High Injury Research Articles

The Impact of Sleep on Athletes Performance and Injury Risk

Introduction and purposeSleep is a critical component of an athlete's health, significantly influencing injury risk, performance, and recovery. It plays a vital role in the healing process, contributing to growth, repair, regeneration, and immunity. Current literature suggests that sleep quality impacts various aspects of athletic performance, including physical and cognitive abilities, recovery, injury risk, and mental well-being. This narrative review aims to explore the impact of sleep on the musculoskeletal system of athletes, particularly focusing on injury risk, performance, and recovery. It seeks to synthesize existing research to highlight the importance of sleep quality and duration in maintaining and enhancing athletic performance.Description of the state of knowledgeThe findings indicate that less than 7 hours of sleep is consistently associated with an increased risk of musculoskeletal injury, with athletes experiencing a 1.7 times higher risk if this sleep pattern persists for at least 14 days. Some studies also highlight that athletes obtaining fewer than 6 hours of sleep per day show significant performance declines and higher injury rates.SummaryWhile evidence clearly links certain sleep behaviors to increased musculoskeletal injury and pain, it is crucial to consider sleep as one aspect of an athlete's overall health and well-being. Adequate sleep is essential for optimal athletic performance, injury prevention, and recovery. Tailored sleep strategies should be integrated into training and recovery protocols to enhance the overall health and performance of athletes.

More Than Just a Pain in the Back: Pain Among American Nurses and Its Relationship to Modifiable Work Factors and Work Performance.

Nursing is a profession with high rates of workplace injuries, hazards, and turnover. Improving the health and safety of nurses at work is vital to retain and grow the workforce to meet future demands. The purpose of this study was to describe the breadth of pain among American nurses and explore the relationships between this pain and modifiable work factors and perceived work performance. We used a cross-sectional descriptive design of 2312 nurses from across the United States. Nurses completed a survey containing questions about demographics, the presence of pain in the past week, the number of pain sites, pain locations, severity, and the impact on work performance. The median number of pain locations reported was 2, back pain was the most reported pain site, and average pain severity ranged from 4 to 5. Significant modifiable work factors associated with pain were average patient load and shift length. Many participants indicated that their pain impacted work performance, while a smaller proportion acknowledged that their pain impacted patient care. Pain among nurses spans multiple locations, is moderately severe, and impacts work performance. Addressing related modifiable work factors may decrease pain and the impact on the health, safety, and work performance of the nursing workforce.

CNS and Thorax Injury and Associated Risks Factors in Equestrian Sports.

Equestrian sports continue to gain popularity in the United States and are associated with a high injury rate, especially involving the central nervous system and thorax. Due to this high rate of injury and the potential for long-term consequences associated with participation, an understanding of the unique risks of this sport is needed. To describe severe injury in equestrian sports and review the role that protective gear plays in injury mitigation. The PubMed Database was searched using the search terms "equestrian" and "horse" combined with "spinal cord injury," "head injury," "traumatic brain injury," "experience levels," and "demographics." A total of 53 papers were selected based on their relevance of epidemiology, risk factors, and management of injuries sustained during equestrian activities. Case studies, randomized controlled trials, prospective studies, and retrospective studies were all included for further review. Systematic review. Level 4. None. Injuries to the thorax, including fractures, pneumothoraces, internal organ contusions, and crush injuries, have been cited in multiple national and international trauma registries as the most prevalent injury location in equestrians; however, head and neck injuries, high cervical spine fractures, and closed head injuries are reported to be associated with the highest rates of mortality. Helmets provide protection against skull fracture and traumatic brain injury. Vests were not associated with diminished rates of spinal cord injuries; however, they may provide protection to the thorax. Riding experience also plays a role in reducing the prevalence of injury. Equestrian-related activities are associated with a high risk of injury despite protective measures. Protective gear can mitigate some injury risk but does not protect against spinal injury. Continued investigation into improving protective equipment, rider education, and preventative strategies to mitigate this risk is needed.

