Local Injury Research Articles

Changyanning tablet alleviates Crohn's disease by inhibiting GPX4-mediated ferroptosis.

Changyanning tablets (CYN) are a marketed traditional Chinese medicine composed of Diijincao (Euphorbia humifusa Willd.), Jinmaoercao (Hedyotis chrysotricha (Palib.) Merr.), Zhangshugen (root of Cinnamomum camphora (L.) J.Presl), Xiangru (Elsholtzia ciliate (Thunb.) Hyl.), and Fengxiangshuye (leaf of Liquidambar formosana Hance). They possess the functions of clearing heat, removing dampness, and regulating qi. CYN is used for the treatment of diarrhea and dysentery caused by damp heat in the large intestine, with symptoms such as diarrhea, or stools with pus and blood, tenesmus, abdominal pain and distension, acute and chronic gastroenteritis, diarrhea, bacterial diarrhea, and indigestion in children. This study aims to explore the intervention effects of CYN on Crohn's disease (CD) and its potential mechanisms. The therapeutic effect and potential mechanism of CYN on CD were investigated based on the 2,4,6-Trinitrobenzenesulfonic acid solution (TNBS)-induced rat model. In vivo and in vitro experiments confirmed that CYN can alleviate CD by inhibiting GPX4-mediated ferroptosis. siRNA was used to knock down GPX4 for reverse validation. Finally, active components of CYN inhibiting ferroptosis were identified using UPLC-MS and the RSL3-induced HCoEpiC ferroptosis cell model. CYN significantly improved ferroptosis-related indicators (GSH, MDA, GPX4, and SLC7A11) in the colons of TNBS-induced CD rats. Screening with three ferroptosis inducers (RSL3, FINO2, and erastin) revealed that CYN was most effective against RSL3 (a ferroptosis inducer targeting GPX4)-induced apoptosis. Subsequently, the resistance effect of CYN on RSL3-induced ferroptosis was confirmed in vitro. Further in vivo experiments showed that CYN alleviated local CD-like intestinal injury induced by RSL3 enema. siRNA knockdown of GPX4 in HCoEpiC cells further validated GPX4 as major target of CYN in inhibiting ferroptosis. Finally, UPLC-MS and in vitro experiments identified rutin, rosmarinic acid, and kaempferol-3-O-sophoroside as key active components of CYN for inhibiting ferroptosis. CYN alleviates CD by inhibiting GPX4-mediated ferroptosis, highlighting its clinical potential for treating CD and enhancing the understanding of the pathogenic and therapeutic mechanisms associated with CD.

Metabolomics identifies plasma biomarkers of localized radiation injury

A radiological accident may result in the development of a local skin radiation injury (LRI) which may evolve, depending on the dose, from dry desquamation to deep ulceration and necrosis through unpredictable inflammatory waves. Therefore, early diagnosis of victims of LRI is crucial for improving medical care efficiency. This preclinical study aims to identify circulating metabolites as biomarkers associated with LRI using a C57BL/6J mouse model of hind limb irradiation. More precisely, two independent mice cohorts were used to conduct a broad-spectrum profiling study followed by a suspect screening analysis performed on plasma metabolites by mass spectrometry. An integrative analysis was conducted through a multi-block sparse partial least square discriminant analysis (sPLS-DA) to establish multi-scale correlations between specific metabolites levels and biological, physiological (injury severity), and functional parameters (skin perfusion). The identified biomarker signature consists in a 6-metabolite panel including putrescine, uracil, 2,3-dihydroxybenzoate, 3-hydroxybenzoate, L-alanine and pyroglutamate, that can discriminate mice according to radiation dose and injury severity. Our results demonstrate relevant molecular signature associated with LRI in mice and support the use of plasma metabolites as suitable molecular biomarkers for LRI prognosis and diagnosis.

Histopathological characterization of skin and muscle lesions induced by lionfish (Pterois volitans) venom in a murine experimental model.

