 19-9 0-35 U/mL 1480 n/a n/a 85 49 n/a AST, aspartate aminotransferase; ALT, alanine aminotransferase; ALP, alkaline phosphatase; CA19-9, carbohydrate antigen 19-9; n/a, not available. * ANA, anti-AMA, anti-SMA, anti-mitochondrial, anti-TTG, anti-LKM 1/2 IgG, and EBV IgG antibodies were negative. Serum IgA, A1AT, ceruloplasmin, TSH, iron levels, hepatitis panel, serum protein electrophoresis and acetaminophen levels were normal. Acetaminophen, multivitamin, iron, triamterene- HCTZ, omeprazole and atorvastatin were stopped on discharge. ** Three weeks post hospitalization. Repeat EUS/ERCP showed biliary decompression. VBDS diagnosed on liver biopsies. *** Seen in liver clinic. Started ursodiol 2000mg daily. Figure 1.: (A) ERCP with cholangiogram showing a low-grade distal biliary stricture without significant upstream dilation. (B) Liver biopsy with H&E stain, 500 μm magnification showing small portal tracts with no bile ducts (red circle); note marked cholestasis (arrows) in dilated canaliculi and lack of ductular reaction. Also visible at this magnification is the ballooning degeneration of hepatocytes. (C) Liver biopsy with cytokeratin 7 immunostain, 500 μm magnification. Small portal tracts with no terminal/small bile ducts. Early signs of ductular reaction seen by hepatocytes taking up CK7 stain (arrows).

Work-related injuries in the Australian education sector: A retrospective cohort study

IntroductionEducators are exposed to several work-related hazards. Evidence suggests musculoskeletal pain, psychological distress, and student-inflicted violence-related injuries are common. However, there is little evidence on the burden of workplace injury among Australian educators. AimTo compare incidence of injury claims and duration of compensated time off work between educators and non-educators, and associated factors. MethodsRetrospective cohort study of 1,559,676 Australian workers’ compensation claims, including 84,915 educator claims, lodged between July 2009 to June 2015, from the National Dataset for Compensation-based Statistics. Cases were included if aged 18+ years and working in the education sector less than 100 h per week. Negative binomial regression models estimated the relative risk of making a compensation claim and survival analyses calculated disability duration within educators by sex, age, injury type and mechanism, socioeconomic area, remoteness, and jurisdiction. ResultsCompared to non-educators, educators had lower rates of injury claims and shorter disability durations. However, educators had a higher rate of claims for mental health conditions and assault, with the highest risk being among those in special education and education aides. Among educators, injury claim rates were highest among special educators, education aides, and secondary educators. Discussion and ConclusionThough surveys indicate Australians in the education sector have higher incidences of work-related injuries, this study found lower incidence of injury claims and shorter disability durations than others. Educators’ injury-reporting and absenteeism behaviors may be constrained by ethical, social, and administrative attitudes. Educators had higher rates of claims for mental health and assault-related injury, particularly special educators, and education aides, which suggests a need for targeted prevention efforts.

The Association Between the Duration of Chest Compression and Thoracic Injuries in Patients With Non-Traumatic Out-of-Hospital Cardiac Arrest.

Current guidelines emphasize the indispensability of high-quality chest compression for improving survival in patients who experience out-of-hospital cardiac arrest (OHCA). However, chest compression can cause thoracic injuries that may contribute to poor prognosis; therefore, the purpose of this study is to identify the predictors of thoracic injuries and evaluate the association between thoracic injuries and prognosis.Methods and Results: Between June 2017 to July 2019, Utstein-style data on 384 consecutive adult patients who experienced non-traumatic OHCA and who were transferred to our hospital (Aso Iizuka Hospital) were collected. Each patient underwent a full-body computed tomography scan. Two-hundred and thirty-four patients (76%) had thoracic injuries (Group-T). The duration of chest compression was significantly longer in Group-T than in patients without thoracic injuries (Group-N; 43 vs. 32 min, respectively, P<0.001). Multivariate analysis revealed that older age and longer chest compression duration were predictors of thoracic injuries (odds ratios 1.03 and 1.07, respectively, P≤0.005). Among patients who achieved return of spontaneous circulation, Kaplan-Meier curves showed a significantly higher cumulative survival rate in Group-N than in Group-T at the 30-day follow up (log-rank test P=0.009). Older age and longer chest compression duration were independent predictors of thoracic injuries due to chest compression in patients who experienced non-traumatic OHCA. Moreover, the presence of thoracic injuries was associated with worse short-term prognosis.