Patterns and correlates of traumatic stress, depression, anxiety, and moral injury in U.S. health care providers late in the COVID-19 pandemic.

Providing health care during the COVID-19 pandemic has been associated with a high mental health burden for health care providers. This study examined patterns of responses and correlates of class membership across commonly assessed mental health symptoms, psychosocial functioning, and moral injury for providers in the United States in Fall 2022. A convenience sample of 1,504 primary care physicians, pediatricians, nurse practitioners, and physician assistants who had been in practice for three or more years (Mage = 46.1 years, SDage = 11.3, 58% male) completed self-report measures in an online, opt-in panel survey from September to November 2022. Using latent class analysis, three classes were identified: No/Low Symptoms (64.8%), High Moral Injury (19.9%), and Elevated Symptoms (15.2%). Several factors were correlated with class membership including age, sex, social support, personal risk of COVID-19, pandemic-related work stressors, proportion of COVID-19 patients seen at the height of the pandemic, and death of a patient due to COVID-19. This study found high levels of mental health symptoms, and problems with psychosocial functioning and moral injury in health care providers well past the pandemic's peak. The results also demonstrated the importance of considering the unique contribution of moral injury to psychosocial functional difficulties experienced by health care providers during the pandemic given their defined role as essential workers. These findings have implications for preventing and managing mental health problems and burnout among providers postpandemic as well as for future pandemics at both the organizational and individual levels. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Banxia Xiexin Tang attenuates high glucose-induced hepatocyte injury by activating SOD2 to scavenge ROS via PGC-1α/IGFBP1.

The online version contains supplementary material available at 10.1007/s13205-024-04060-0.

Evaluating Adolescent Patient Outcomes and Staff Member Injuries at a General Psychiatric Inpatient Unit.

Short-term pediatric psychiatric hospitalization is used to manage acute-crisis behaviors. Few studies have detailed their clinical model and key metrics such as patient behavioral health outcomes and staff experience. This study describes a model which emphasizes group therapy based on dialectical behavior therapy during brief inpatient stays (average length of stay of 8 days). The study variables assessed included patient symptoms of depression, anxiety, and anger at discharge, patient satisfaction, and staff safety. The program produced significant improvements in adolescent depression, anxiety, and anger, and patients reported high satisfaction with the services received. However, there was a high rate of staff injuries, correlated with staffing ratios and the time of day. The key findings from this study demonstrate the effectiveness of brief inpatient programs and highlight variables that may impact staff experiences on these units, which could serve as further discussion points to improve clinical care.

RBM15 Promotes High Glucose-Induced Lens Epithelial Cell Injury by Inducing PRNP N6-Methyladenine Modification During Diabetic Cataract

Purpose Diabetic cataract (DC) is a major cause of blindness worldwide. Prion protein (PRNP) was proved to be up-regulated and hypomethylated in DC samples. Here, we investigated whether PRNP was involved in DC progression in N6-methyladenosine (m6A)-dependent manner, and its potential mechanisms. Methods Levels of genes and proteins were assayed using qRT-PCR and western blotting. Cell proliferation and apoptosis were determined using Cell Counting Kit-8 assay, 5-thynyl-2’-deoxyuridine (EdU) assay, and flow cytometry, respectively. Oxidative stress was analyzed by measuring the production of glutathione peroxidase (GSH-PX), superoxide dismutase (SOD), and malondialdehyde (MDA). The m6A modification was determined by RNA immunoprecipitation (Me-RIP) assay. The interaction between RBM15 (RNA binding motif protein 15) and PRNP was probed using RIP assay. Results PRNP was highly expressed in DC patients and HG-induced HLECs. Functionally, PRNP deficiency reversed HG-induced apoptosis and oxidative stress in HLECs. Mechanistically, RBM15 induced PRNP m6A modification and directly bound to PRNP. Knockdown of RBM15 abolished HG-induced apoptotic and oxidative injury in HLECs, while these effects were rescued after PRNP overexpression. Conclusion RBM15 silencing suppressed HG-induced lens epithelial cell injury by regulating PRNP in an m6A-mediated manner, hinting a novel therapeutic strategy for DC patients.