Fish venoms have been poorly characterized and the available information about their composition suggests they are uncomplicated secretions that, combined with epidermal mucus, could induce an inflammatory reaction, excruciating pain, and, in some cases, local tissue injuries. In this study, we characterized the 24-hour histopathological effects of lionfish venom in a mouse experimental model by testing the main fractions obtained by size exclusion-HPLC. By partial proteomics analysis, we also correlated these in vivo effects with the presence of some potentially toxic venom components. We observed a strong lesion on the skin and evident necrosis in the skeletal muscle. None of the tissue-damaging effects were induced by the fraction containing cytolysins, membrane pore-forming toxins ubiquitously present in species of scorpionfish, stonefish, and lionfish, among others. On the contrary, injuries were associated with the presence of other components, which have remained practically ignored so far. This is the case of an abundant protein, present in venom, with homology to a Golgi-associated plant pathogenic protein 1-like (GAPR1), which belongs to the same protein superfamily as venom CRISPs and insect allergens. This GAPR1-like protein and the hyaluronidase are probably responsible for the hemostasis impairment and hemorrhagic lesions observed in mouse skin, whereas muscle injuries can be indirectly caused by a combination of inflammatory and hemorrhagic events. More information is required to establish the components accountable for the myonecrotic effect.

Social cognition in acquired brain injury: adaptation and validation of the Brief Assessment of Social Skills (BASS)

ABSTRACT Background Acquired brain injury (ABI) is associated with social cognitive impairments, yet these impairments are often overlooked during clinical assessments. There are few validated and clinically appropriate measures of social cognition in ABI. The current study examined the validity of the Brief Assessment of Social Skills (BASS) in measuring social cognition following ABI. Method Twenty-eight people with ABI were recruited from local brain injury rehabilitation and support services and completed measures of social cognition, general intellectual ability, and social functioning. Twenty-eight controls demographically matched for age, gender, and years of education also performed these measures. Results A diagnosis of ABI was significantly associated with poorer performance on five subtests of the BASS. The BASS had moderate correlations with established measures of social cognition and measures characteristics that are distinguishable from general cognition. There was minimal evidence of a relationship between performance on the BASS and social functioning, with a significant relationship between a BASS subscale and informant-reported living skills and total social functioning. Using a series of case studies, the clinical utility of the BASS was emphasized by the development of unique social cognitive profiles across ABI individuals, including impairments in areas not significant at a group level. Discussion The BASS is a brief and comprehensive measure that is able to detect social cognition impairments in ABI patients. Given the prevalence of impairment in social cognition following ABI and the implications of these abilities on social functioning, this measure can be used in comprehensive neuropsychological assessment to guide and monitor progress toward rehabilitation goals.

Surgical treatment of a case of avulsion of the lateral head of the gastrocnemius muscle in a cat

AbstractAvulsion of the origin of the gastrocnemius muscle is a rare condition typically resulting from an acute, low‐grade local muscle injury: it usually presents as a weight‐bearing lameness with a tarsal hyperflexion. Surgical reattachment of the avulsed portion of the muscle is considered the treatment of choice. Overall, this pathology carries a good prognosis when a positive surgical outcome is achieved. A 9‐year‐old, female, neutered, domestic shorthair cat presented with an acute‐onset, weight‐bearing lameness and a plantigrade stance in the right hindlimb. Clinical and radiographic findings lead to a diagnosis of avulsion of the lateral origin of the gastrocnemius muscle: this was surgically anchored as close as possible to its anatomical origin, the tarsocrural joint was then locked in extension using a calcaneo‐tibial cortical positional screw for 5 weeks, and the leg was splinted for 7 weeks post‐operatively. At the 4‐month post‐surgical follow‐up, the cat showed a satisfactory limb function.

Сравнение эффективности различных способов лечения тяжелых местных лучевых поражений в эксперименте