A novel bone graft technique combined with plating for aseptic recalcitrant long bone nonunion

BackgroundTo evaluate the outcomes and efficacy of a new technique of autogenous iliac crest bone grafting combined with locking compression plate (LCP) vertical fixation for aseptic recalcitrant long bone nonunion.MethodsFrom July 2010 to September 2020, 36 aseptic recalcitrant long bone nonunions were treated with a bone-forming channel technique and internal LCP fixation. All the patients had received one or more failed treatments. The injury mechanism, nonunion type and duration, and prior treatments were recorded pre-operation. The routine treatment process included nonunion area exposure, previous implant removal, sclerotic bone debridement, LCP fixation, bone-forming channel creation, and iliac bone grafting, and a second LCP fixation when required. At follow-up, X-ray images were obtained to assess bone healing and implant failure. Visual analog scale (VAS), fracture site stability, limb function, activity, muscle strength, limb length, and complications were recorded.ResultsA total of 34 patients (24 males and 10 females) were finally enrolled, with a mean age of 49.8 ± 12.3 years. At a mean follow-up of 35.6 ± 22.0 months, 32 patients displayed bone union, with a healing rate of 94.1% and mean union time of 6.8 ± 2.4 months. The VAS score was 0.7 ± 1 at the final follow-up. The functional results showed that 19 patients were excellent, 11 patients were good, 2 patients were poor, and 2 patients did not heal.ConclusionBone-forming channel technique combined with LCP vertical fixation is an excellent option to treat recalcitrant long bone nonunion.Level of evidenceTherapeutic Level IV.

Investigation of Injury Anxiety Level in Handball Players in Terms of Different Variables

Bu çalışmanın amacı, hentbolcularda yaralanma kaygısı düzeylerinin belirlenerek farklı değişkenler açısından spor yaralanması kaygı ölçeği alt boyut düzeylerinin karşılaştırılmasıdır. Lisanslı olarak hentbol oynayan ve çalışmaya dahil edilme kriterlerine uyan 164 kadın-erkek hentbolcu çalışmanın örneklem grubunu oluşturmuştur. Araştırma verileri demografik bilgi formu ve spor yaralanması kaygı ölçeği kullanılarak oluşturulan anket formu ile Google Doc ile online ortamda toplanmıştır. Verilerin analizinde öncelikli olarak verilere normallik analizleri uygulanmış ve verilerin normal dağılıma uyduğu belirlenmiştir. İki bağımsız grup arasında niceliksel sürekli verilerin karşılaştırılmasında Independent Sample T-Testi, ikiden fazla bağımsız grup arasında One-Way Anova testi kullanılmıştır. Değişkenler arasındaki ilişki düzeyinin belirlenmesinde ise Pearson Korelasyon testi uygulanmıştır. Test sonuçlarında cinsiyet, sporculuk düzeyi ve yaralanma bölgesi açısından yaralanma kaygısı alt boyutlarında anlamlı fark görülürken (p0,05). Ayrıca yaralanma süresi ile yaralanma kaygısı alt boyutları arasında ilişki olduğu görülmüştür (p

Associations between intraoperative hypotension, duration of surgery and postoperative myocardial injury after noncardiac surgery: a retrospective single-centre cohort study