Train Climbing-A new old trend in adolescents: Treatment of high voltage injuries and planning of a pilot project to raise awareness.

An increasing number of high voltage electric burn injuries in atypically younger patient collective of train surfers and climbers at our levelI center for burns was recognized. The purpose of this study was aretrospective data evaluation and as aconsequence the implementation of an awareness program against train surfing. In aretrospective analysis of prospectively collected data, 17patients with high voltage injuries, who had been treated at our unit between January 2022 and January 2023, were identified. Of these patients seven were treated for injuries due to train surfing or climbing and therefore included in this study. The patients were assessed clinically for total burn surface area (TBSA), degree of burn, associated Injuries, hospital length of stay, number and type of surgeries (fasciotomy, minor/major amputations, defect coverage split skin graft or flaps). Atotal of seven males formed the basis of this report with an average age of 17.7 years (range 14-21years). The highest ABSI (Abbreviated Burn Severity Index) score was 12, leading to the death of the 21-year-old patient who had 80% TBSA as well as multiple comorbidities including severe brain damage. The mean duration of stay at the intensive care unit (ICU) was 24.8 days and the mortality rate was 14.29%. This study highlighted the severity of injuries, with amean TBSA of 41.42% and amortality rate of 14.29% among the study population. Train climbing and surfing patients presented with severe injuries and fatal long-term consequences. Apilot project involving several stakeholders was initiated in order to raise awareness of the dangers of electric arcs and the risk involved.

Perioperative surveillance of myocardial injury after non-cardiac surgery in patients with hip fracture: A retrospective cohort study.

Myocardial injury after non-cardiac surgery is due to ischaemia either during non-cardiac surgery or within 30 days after it. Our surveillance protocol includes hip fracture template and high-sensitivity troponin stratification, as recommended in European countries. Our retrospective study cohort included surgical patients for hip fracture at our hospital in Japan. The primary outcome was the rate of myocardial injury after non-cardiac surgery in comparison to patients managed with (213) and without (176) hip fracture template. The hip fracture template was used more in patients with myocardial injury after non-cardiac surgery than those without myocardial injury after non-cardiac surgery. When hip fracture template was used, patients had a higher likelihood of myocardial injury after non-cardiac surgery after adjusting for age, time to operation, diabetes mellitus, and chronic kidney disease (odds ratio 41.3; 95% confidence interval: 12.1, 259.6). Patients with myocardial injury after non-cardiac surgery had higher in-hospital mortality than those without myocardial injury after non-cardiac surgery, even in adjusted analysis. There was a high detection rate of myocardial injury after non-cardiac surgery when patients with hip fractures were managed with hip fracture template. Myocardial injury after non-cardiac surgery was associated with in-hospital mortality.

Performance Optimization and Injury Mitigation for Air Force Student Fighter Pilots.