Purpose: To compare the effectiveness of different methods of treating severe local radiation injuries (LRI) under the same experimental conditions. Material and methods: Male rats of the Wistar-Kyoto inbred line were locally irradiated in the ilioplumbar region of the back using an X-ray unit LNK-268 at a dose of 110 Gy (tube voltage 30 kV, current 6.1 mA, Al filter 0.1 mm thick), at a dose rate of 20.0 Gy/min. The area of the irradiation field was 8.2 cm2. Such radiation exposure led to the occurrence of severe LRI in rats with long-term non-healing skin ulcers, without critical radiation exposure to the underlying tissues. For the treatment of severe LRI, surgical methods, cell or drug therapy were used, which were used separately from each other. Treatment began on the 28th day after local irradiation, that is, during the period when the radiation ulcer had already formed and regenerative processes began to activate in the affected area. Various surgical approaches were used: from complete excision of the radiation ulcer to removal of various volumes of necrotic tissue within the radiation ulcer. Cell therapy consisted of transplantation of syngeneous cells of the stromal vascular fraction of adipose tissue or cultured syngeneous multipotent mesenchymal stromal cells. The cells were injected subcutaneously around the radiation ulcer twice at 1-week intervals. For drug therapy of severe local radiation injuries, we used a veterinary complex antibiotic ‒ levotetrasulfin forte, as well as drugs that affect the microcirculation and trophism of irradiated tissues – pentoxifylline and detralex. The drugs were used once a day from the 28th to the 49th day after irradiation. Results and coclusion: The use of surgical methods, cell or drug therapy facilitated the course of the pathological process and accelerated the healing of radiation ulcers. However, different treatments for severe LRI have had different efficacy. In terms of the rate and quality of healing of severe local radiation injuries, drug therapy is less effective than cellular therapy, and cell therapy is less effective than complete surgical excision of radiation ulcers.

КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ МЕСТНОГО ЛУЧЕВОГО ПОРАЖЕНИЯ ТЯЖЕЛОЙ И КРАЙНЕ ТЯЖЕЛОЙ СТЕПЕНИ БОЛЬШОЙ ПЛОЩАДИ С НЕБЛАГОПРИЯТНЫМ ТЕЧЕНИЕМ РАНЕВОГО ПРОЦЕССА

Purpose: to familiarize medical workers with the unfavorable course of local radiation injury (LRI) due to its depth and area, damage to underlying bone structures and internal organs, the presence of concomitant severe somatic disease, drug addiction and the impossibility of radical surgical intervention due to a lack of own tissues to hide the ulcerative defect. Material and methods: The article presents a clinical observation of a 46–year-old man who had accidental household contact with a radiation source of electric current RIT-90 with an activity of 30 kCu – a powerful source of bremsstrahlung. Results: The patient suffered severe acute radiation syndrome from extremely uneven beta-gamma irradiation (moderate bone marrow syndrome, acute posterior thoracic LRI of extremely severe degree (IV) – 5%, severe and moderate degree – 10% and both hands of mild degree (I) – 2%). He was admitted to the clinic for treatment 3 months after irradiation. On admission, against the background of pronounced hyperpigmentation and atrophy of the skin of the left and partly right half of the back, there were ulcerative defects in the form of a figure eight (diameter – 10 and 3 cm). The ulcers are covered with a thick layer of fibrin with scanty discharge. Within 3 months after admission to the clinic, pulmonary tuberculosis was treated with good clinical effect. 6 months after the irradiation, a phased surgical treatment was initiated. However, necrotization of transplanted autografts and infection of the ulcerative surface were almost constantly noted. Despite the ongoing supportive, detoxification and antibacterial therapy, multiple organ failure developed, which led to the death of the patient. Conclusions: With extensive and deep radiation lesions accompanied by severe damage to underlying bone structures and vital internal organs localized in anatomical areas that are not subject to amputation, in the presence of severe concomitant somatic pathology in the patient, surgical closure of the skin defect with a full-layer flap with axial blood supply capable of restoring trophicity of the affected tissues becomes an almost unsolvable problem. Covering with patient’s tissues is impossible, first of all, due to the complexity of the necessary size flap extraction. The remaining open skin defect is the gateway to infection with its further generalization and death of the patient. It is possible that the solution in this case may be the use of various collagen films or artificial skin, which will mechanically close the defect, however, the inability to restore trophicity in the area of affected tissues still makes the prognosis extremely unfavorable.

Indocyanine green fluorescence angiography in the management of intestinal injuries following penetrating abdominal trauma: a case-control study comparing postoperative outcomes.