BackgroundStudies of intraoperative hypotension typically specify a blood pressure threshold associated with adverse outcomes. Such thresholds are likely to be study-biased, investigator-biased, or both. We hypothesised that a newly developed modelling method without a threshold, which is biologically more plausible than a threshold-based approach, would reveal a continuous association between exposure to intraoperative hypotension and adverse outcomes. MethodsSingle-centre, retrospective cohort study of subjects ≥60 yr old undergoing noncardiac surgery. We modelled intraoperative hypotension using three different approaches: (1) unweighted, (2) weighted for degree of hypotension (depth), and (3) weighted for duration of hypotension. The primary outcome was myocardial injury, defined as elevated troponin I (>60 ng L−1) measured during the first 3 days after surgery. The associations between the three models, postoperative myocardial injury, and mortality (secondary outcome) were reported as penalised adjusted odds ratios (ORs) scaled between the 75th and 25th percentiles. ResultsMyocardial injury occurred in 1812/15 452 (12%) procedures, with 554/15 452 (3.6%) procedures resulting in death before discharge from hospital. The unweighted lower blood pressure measure (OR: 0.26, 95% confidence interval [CI]: 0.12–0.53) and the depth-weighted measure (OR: 4.4, 95% CI: 2.6–7.4) were associated with myocardial injury. The duration-weighted measure was not associated with myocardial injury (OR: 0.89, 95% CI: 0.61–1.3). The unweighted measure (OR 0.08, 95% CI: 0.01–0.40) and the depth-weighted measure (OR: 12, 95% CI, 3.8–35) were associated with in-hospital mortality, but not the duration-weighted measure (OR: 1.3, 95% CI: 0.53–3.0). ConclusionsIntraoperative hypotension appears to have a graded association with postoperative myocardial injury and mortality, with depth appearing to contribute more than duration.

IgG subclass deposition in diabetic nephropathy

PurposeThis study aimed to analyze the distribution of IgG subclass in diabetic nephropathy (DN) and its association with clinicopathological features.MethodsThis is a single-center retrospective study enrolling 108 patients with biopsy-proven DN. Immunofluorescence and immunohistochemistry staining were applied, and clinicopathological features and renal outcomes were compared between patients with different patterns or categories of IgG subclass deposition.ResultsBoth IgG and its subclasses colocalized with collagen IV α5 on glomerular basement membrane (GBM) and some of tubular basement membrane (TBM). IgG1 and the Mixed type were two predominant types of deposition, no matter on GBM or TBM, and IgG1 showed a much higher deposition rate on GBM than that on TBM (P = 0.004). IgG subclass deposit on multi-location was more associated with a shorter duration of nephropathy and severer tubular interstitial injury (P < 0.05). The mixed type of IgG subclass deposit on GBM was merely associated with higher levels of proteinuria, whereas the deposition on TBM was more associated with higher levels of proteinuria, lower levels of albumin, more KIM-1 positive area, and thicker TBM (P < 0.05). Survival analysis revealed that none of the pattern or the category of IgG subclass deposit was a risk factor or a renal outcome indicator.ConclusionsIgG subclass was selectively deposited along GBM and/or TBM in DN, and the mixed type of IgG subclass deposition on TBM had more clinical significance than the isotype and that on GBM. IgG subclass deposition is merely a manifestation or a consequence rather than a cause in DN.

Health-related quality of life predictors in people with chronic wounds

ObjectiveTo assess health-related quality of life and its predictors among people with chronic wounds. Material and methodsA cross-sectional, analytical study was conducted with 85 people with chronic wounds, from July to September 2019, at a university hospital in the state of Paraíba, Brazil. Data were collected using forms and the Cardiff Wound Impact Schedule (CWIS). For data analysis, multiple linear regression was performed. ResultsThe mean quality of life score according to the CWIS was 45.57. The variables gender, marital status, comorbidities, duration of injury and appearance of exudate were negatively associated with the well-being domain. Injury duration, tissue depth, tissue type, and exudate volume were variables negatively associated with physical symptoms and mastery of daily living. Religion, wound origin, duration, lesion size, and tissue depth were negatively associated with the social life domain. ConclusionSociodemographic characteristics and wound-related aspects need to be considered when assessing and caring for patients with chronic wounds to ensure a better quality of life.

Context-dependent roles of cellular senescence in normal, aged, and disease states.