Military fighter aircrew report high rates of cervical pain and injury. There is currently no consensus regarding the best training methods for this population. Eglin Air Force Base (AFB) and Luke AFB have multidisciplinary teams specializing in aircrew training, performance, and injury mitigation. All student pilots (SPs) completing Basic Course training at these locations engage in an 8-week Spine Training Program (STP). The STP originated at Luke AFB in 2020 and was expanded to Eglin AFB in 2022. The primary aim of this study was to assess whether the STP led to significant changes in the performance measure studied, Cervical Endurance Hold (CEH). Further, this study aimed to determine if the CEH training effect was independent of location of STP administration. We hypothesized that SPs would exhibit statistically significant CEH training adaptations irrespective of base location. Air Force F-16 and F-35 SPs from Luke AFB and Eglin AFB were actively enrolled in the Basic Course and participated in the standardized STP from 2020 to 2023. The CEH test was administered prior to (intake) and following (exit) the 8-week STP. SPSS for Windows version 29 software (IBM, Armonk, NY) was used to retrospectively analyze the data from this study. Participants were excluded if they were unable to perform the CEH test at intake or exit. The study was approved by the Air Force Research Laboratory Institutional Review Board and was performed in accordance with the ethical standards of the Declaration of Helsinki. One hundred and ninety-eight SPs (Luke AFB, males n = 170, females n = 12; Eglin AFB, males n = 16) completed the STP program. There was no significant difference between intake and exit concerning age, height, weight, % body fat, and fat-free mass at Luke AFB or Eglin AFB (P < 0.05). Statistically significant improvements in CEH were observed within all groups from intake to exit (P < 0.001). When considering all participants collectively, there was a notable33.6% increase in CEH from intake to exit (P < 0.001) with an overall effect size of d = 1.14. When analyzing specific subgroups, females from Luke AFB experienced a significant 20.4% increase in CEH (P < 0.001, d = 1.14), males from Luke AFB exhibited a significant 34.5% increase (P < 0.001, d = 1.09), and males from Eglin AFB demonstrated a significant increase of 55.7% in CEH (P < 0.001, d = 1.97). This retrospective analysis showed significant improvements in the CEH across all groups following the completion of the STP. Furthermore, CEH results from both bases exhibited a large effect size indicating a meaningful change was found between intake and exit regardless of training location. These preliminary study results should be interpreted with caution as a control group was unable to be established. In the future, a randomized control trial should be performed to test the STP used in this study against other STP programs. This may better inform experts on the best spine training methods for fighter aircrew.

Outpatient Prescriptions for Insomnia Medications During the First Year Following Combat-Related Amputations.

Sleep-related disorders are associated with pain, fatigue, and deficits in cognitive performance, which may interfere with successful rehabilitation. The study objectives were to (1) quantify outpatient prescriptions for insomnia medications during the first year following combat-related amputations, (2) examine longitudinal changes in prescriptions for insomnia medications, and (3) analyze patient characteristics associated with prescriptions for insomnia medications. This was a retrospective study of DoD casualty records from the Expeditionary Medical Encounter Dataset and prescriptions for outpatient medications from the Pharmacy Data Transaction Service. Patients were a total of 1,651 U.S. service members who sustained major limb amputations in Operations Iraqi and Enduring Freedom from 2001 through 2017 and had outpatient prescriptions for any medication during the first year postinjury. Prescriptions for medications recommended for insomnia were low-dose antidepressants, anxiolytic sedatives, benzodiazepines, melatonin receptor agonist, and low-dose quetiapine. These prescription medications were analyzed by medication type, postinjury time, and patient characteristics during the first year postinjury. During the first year postinjury, 78% of patients (1,291 of 1,651) had outpatient prescriptions for insomnia medications, primarily anxiolytic sedative drugs (e.g., zolpidem), averaging a total of 86 prescription days (median = 66). The prevalence of these prescriptions declined substantially during the first year, from 57% of patients during the first quarter to 28% during the fourth quarter postinjury. In univariate analyses, multiple patient characteristics, including high Injury Severity Score, continued opioid and non-opioid analgesic prescriptions, and diagnoses of chronic pain, mood disorder, and posttraumatic stress disorder, were significantly associated with higher prevalence and duration of outpatient prescriptions for insomnia medications. The present results indicate a high prevalence of outpatient prescriptions for insomnia medications following combat-related amputations, a prevalence that is substantially higher than previously reported among active duty personnel. These findings can inform DVA/DoD guidelines for amputation care and insomnia among military subpopulations. The results highlight the need for more research on the treatment of insomnia during early postinjury rehabilitation among patients who sustained serious combat injuries.

Pre-task planning for construction worker safety and health: Implementation and assessment.