The surgical management of penetrating hollow visceral injuries includes primary repair or exteriorization. Tissue perfusion at the site of gastrointestinal suture repair may be challenging to assess and is vulnerable to local energy transfer-related injury, micro- or macro-circulatory insufficiency, or splanchnic vasoconstriction for various reasons. Breakdown of suture lines can lead to potentially life-threatening complications. The intraoperative use of indocyanine green fluorescence angiography (ICG-FA) may reduce the risk of postoperative morbidity and mortality by ensuring optimal tissue perfusion at the chosen site of suture repair. The authors conducted a retrospective review of the postoperative complications, length of ICU stay, and length of hospital stay in patients undergoing laparotomy, with and without ICG-FA for penetrating abdominal trauma at a Level One Trauma Center in Cape Town, South Africa. One hundred patients were included in the study, of which 20 underwent laparotomy with ICG-FA, and 80 did not. The overall complication rate was significantly lower in the ICG-FA group (OR 0.336, p =0.0412). The anastomotic leak rates in the ICG-FA and control groups were 0% and 6.25%, respectively ( p =0.5799). Revision surgery was required in 2 and 14 patients in the ICG-FA and control groups, respectively (OR 0.524, p =0.516). The mean length of stay in the hospital showed no statistical difference, 8.6 and 5.3 days for the ICG-FA and control groups, respectively ( p =0.092). The mean length of ICU stay was 6.3 and 2.3 days for the ICG-FA and control groups, respectively ( p =0.1642). Lower levels of overall postoperative complications and lower rates of revision surgery in patients undergoing laparotomy with ICG-FA are promising. Non-significant findings regarding the relationship between the usage of ICG-FA and anastomotic leak rates suggest the need for larger randomized studies.

Успешное лечение и реабилитация профессионального местного лучевого поражения кисти методом пересадки пальца стопы на кисть

Purpose: To introduce a wide range of specialists with the technique of reconstructive plastic surgery, which was first used in local radiation injury (LRI). Material and methods: clinical analysis of the case histories of the severe LRI of the hand. The report describes the results of the first autotransplantation of the II toe in the position of the right hand III finger for the restoration of grip function in LRI. Results: Patient L., 38 years old, was admitted to the A.I. Burnazyan Federal Medical Biophysical Center in 2010 for the treatment of late consequences of severe LRI of the right hand resulting from contact with a gamma radiation source (Ir 192) in 2008. In the period from 2010 to 2018, the patient underwent repeated surgical operations, including reconstructive plastic surgery, which made it possible to achieve healing of constantly recurring late radiation ulcers. However, multiple necrectomies, exarticulations, finger amputations and resections of the phalanges led to the formation of a functionally defective hand and persistent disability of the patient. In 2018, the patient was admitted to the clinic for reconstructive surgery to restore the function of hand grip - microsurgical transplantation of the II toe into the position of the III finger of the hand. As a result of the treatment, the function of grabbing objects with the right hand was restored, and the patient’s ability to work was largely restored. Conclusions: The obtained long-term functional and aesthetic results allow us to consider the applied method of fingerless hand reconstruction by autotransplantation of the toe with the imposition of microvascular anastomoses optimal. It is advisable to use this type of surgical treatment more widely for the rehabilitation of patients with severe and extremely severe hand LRI.