Cellular senescence is a state of irreversible cell cycle arrest that often emerges after tissue damage and in age-related diseases. Through the production of a multicomponent secretory phenotype (SASP), senescent cells can impact the regeneration and function of tissues. However, the effects of senescent cells and their SASP are very heterogeneous and depend on the tissue environment and type as well as the duration of injury, the degree of persistence of senescent cells and the organism's age. While the transient presence of senescent cells is widely believed to be beneficial, recent data suggest that it is detrimental for tissue regeneration after acute damage. Furthermore, although senescent cell persistence is typically associated with the progression of age-related chronic degenerative diseases, it now appears to be also necessary for correct tissue function in the elderly. Here, we discuss what is currently known about the roles of senescent cells and their SASP in tissue regeneration in ageing and age-related diseases, highlighting their (negative and/or positive) contributions. We provide insight for future research, including the possibility of senolytic-based therapies and cellular reprogramming, with aims ranging from enhancing tissue repair to extending a healthy lifespan.

Duration of Acute Kidney Injury and In-Hospital Mortality in Elder Patients with Severe COVID-19: A Retrospective Cohort Study.

Background Patients with severe coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality. This study evaluated the prognostic impact of AKI duration on in-hospital mortality in elder patients. Methods We performed a retrospective study of 126 patients with confirmed COVID-19 with severe or critical disease who treated in the ICU from February 4, 2020, to April 16, 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes serum creatinine (Scr) criteria. AKI patients were divided into transient AKI and persistent AKI groups based on whether Scr level returned to baseline within 48 h post-AKI. Results In total, 107 patients were included in the final analysis. The mean age was 70 (64–78) years, and 69 (64.5%) patients were men. AKI occurred in 48 (44.9%) during their ICU stay. Of these, 11 (22.9%) had transient AKI, and 37 (77.9%) had persistent AKI. In-hospital mortality was 18.6% (n = 11) for patients without AKI, 72.7% (n = 8) for patients with transient AKI, and 86.5% (n = 32) for patients with persistent AKI (P < 0.001). Kaplan–Meier curve analysis revealed that patients with both transient AKI and persistent AKI had significantly higher death rates than those without AKI (log-rank P < 0.001). Multivariate Cox regression analysis revealed that transient and persistent AKI were an important risk factor for in-hospital mortality in older patients with severe COVID-19 even after adjustment for variables (hazard ratio [HR] = 2.582; 95% CI: 1.025–6.505; P = 0.044; and HR = 6.974; 95% CI: 3.334–14.588; P < 0.001). Conclusions AKI duration can be an important predictive parameter in elder patients suffering from COVID-19 and are admitted to ICU. Among these patients, those exhibiting persistent AKI have a lower in-hospital survival rate than those with transient AKI, emphasizing the importance of identifying an appropriate treatment window for early intervention.

Surgical outcomes associated with sleep apnea syndrome in Stanford A aortic dissection patients

BackgroundPatients suffering from aortic dissection (AD) often experience sleep apnea syndrome (SAS), which aggravates their respiratory function and aortic false lumen expansion.MethodsWe analyzed the peri-operative data of Stanford A AD patients, with or without SAS, between January 2017 and June 2019. Subjects were separated into SAS positive (SAS+) and SAS negative (SAS−) cohorts, based on the Apnea-Hypopnea Index (AHI) and the Oxygen Desaturation Index (ODI). We next analyzed variables between the SAS+ and SAS− groups.Results155, out of 198 AAD patients, were enlisted for this study. SAS+ patients exhibited higher rates of pneumonia (p < 0.001), heart failure (HF, p = 0.038), acute kidney injury (AKI, p = 0.001), ventilation time (p = 0.009), and hospitalization duration (p < 0.001). According to subsequent follow-ups, the unstented aorta false lumen dilatation (FLD) rate increased markedly, with increasing degree of SAS (p < 0.001, according to AHI and ODI). The SAS+ patients exhibited worse cumulative survival rate (p = 0.025). The significant risk factors (RF) for poor survival were: severe (p = 0.002) or moderate SAS (p = 0.008), prolonged ventilation time (p = 0.018), AKI (p = 0.015), HF New York Heart Association (NYHA) IV (p = 0.005) or III (p = 0.015), pneumonia (p = 0.005), Marfan syndrome (p = 0.010), systolic blood pressure (BP) upon arrival (p = 0.009), and BMI ≥ 30 (p = 0.004).ConclusionsSAS+ Stanford A AD patients primarily exhibited higher rates of complications and low survival rates in the mid-time follow-up. Hence, the RFs associated with poor survival must be monitored carefully in SAS patients. Moreover, the FLD rate is related to the degree of SAS, thus treating SAS may mitigate FLD.