Compared to other industry sectors, construction workers experience a disproportionately high rate of occupational injuries and fatalities. As research findings suggest, most of these incidents could be prevented if hazards were proactively recognized and properly addressed. In the construction industry, pre-task planning (PTP) is a preventive process intended to describe each step of work, identify associated safety and health hazards, and recommend controls to eliminate or mitigate the hazards before work begins. Despite its importance, the construction industry lacks comprehensive guidelines to design and implement PTP in a consistent and effective manner. To fill this gap, this study pursued two objectives: (1) identify shortcomings in current PTP practices and explore recommended solutions from practitioners' perspectives and (2) translate research findings into an applied tool to help practitioners assess and improve the quality of their PTP process. To fill the gap, 28 construction safety and health professionals and 104 workers were interviewed, and seven onsite PTP sessions were directly observed. Shortcomings of current PTP practices as well as recommended solutions were categorized as (1) planning and implementation, (2) all-trades coordination, (3) engagement and buy-in, (4) training and logistics, (5) workforce diversity and the language barrier, and (6) PTP content accessibility. An effective PTP process should be based on workers' direct involvement and input on task requirements and hazards. It needs to be regularly updated to reflect the changing work conditions. In addition to task-related information, to increase workers' awareness, PTP should paint a holistic view of the project and other trades' scopes.

Identifying Risk Factors for Open Reduction in Pediatric Supracondylar Humerus Fractures.

Supracondylar humerus fractures (SCHFs) are the most common injuires of the elbow in children, often categorized by the Gartland classification. While type 1 and 2 fractures commonly managed conservatively, type 3 and 4 fractures typically require surgical treatment. Although closed reduction and percutaneous pinning have shown success, open reduction may be required in cases where adequate reduction cannot be achieved. This study aims to identify radiological and clinical risk factors associated with transitioning from closed reduction to open reduction in Gartland type 3 and 4 SCHF in children. We retrospectively analysed 159 patients operated on between 2014 and 2022 for Gartland type 3 and 4 SCHF. Parameters including age, gender, injury severity, time to surgery, neurovascular damage, medial spike angle, fracture-skin distance, medial-lateral deviation, rotation, fracture level, and Baumann angle were evaluated. A total of 159 SCHF in children aged 3 to 12 years, classified as Gartland type 3 (106 patients, 66.6%) and type 4 (53 patients 33.4%), underwent surgical intervention. Notably, 46 patients (28.9%) initially managed with closed reduction exhibited failure, prompting the necessity for conversion to open reduction. Injury severity, lateral deviation, advanced age, low medial spike angle, and low fracture tip-to-skin distance were found to be factors that could potentially increase the need for open reduction (P<0.05). Logistic regression analysis showed that the low medial spike angle, flexion type injury, and low fracture type increased the likelihood of open surgery (P<0.05). Sex, side, duration to surgery, and Baumann angle showed no significant associations. SCHF commonly necessitate surgical intervention in children. Although the risk factors for failed closed reduction and the need for open surgery have been discussed in the literature, there is no consensus. Preoperative planning, particularly for patients with specific factors like lateral deviation, advanced age, low medial spike angle, low fracture-to-skin distance and high injury severity, should consider potential open surgery requirements. Level III.

Neuregulin 4 Attenuates Podocyte Injury and Proteinuria in Part by Activating AMPK/mTOR-Mediated Autophagy in Mice.