РЕЗУЛЬТАТЫ ДЛИТЕЛЬНОГО МЕДИЦИНСКОГО НАБЛЮДЕНИЯ НЕПОСРЕДСТВЕННЫХ УЧАСТНИКОВ АВАРИИ НА ЧАЭС В РОССИЙСКОЙ ФЕДЕРАЦИИ

Purpose: to present the materials of long-term (38 years) monitoring of the health status of a group of patients who had underwent acute radiation syndrome (ARS) in 1986 as a result of the Chernobyl accident and had been living in the territory of the Russian Federation. Materials and methods: the results of cytogenetic dynamic observation of 74 direct participants in the Chernobyl accident who had been examining at the clinic in the period from 1986 to 2012, as well as the results of dynamic inpatient observation of 10 of them permanently residing in Moscow, are summarized. Medical supervision consisted of annual planned hospitalizations in connection with patient requests, or emergency hospitalizations in connection with the detection of acute or exacerbation of a chronic disease. Laboratory and instrumental examination of organs and organ systems critical to the effects of radiation, as well as an extended cancer search, was carried out. Results: according to cytogenetic studies for all degrees of severity of ARS, starting from the 1st degree, the frequency of translocations in blood lymphocytes significantly exceeds the spontaneous level. The initial level of translocations depends on the initial dose estimate. The time of decrease in the frequency of translocations due to the presence of part of the translocations in unstable cells, from the initial value to an established constant level, apparently occurs in the first 5-8 years. Analysis of individual blood curves revealed transient moderate cytopenia, most often thrombocytopenia. Myelodysplastic syndrome (MDS) and leukemias were detected in 5 patients (2- Moscow group, 3- Ukranian group) from the entire group who underwent ARS as a result of the Chernobyl accident, which significantly exceeds the expected level. The diagnosis of radiation cataract was established in 11 patients. Two patients underwent surgical treatment. In the acute period ARS local radiation injuries (LRI) was detected in 59 patients. By 2005, 38 patients with the effects of LRI were observed (33 in Ukraine and 5 in Moscow). The most severe long-term consequences in the form of pronounced cicatricial atrophic changes, radiation fibrosis, and late radiation ulcers were detected in patients with grade III – IV LRI. 1 out of 10 observed patients developed primary multiple metachronous cancer of the genitourinary system, 2 patients – prostate cancer, 1 – metastatic lesion with an undetected primary tumor, 3 – multiple foci of basal cell skin cancer. The causes of death in 8 out of 10 patients were: cardiovascular pathology, MDS and leukemia, cirrhosis of the liver, oncological disease with undetected primary localization of the tumor, suicide in an oncological patient. Conclusions: The experience of providing medical care to victims of the Chernobyl accident with acute radiation injuries and further in the period of long-term consequences indicates the need to maintain constant readiness to provide medical care in case of a radiation accident, as well as adequate information during and after the accident, which will reduce the long-term consequences. Patients who have undergone ARS need lifelong medical supervision and the provision of necessary medical care. The main causes of permanent disability of patients who have undergone ARS are the consequences of LRI (recurrent late radiation ulcers, radiation fibrosis, contractures, scars, etc.). Radiation cataract is the cause of temporary disability (before surgical treatment). Patients who have undergone ARS need adequate social adaptation. The revealed effect of exposure to relatively uniform radiation is an increase in the frequency of MDS and leukemia.

Evaluation and management of pressure ulcers in plastic surgery department at tertiary care center in India

Background: A pressure ulcer also known as decubitus ulcers, bedsores, or pressure sores is a localized injury to the skin and/ or underlying tissue usually over a bony prominence, as a result of unrelieved pressure or pressure in combination with shear. When extrinsic pressure exceeds the capillary pressure of 32 mmHg than vessel occluded and blood flow stops. When pressure not relieved for 5 minute every 2 hour, then necrosis and ulceration will result. Methods: Retrospective study of 74 patients with pressure injury admitted in SMS hospital Jaipur during 3 year duration from September 2019 to August 2022 requiring plastic surgery intervention. Patient specific factor, wound characteristics and flap outcomes analysed in study. Results: Patients with early-stage pressure injury (stage I and II) and advance stage (stage III and IV) with deteriorating or terminal co-morbidities, managed with conservative treatment in form of dressing with pressure management. Patients with advance stage pressure injury (stage III and IV) managed with active operative intervention in form of debridement and flap cover surgery. Conclusions: Prevention of pressure ulcer development is mainstay in management of both development and recurrence of pressure ulcer.

Implantable Multifunctional Micro-Oxygen Reservoir System for Promoting Vascular-Osteogenesis via Remodeling Regenerative Microenvironment.

Hypoxia and reactive oxygen species (ROS) overaccumulation cause persistent oxidative stress and impair intrinsic regenerative potential upon tissue injury. For local tissue injury with hypoxia, such as bone fracture and defects, a localized-sufficient oxygen supply is highly desirable but remains challenging. Therefore, to explore a strategy and its intrinsic mechanism for supplying oxygen locally and remodeling the regenerative microenvironment, an innovative oxygenating hydrogel microsphere system with sustained oxygenation and antioxidant properties is introduced by loading CaO2@SiO2@PDA (CSP) nanoparticles. Specifically, the CSP nanoparticles exhibited broad-spectrum free radicals scavenging ability, along with prolonged controlled-release of oxygen once integrated into the gelatin methacrylate anhydride (GelMA) microspheres (CSP-GM). The CSP-GM with extra cellular matrix (ECM)-mimicking structures reconstructed living niches, promoting the adhesion and proliferation of bone marrow stromal cells (BMSCs). As a multifaceted microenvironment regulator, CSP-GM remodeled the regenerative microenvironment by synergistically producing oxygen and scavenging ROS, recovering mitochondrial homeostasis and antioxidant defenses of BMSCs, promoting angiogenesis and osteogenesis under hypoxia conditions via precisely modulating the Nrf2/HO-1 signaling pathway. The multiple pro-regenerative effects of the implantable functionalized micro-oxygen reservoir on bone repair are further corroborated by the enhanced vascularized bone formation in rat femoral defects, presenting a comprehensive and promising strategy for tissue repair.