Segmental Bioimpedance Analysis as a Predictor of Injury and Performance Status in Professional Basketball Players: A New Application Potential?

Bioelectrical impedance vector analysis (BIVA) is a technique used for the assessment of body composition based on the electrical properties of biological tissues and for evaluating variations related to hydration and nutrition status changes. The present study aimed to investigate the possibility of predicting performance status and injuries using segmental BIVA analysis. Data were collected from 14 professional male athletes aged between 20 and 39 years of Caucasian and Afro-American ethnicity belonging to the US Victoria Libertas Pallacanestro Pesaro team in the Italian Serie A basketball championship. From an analysis of training injuries, the data highlight a possible positive link between the number of training injuries and upper hemisoma reactance (XCEmsSup) (t = 2.881, p = 0.007), an inverse relationship between training injury duration and higher right lower limb reactance (XCLegDx) (t = −4.213, p < 0.001), and an inverse relationship between injury duration and higher body mass index (t = −4.213, p < 0.001), highlighting how higher cellularity seems less prone to severe training injuries. Analyzing match-day injuries, right upper-limb higher reactance (XCArmdx) negatively correlates with match-day number of injuries (t = −4.469, p < 0.001), right upper limb resistance (RZArmDx) negatively correlates with lower match-day injury duration (t = −4.202, p < 0.001), and trunk resistance (RZTrunk) positive correlates with lower match-day injury duration (t = 2.803, p = 0.008), in contrast with the training data analysis. Analyzing the relationship between the BIVA parameters and performance indicators, right upper limb resistance (RzArmDx) has a positive link with plus–minus (t = 2.889, p = 0.007); however, RzArmDx negatively correlates with assist number (t = −3.362, p = 0.002), and BMI is directly proportional to assist number (t = 2.254, p = 0.032). These first data suggest a good correlation between the cellularity of different body districts and the risk of injuries in training but still leave several doubts surrounding the concrete predictive potential regarding performance and injuries during competitions while considering the numerous factors involved. Further studies on BIVA and similar applications could provide tools for managing athlete health and physical integrity preservation and potentially help us better understand the factors involved in improving performance.

Treatment of Fracture Distal End Humerus with open Reduction and Internal Fixation with Plate Osteosynthesis

AbstractBackground: Fractures of distal humerus represent one of the most complicated and challenging fractures in the upperextremity. These are rare fractures. Most fractures involve the joint surface, significant proportions are open, and thecomplex three-dimensional geometry of the distal humerus poses a considerable challenge to reconstruction.Objectives: To study the treatment of fracture distal end humerus with open reduction and internal fixation with plateosteosynthesisMethods: A prospective study of 15 consecutive cases of intercondylar fractures of humerus treated by open reductionand internal fixation over two and half years was conducted. These included 12 fresh cases and 3 old cases. Case wisedetailed study was done in 12 cases by noting the age, sex social status, nature of violence and the duration of injury,information regarding medical problems and any local problems, in relation to bone and joint.Results: At follow up, patients were assessed clinically and radiologically, most patients regained fair to good range ofmotion obtained in 3 months time fracture was united in an average of a 10 weeks and olecranon osteotomy in an averageof 8 weeks. Patients were followed up for an average of 9 months, excellent results were found in five cases (33.33%).Good results in five cases(33.33%) and fair results were obtained in three (20%) cases, poor results in two cases(13.33%)Conclusion: Comminuted fractures of distal humerus in the hands of competent surgeon with open reduction, anatomicassemblage and internal fixation of the fragments offer better results in majority of the cases. In young patients the resultsare good and in old patients results fair probably because of good physiotherapy in young and also cartilage changes limitthe functional outcome in the old. Physiotherapy has a great role in the outcome of functional result.