In this study, we investigate the effect of neuregulin 4 (NRG4) on podocyte damage in a mouse model of diabetic nephropathy (DN) and we elucidate the underlying molecular mechanisms. In vivo experiments were conducted using a C57BL/6 mouse model of DN to determine the effect of NRG4 on proteinuria and podocyte injury, and in vitro experiments were performed with conditionally immortalized mouse podocytes treated with high glucose and NRG4 to assess the protective effects of NRG4 on podocyte injury. Autophagy-related protein levels and related signaling pathways were evaluated both in vivo and in vitro. The involvement of the adenosine monophosphate-activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR) pathway was detected using chloroquine or AMPK inhibitors. The results showed that the AMPK/mTOR pathway was involved in the protective roles of NRG4 against high glucose-mediated podocyte injury. Also, NRG4 significantly decreased albuminuria in DN mice. PAS staining indicated that NRG4 mitigated glomerular volume and mesangium expansion in DN mice. Consistently, western blot and RT-PCR analyses confirmed that NRG4 decreased the expression of pro-fibrotic molecules in the glomeruli of DN mice. The immunofluorescence results showed that NRG4 retained expression of podocin and nephrin, whereas transmission electron microscopy revealed that NRG4 alleviated podocyte injury. In DN mice, NRG4 decreased podocyte apoptosis and increased expression of nephrin and podocin, while decreasing the expression of desmin and HIF1α. Overall, NRG4 improved albuminuria, glomerulosclerosis, glomerulomegaly, and hypoxia in DN mice. The in vitro experiments showed that NRG4 inhibited HG-induced podocyte injury and apoptosis. Furthermore, autophagy of the glomeruli decreased in DN mice, but reactivated following NRG4 intervention. NRG4 intervention was found to partially activate autophagy via the AMPK/mTOR signaling pathway. Consequently, when the AMPK/mTOR pathway was suppressed or autophagy was inhibited, the beneficial effects of NRG4 intervention on podocyte injury were diminished. These results indicate that NRG4 intervention attenuates podocyte injury and apoptosis by promoting autophagy in the kidneys of DN mice, in part, by activating the AMPK/mTOR signaling pathway.

Sex-Specific Outcomes After Anterior Cruciate Ligament Reconstruction Using an All–Soft Tissue Quadriceps Tendon Autograft in a Young Active Population

Background: The ideal graft for anterior cruciate ligament (ACL) reconstruction (ACLR) in young athletes has a high return-to-sport (RTS) rate and a low reinjury rate. Quadriceps tendon autografts are being used with increasing frequency for ACLR in this population, despite a paucity of evidence to support their use. Purpose: To report the RTS rate, ipsilateral reinjury rate, and contralateral ACL injury rate in a young athletic population undergoing primary ACLR using an all–soft tissue quadriceps tendon (ASTQT) autograft. Study Design: Cases series; Level of evidence, 4. Methods: Patients aged 14 to 22 years who underwent primary ACLR using an ASTQT autograft by a single surgeon between January 1, 2005, and April 30, 2020, were identified via electronic medical records and contacted ≥24 months after ACLR to complete a survey regarding subsequent ipsilateral or contralateral ACL injuries and RTS. Patients who had undergone previous ACLR (ipsilateral or contralateral) were excluded. Results: A total of 656 patients (330 male, 326 female; mean age, 17.9 years) were identified, and 395 patients completed the survey (60.2%; 174 male, 221 female; mean age, 17.8 years) with a mean follow-up of 73 ± 29 months (range, 24-139 months). The RTS rate was high (male: 87.7%; female: 82.8%; P = .19). Male and female patients had similar rates of revision ACLR (male: 12.6%; female: 10.0%; P = .40) and contralateral ACL injuries (male: 13.8%; female: 11.3%; P = .46). Conclusion: A high RTS rate and similar rates of ipsilateral and contralateral ACL injuries were found for male and female patients in a young athletic population undergoing primary ACLR using an ASTQT autograft. These results help one to better understand the utility of ASTQT grafts to support successful ACLR in young athletic populations, for which ASTQT grafts appear to yield favorable outcomes.

Test-Retest Reliability and Visual Perturbation Performance Costs During 2 Reactive Agility Tasks.