Imaging the large-scale and cellular response to focal traumatic brain injury in mouse neocortex.

Traumatic brain injury (TBI) affects neural function at the local injury site and also at distant, connected brain areas. However, the real-time neural dynamics in response to injury and subsequent effects on sensory processing and behaviour are not fully resolved, especially across a range of spatial scales. We used in vivo calcium imaging in awake, head-restrained male and female mice to measure large-scale and cellular resolution neuronal activation, respectively, in response to a mild/moderate TBI induced by focal controlled cortical impact (CCI) injury of the motor cortex (M1). Widefield imaging revealed an immediate CCI-induced activation at the injury site, followed by a massive slow wave of calcium signal activation that travelled across the majority of the dorsal cortex within approximately 30s. Correspondingly, two-photon calcium imaging in the primary somatosensory cortex (S1) found strong activation of neuropil and neuronal populations during the CCI-induced travelling wave. A depression of calcium signals followed the wave, during which we observed the atypical activity of a sparse population of S1 neurons. Longitudinal imaging in the hours and days after CCI revealed increases in the area of whisker-evoked sensory maps at early time points, in parallel to decreases in cortical functional connectivity and behavioural measures. Neural and behavioural changes mostly recovered over hours to days in our M1-TBI model, with a more lasting decrease in the number of active S1 neurons. Our results in unanaesthetized mice describe novel spatial and temporal neural adaptations that occur at cortical sites remote to a focal brain injury.

Synergistic Effect and Mechanism of Combined Astaxanthin and Curcumin Administration on Ovarian Function in PCOS Mice.

To investigate the synergistic effect of astaxanthin and curcumin on ovarian function in polycystic ovary syndrome (PCOS) mice and to elucidate the underlying mechanisms, fifty 4-week-old female mice were randomly divided into five groups: (i) normal control group; (ii) PCOS model group; (iii) PCOS + astaxanthin group; (iv) PCOS + curcumin group; and (v) PCOS + astaxanthin-curcumin. Throughout the study, various parameters were meticulously evaluated, including serum levels of key reproductive hormones (testosterone (T), estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and anti-Müllerian hormone (AMH)), as well as monitoring alterations in the estrous cycle, follicle development, and ovulation rates. Additionally, markers of oxidative stress and inflammation were measured. Findings revealed that PCOS mice exhibited disordered estrous cycle, polycystic ovarian morphologies, abnormal serum reproductive hormones and lipid metabolism, heightened oxidative stress, and augmented inflammatory responses. Notably, upon administration of the combined astaxanthin and curcumin, PCOS mice exhibited significant improvements in their estrous cyclicity and ovarian histology. The treatment led to a significant reduction in serum total cholesterol (TC) levels and normalization of T, E2, FSH, LH, and AMH levels. Moreover, there was a marked decrease in the levels of serum reactive oxygen species (ROS) and malondialdehyde (MDA), indicating attenuation of oxidative stress. Concurrently, the activity of the antioxidant enzyme catalase (CAT) significantly increased, while proinflammatory cytokines interferon-γ (IFN-γ) and interleukin-6 (IL-6) in the ovarian tissue were notably decreased. The combined treatment also resulted in a substantial increase in the number of ova and a significant decline in the rate of abnormal ova, with these therapeutic effects proving more effective compared to either astaxanthin or curcumin alone. In conclusion, the co-administration of astaxanthin and curcumin demonstrated a remarkable effect in improving abnormal lipid metabolism and restoring reproductive endocrine functions in PCOS mice. Furthermore, it effectively mitigated systemic and local oxidative stress and chronic inflammatory injury, thereby promoting follicular growth and enhancing ovulatory function in the context of PCOS.

A Clinicopathological Study of Scrotal Calcinosis and Literature Review.