High secondary injury rates after orthopedic surgeries have motivated concern toward the construct validity of return-to-sport test batteries, as it is evident that common strength and functional assessments fail to elicit pertinent behaviors like visual search and reactive decision making. This study aimed to establish the test-retest reliability of 2 reactive agility tasks and evaluate the impact of visual perturbation on physical performance. Fourteen physically active individuals completed 2 agility tasks with reaction time (ie,4 corner agility), working memory, and pathfinding (ie,color recall) components. Participants completed both tasks 4 times in 2 sessions scheduled 7days apart. Outcomes included performance metrics of reaction time, time to target, number of targets, and total time assessed with reactive training timing gates. To assess test-retest reliability, we used intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change (MDC). Stroboscopic goggles induced visual perturbation during the fourth trial of each task. To assess the effect of visual perturbation, we used paired t tests and calculated performance costs. The 4-corner agility task demonstrated excellent reliability with respect to reaction time (ICC3,1 = .907, SEM = 0.13, MDC = 0.35s); time to light (ICC3,1 = .935, SEM = 0.07, MDC = 0.18s); and number of lights (ICC3,1 = .800, SEM = 0.24, MDC = 0.66 lights). The color recall task demonstrated good-to-excellent test-retest reliability for time to lights (ICC3,1 = .818-.953, SEM = 0.07-0.27, MDC = 0.19-0.74s); test time (ICC3,1 = .969, SEM = 5.43, MDC = 15.04s); and errors (ICC3,1 = .882, SEM = 0.19, MDC = 0.53 errors). Visual perturbation resulted in increased time to target (P = .022-.011), number of targets (P = .039), and total test time (P = .013) representing moderate magnitude degradation of performance (d = 0.55-0.87, performance costs = 5%-12%). Both tasks demonstrated acceptable test-retest reliability. Performance degraded on both tasks with the presence of visual perturbation. These results suggest standardized reactive agility tasks are reliable and could be developed as components of dynamic RTS testing.

Puerarin ameliorates high glucose-induced MIN6 cell injury by activating PINK1/Parkin-mediated mitochondrial autophagy

The dysfunction of pancreatic β-cells plays a pivotal role in the pathogenesis of type 2 diabetes mellitus (T2DM). Despite numerous studies demonstrating the anti-inflammatory and antioxidant properties of puerarin, the protective effects of puerarin on β-cells remain poorly understood. Hence, this study aimed to explore the effects of puerarin on β-cell dysfunction in a hyperglycemic environment via the PINK/Parkin-mediated mitochondrial autophagy pathway. The alterations in cell viability of MIN6 cells exposed to glucose concentrations of 5 mM, 10 mM, 20 mM, and 30 mM for 24 h, 48 h, and 72 h, respectively, were assessed using the CCK-8 assay to optimize the modeling conditions. Subsequently, cellular insulin secretion was measured using enzyme-linked immunosorbent assay (ELISA), apoptosis rate by flow cytometry, mitochondrial membrane potential alteration by JC-1, cellular ROS production by the DCFH-DA fluorescent probe, and fusion of cellular autophagosomes and lysosomes through adenoviral infection analysis. Furthermore, gene and protein expression levels of the PINK/Parkin-mediated mitochondrial autophagy pathway and mitochondrial apoptosis pathway were assessed using real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot, respectively. Results indicated a significant decrease in MIN6 cell viability following 48 h of exposure to 30 mM glucose concentration. Puerarin intervention markedly attenuated ROS production, restored mitochondrial membrane potential, induced PINK/Parkin-mediated mitochondrial autophagy, suppressed activation of the mitochondrial apoptotic pathway, mitigated apoptosis, and enhanced insulin secretion in a high glucose (HG) environment. The findings of this investigation contribute to a deeper understanding of the precise mechanism underlying the protective effects of puerarin on β-cells and offer a theoretical foundation for advancing puerarin-based therapeutics aimed at ameliorating T2DM.

Smart inspection of rail wheels with matrix arrays

Rail wheels are one of the most safety critical safety components of rolling stock. Any failure can lead to catastrophic events resulting in high material damage and personal injury or even fatalities. Therefore, international railway standards require non-destructive inspection by means of ultrasound testing (UT) on a regular basis. Due to increasing distances, loads and speeds there are increasing demands on the precision and the scope of testing. However, the inspection of train wheels is complicated due to the large variety of wheel geometries and the further influence of different milage. Moreover, extended inspection areas up to a full body inspection define many different defect positions, which are to some part difficult to access. This article describes industrial solutions, which allow the full-body inspection of train wheels including face, flange, web and tread for volumetric defects (from 2mm diameter) and surface cracks (from 5 mm length and 1 mm depth). In the latest upgrade, these systems can be now equipped with matrix probes. At the beginning of the article basic principles and general probe configurations will be discussed. The main part of this article is then dedicated to highlight the positive impact of the implementation of matrix probes. Besides a reduction of the form factor due to the decreased number of probes, matrix probes allow a direct coupling check thus fundamentally amending the existing state-of-the-art. Other advantages refer to improved settings for a higher reliability of the system. Finally, it is outlined in which way matrix probes provide additional functionalities to extend the current state-of-the-art towards a smart inspection.

Restoration of respiration in high cervical spinal cord injury via phrenic nerve reinnervation: illustrative case.

Traumatic high cervical spinal cord injury (SCI) can result in a devastating loss of functional respiration, leaving patients permanently dependent on mechanical ventilation. Nerve transfer is a promising reinnervation strategy that has the potential to restore connectivity in paralyzed distal muscles. The spinal accessory nerve (SAN) remains functional in most cases after high cervical SCI and can serve as a donor to reinnervate the phrenic nerve (PN), thereby improving diaphragmatic function. Information regarding thorough physical, electrodiagnostic, and pulmonary assessments to establish candidacy for nerve transfer, as well as the surgical procedure, was summarized with an illustrative case. The patient demonstrated improvement in pulmonary function testing but did not achieve independent respiration. A systematic literature review identified 3 studies with 9 additional patients who had undergone SAN-to-PN transfer. The nerve transfer meaningfully restored diaphragmatic function, improving pulmonary function tests and reducing ventilator dependency. Respiratory dependency significantly impacts the quality of life of patients with a high cervical SCI. The use of the lower SAN motor branch for PN transfer is safe and does not result in a meaningful downgrade in trapezius function. Outcomes following this procedure are promising but heterogeneous, indicating a need for significant innovation and improvement for future therapies. https://thejns.org/doi/10.3171/CASE24236.

Effect of extracellular matrix stiffness on efficacy of Dapagliflozin for diabetic cardiomyopathy

BackgroundExtracellular matrix (ECM) stiffness is closely related to the progress of diabetic cardiomyopathy (DCM) and the response of treatment of DCM to anti-diabetic drugs. Dapagliflozin (Dapa) has been proven to have cardio-protective efficacy for diabetes and listed as the first-line drug to treat heart failure. But the regulatory relationship between ECM stiffness and treatment efficacy of Dapa remains elusive.Materials and methodsThis work investigated the effect of ECM stiffness on DCM progression and Dapa efficacy using both in vivo DCM rat model and in vitro myocardial cell model with high glucose injury. First, through DCM rat models with various levels of myocardial injury and administration with Dapa treatment for four weeks, the levels of myocardial injury, myocardial oxidative stress, expressions of AT1R (a mechanical signal protein) and the stiffness of myocardial tissues were obtained. Then for mimicking the stiffness of myocardial tissues at early and late stages of DCM, we constructed cell models through culturing H9c2 myocardial cells on the polyacrylamide gels with two stiffness and exposed to a high glucose level and without/with Dapa intervention. The cell viability, reactive oxygen species (ROS) levels and expressions of mechanical signal sensitive proteins were obtained.ResultsThe DCM progression is accompanied by the increased myocardial tissue stiffness, which can synergistically exacerbate myocardial cell injury with high glucose. Dapa can improve the ECM stiffness-induced DCM progression and its efficacy on DCM is more pronounced on the soft ECM, which is related to the regulation pathway of AT1R-FAK-NOX2. Besides, Dapa can inhibit the expression of the ECM-induced integrin β1, but without significant impact on piezo 1.ConclusionsOur study found the regulation and effect of biomechanics in the DCM progression and on the Dapa efficacy on DCM, providing the new insights for the DCM treatment. Additionally, our work showed the better clinical prognosis of DCM under early Dapa intervention.