Objective. We aimed to investigate the clinicopathological features and pathogenesis of scrotal calcinosis. Methods. Hematoxylin and eosin (HE)-stained slides were performed on 14 patients with scrotal calcinosis, and the clinicopathological characteristics were analyzed together with clinical data. Meanwhile, 81 patients with extrascrotal calcinosis cutis and 7480 patients with epidermoid cysts without calcification in the skin of various parts of the body were collected and analyzed to explore the etiology and pathogenesis of scrotal calcinosis in conjunction with the literature review. Results. All our patients were adult men with a mean age of 38.2 years, with clinical manifestations of multiple scrotal nodules of varying sizes, microscopically characterized by intradermal calcium deposits, of which 3 lesions had a cystic cavity lined with squamous epithelium. Conclusions. Scrotal calcinosis is a rare benign disease that presents clinically as single or multiple hard nodules in the scrotum, usually asymptomatic, and it is histopathologically characterized by intradermal calcium deposition. There is still controversy as to whether it is idiopathic. We believe that scrotal calcinosis is not idiopathic and originates from epidermoid cysts. Prolonged local compression or injury may be one reason for the development of calcification, and perhaps there are other unknown factors contributing to the development of the disease. Surgical excision is the main treatment for this disease with satisfactory therapeutic effectiveness.

Early Postoperative Weight Bearing Following the Reconstruction of Traumatic Complex Tibial Bone Defects by Vascularized Free Fibula and Ilizarov External Fixator: A Case Series.

Post-traumatic tibial bone defects represent a significant challenge to orthopedic surgeons. Various reconstructive methods are available based on associated local soft tissue injury and defect size. Free vascularized fibular graft represents a major successful technique; combined with a rigid Ilizarov external fixator, it allows safe, immediate postoperative weight bearing. In this article, we describe a series of six patients managed according to the previously presented plan, achieving satisfactory results. A series of six patients, all males with an average age of 33.3 years, underwent reconstruction for post-traumatic complex tibial bony defects using contralateral free vascularized fibular grafts and Ilizarov external fixation. Initially, all patients underwent multiple sessions of debridement and a simple pin-to-bar external fixator. The bony defect averaged 15 cm, and the average harvested length of the fibula used for reconstruction was 22.1 cm. All patients started immediate total weight bearing postoperatively, with a mean time of 17 days after bony union Ilizarov was replaced with minimally invasive plate osteosynthesis (MIPO) in all patients, and continued full weight bearing (FWB). During the follow-up period, averaging 19.3 months, all patients achieved bony union with a mean time of 3.75 months. Patients spent an average of 6.4 months in the Ilizarov frame before it was replaced with MIPO; graft hypertrophy occurred in all patients, averaging 52.6%. The combined use of a vascularized fibular bone graft and an Ilizarov frame proves to be a successful and safe approach for immediate postoperative FWB. This yields comparable outcomes in terms of union and function.

THE ROLE OF THE INTENSIVIST NURSE IN THE CARE AND PREVENTION OF PRESSURE INJURIES: Narrative literature review

Pressure injuries (PPI) or pressure ulcers are an important public health problem, affecting mainly patients with long-term hospitalization or hospitalized in intensive care beds. These are localized injuries, most frequently in places with bony prominences, soft and underlying tissues after being in direct contact in the form of pressure on a rigid surface for a prolonged period of time. Although it is the care of the entire care team, nursing has a very important role in preventing and caring for this type of injury. For this reason, the present study aimed to evaluate the high incidence rates of pressure injuries in seriously ill hospitalized patients, knowledge and the performance of the intensive care nursing team on pressure injuries. The study was organized in the form of a bibliographic review research using a qualitative approach, based on consultation of electronic information bases such as the Brazilian Virtual Health and Nursing Library (VHL), Scientific Electronic Library Online (Scielo), Google Academic, dissertations and monographs published in the period between 2018 and 2023. From the bibliographical research it was possible to verify that the nursing professional is essential for monitoring risk factors and the early identification of the first signs of injury are fundamental for adequate management of the case. The therapeutic process has different forms of coverage that can greatly contribute to the treatment of the injury. Thus, both in prevention actions and in therapeutic interventions, nurses have a prominent role, significantly contributing to reducing the risk of injuries or offering a better health condition and quality of life to patients who present this type of injury.

Imaging the large-scale and cellular response to focal traumatic brain injury in mouse neocortex.

Traumatic brain injury (TBI) affects neural function at the local injury site and also at distant, connected brain areas. However, the real-time neural dynamics in response to injury and subsequent effects on sensory processing and behavior are not fully resolved, especially across a range of spatial scales. We used in vivo calcium imaging in awake, head-restrained male and female mice to measure large-scale and cellular resolution neuronal activation, respectively, in response to a mild/moderate TBI induced by focal controlled cortical impact (CCI) injury of the motor cortex (M1). Widefield imaging revealed an immediate CCI-induced activation at the injury site, followed by a massive slow wave of calcium signal activation that traveled across the majority of the dorsal cortex within approximately 30 s. Correspondingly, two-photon calcium imaging in primary somatosensory cortex (S1) found strong activation of neuropil and neuronal populations during the CCI-induced traveling wave. A depression of calcium signals followed the wave, during which we observed atypical activity of a sparse population of S1 neurons. Longitudinal imaging in the hours and days after CCI revealed increases in the area of whisker-evoked sensory maps at early time points, in parallel to decreases in cortical functional connectivity and behavioral measures. Neural and behavioral changes mostly recovered over hours to days in our M1-TBI model, with a more lasting decrease in the number of active S1 neurons. Our results in unanesthetized mice describe novel spatial and temporal neural adaptations that occur at cortical sites remote to a focal brain injury.

Intraperitoneal MASP-1 Levels are Associated with Peritoneal Solute Transport Rate in Peritoneal Dialysis Patients: A Retrospective Cohort Study.

A major limitation of long-term peritoneal dialysis (PD) is peritoneal membrane dysfunction characterized by faster peritoneal solute-transport rate (PSTR). This study aimed to identify efficient complement factors in peritoneal effluents of continuous ambulatory peritoneal dialysis (CAPD) patients that can predict the PSTR. A multiplex suspension protein array was used to screened related complement pathways in overnight peritoneal effluents among 58 CAPD patients. Then the related complement factors in lectin and classical pathways in effluents were analyzed using ELISA kits among another cohort of 129 CAPD patients. Logistic regression modeling was fitted to predict the PSTR of PD patients. The multiplex suspension protein array showed complement factors including C2, C4b, C5, C5a, Factor D, Factor I, and MBL were detected in effluents of CAPD patients, and the effluent C2 Appearance rate (Ar) and C4b Ar levels were significantly correlated with D/P Cr and D/D0 glucose. The levels of effluents MASP-1 Ar, M-Ficolin Ar, C2 Ar and C4b Ar, which belong to the lectin pathway were also positively correlated with D/P Cr according the ELISA results and these parameters were expressed higher in the high and high-average (H/HA) groups according to the PET results. Moreover, effluent Masp-1 was independently associated with increased PSTR and adverseevents relatedperitonealtransportfunction failure. This study suggested that the lectin pathway may be involvedin local complement activation and peritoneal injury of PD patients, intraperitoneal level of Masp-1 was an independent predictor of increased PSTR in PD patients.

Spatial proteomics and transcriptomics of the maternal-fetal interface in placenta accreta spectrum

In severe Placenta Accreta Spectrum (PAS), trophoblasts gain deep access in the myometrium (placenta increta). This study investigated alterations at the fetal-maternal interface in PAS cases using a systems biology approach consisting of immunohistochemistry, spatial transcriptomics and proteomics. We identified spatial variation in the distribution of CD4+, CD3+ and CD8+ T-cells at the maternal-interface in placenta increta cases. Spatial transcriptomics identified transcription factors involved in promotion of trophoblast invasion such as AP-1 subunits ATF-3 and JUN, and NFKB were upregulated in regions with deep myometrial invasion. Pathway analysis of differentially expressed genes demonstrated that degradation of extracellular matrix (ECM) and class 1 MHC protein were increased in increta regions, suggesting local tissue injury and immune suppression. Spatial proteomics demonstrated that increta regions were characterised by excessive trophoblastic proliferation in an immunosuppressive environment. Expression of inhibitors of apoptosis such as BCL-2 and fibronectin were increased, while CTLA-4 was decreased and increased expression of PD-L1, PD-L2 and CD14 macrophages. Additionally, CD44, which is a ligand of fibronectin that promotes trophoblast invasion and cell adhesion was also increased in increta regions. We subsequently examined ligand receptor interactions enriched in increta regions, with interactions with ITGβ1, including with fibronectin and ADAMS, emerging as central in increta. These ITGβ1 ligand interactions are involved in activation of epithelial–mesenchymal transition and remodelling of ECM suggesting a more invasive trophoblast phenotype. In PAS, we suggest this is driven by fibronectin via AP-1 signalling, likely as a secondary response to myometrial scarring.