Management Of Injuries Research Articles

Pengaruh Education First Aid (E-Fa) Game terhadap Pengetahuan Layperson Pertolongan Pertama Cedera Pada Anak Usia Sekolah

Injuries can affect anyone, including school-age children, and are often caused by a lack of understanding of injury concepts, insufficient knowledge of first aid, and unsafe environments. Therefore, it is crucial to provide first aid and health education to promote overall health and safety. The E-Fa (Education First Aid) Game is a novel approach presented as a game-based Android application. The aim of this study is to analyze the differences in students' knowledge improvement regarding injury management. The study design employed a quasi-experimental approach with a one-group pretest-posttest design. Fifty-one respondents were selected through simple random sampling techniques. Data collection involved the use of questionnaires to measure knowledge variables before and after the intervention with the E-Fa Game. The research was conducted at SMP 12 Jember. Data analysis was performed using the Wilcoxon test. The results revealed that students' knowledge of performing first aid for injuries improved significantly. The average score increased from 5.90 during the pretest to 7.04 during the posttest, with a p-value of 0.000, indicating a significant improvement in knowledge among SMP 12 Jember students in handling injuries after receiving the intervention with the E-Fa Game. This study demonstrates the effectiveness of the E-Fa Game in enhancing schoolchildren's knowledge of injury management.

Utility of Platelet-Rich Plasma Therapy in the Management of Meniscus Injuries: A narrative review.

Menisci are crucial for knee joint functions and meniscal tears are common injuries, especially in sports activities. Platelet-rich plasma (PRP), which enhances healing, has emerged as a promising additive treatment for meniscus injuries, utilizing the regenerative properties of platelets and growth factors for improved clinical outcomes. In studies with a follow-up period of less than one year, the use of platelet-rich plasma (PRP) therapy for meniscus injuries showed significant improvements in knee symptoms and daily activity. Patients experienced enhanced outcomes in terms of pain reduction and increased sports activity, with MRI scans indicating stable meniscus conditions after six months. Studies with a follow-up of more than one year, however, did not find significant differences between groups treated with PRP and groups not treated with PRP in terms of various outcome measures, including pain and knee function. The vascularization of the menisci is vital for their proper function, and insufficient blood supply can affect healing of meniscal injuries. PRP therapy is used to enhance meniscal healing by introducing growth factors and anti-inflammatory agents. PRP therapy may enable athletes with meniscal tears to return to sports more quickly and has less rehabilitation duration. While PRP seems promising as an alternative to failed treatment or as an adjunct to treatment in the short term, its long-term effectiveness remains inconclusive. Patient preferences, commitment to therapy rehabilitation, and cost should all be considered on an individual basis.

A “defend–attack and capture flag” strategy for cascade management of hepatic ischemia reperfusion injury

Hepatic ischemia reperfusion injury (HIRI) following transplantation or resection can lead to irreversible liver dysfunction and even failure, yet current therapeutic interventions are limited. Herein, we introduce a “defend–attack and capture flag” nanotheranostic strategy for the cascade management of HIRI. Firstly, the NIR-II photothermal pretreatment with the developed nanosystem provides preprotection for the liver, acting as “defend”. Subsequently, the pharmacotherapy furnishes direct cure for HIRI via the delivery and controlled release of wedelolactone from the nanosystem, serving as “attack”. Meanwhile, the photoacoustic (PA) imaging ability of the nanosystem enables the real-time monitoring of the inflammatory hypoxia, which is the “flag” to be captured in HIRI treatment. The photothermal preprotection can activate heat shock factor 1 (HSF-1), while the pharmaceutical therapy directly attacks NF-κB, both of which eventually inhibits NLRP3 inflammasome, thus reducing the activity of proinflammatory cytokine IL-1β, ending up with the alleviation of necrosis and apoptosis in HIRI. Such treatment effect can be reported by the real-time PA imaging. By the organic combination of the above three-step mechanism, significantly enhanced therapeutic efficacy was achieved in the animal model of HIRI, providing an effective solution for overcoming the challenge of HIRI.

A comparison of screw and suture button fixation in the management of adolescent ankle syndesmotic injuries.

Ankle injuries involving the tibiofibular syndesmosis often necessitate operative fixation to restore stability to the ankle. Recent literature in the adult population has suggested that suture button fixation may be superior to screw fixation. There is little evidence as to which construct is preferable in the pediatric and adolescent population. This study investigates outcomes of suture button and screw fixation in adolescent ankle syndesmotic injuries. A retrospective matched cohort study over 10 years of pediatric patients who underwent ankle syndesmotic fixation at a large Level 1 Trauma Center was conducted. Both isolated syndesmotic injuries and ankle fractures with syndesmotic disruption were included. Preoperative variables collected include basic patient demographics, body mass index, and fracture type. Suture button and screw cohorts were matched based on age, race, sex, and open fracture utilizing propensity scores. Outcomes assessed include reoperation and implant failure. A total of 44 cases of operative fixation of the ankle syndesmosis were identified with a mean age of 16 years. After matching cohorts based on age, sex, race, and open fracture status, there were 17 patients in the suture button and screw cohorts, respectively. Patients undergoing screw fixation had a six times greater risk of reoperation (p = 0.043) and 13 times greater risk of implant failure (p < 0.001). Out of six cases of reoperation in the screw cohort, five were unplanned. Our findings favor suture button fixation in operative management of adolescent tibiofibular syndesmotic injuries. Compared with screws, suture buttons are associated with lower risk of both reoperation and implant failure. level III therapeutic.

Liver toxicity in oncology trials and beyond: a simplified concept for management of hepatocellular drug-induced liver injury in patients with abnormal baseline liver tests

ABSTRACT Background Management of side effects in clinical trials has to balance generation of meaningful data with risk for patients. A toxicity area requiring detailed management guidelines is drug-induced liver injury (DILI). In oncology trials, patients are often included despite baseline liver test abnormalities, for whom there is no consensus yet on levels of liver test changes that should trigger action, such as drug interruption or discontinuation. Methods We provide an innovative approach to manage hepatocellular DILI in oncology trials for patients with abnormal baseline alanine aminotransferase (ALT) levels. The algorithm proposed is based on mathematical derivation of action thresholds from those generally accepted for patients with normal baselines. Results The resulting algorithm is grouped by level of baseline abnormality and avoids calculation of baseline multiples. Suggested layered action levels are 4, 6, and 11 × Upper Limit of Normal (ULN) for patients with baseline ALT between 1.5 and 3 × ULN, and 6, 8, and 12 × ULN for patients with baseline ALT between 3 and 5 × ULN, respectively. Conclusions Our concept and resulting algorithm are consistent, transparent, and easy to follow, and the method for derivation from consensus-based thresholds may also be applicable to other drug toxicity areas.

Repositioning of herniated buccal fat pad following blunt trauma - Rare case report in pediatric patients

Herniation of the buccal fat pad in pediatric patients is a rare injury, occurring due to a breach in the buccinator muscle, often termed traumatic pseudolipoma in infants. This condition plays a crucial role in cheek contour in adults. Two case reports detailing the management of this rare injury in young children emphasize the importance of assessing mucosal perforation and considering previous trauma history for accurate diagnosis. These reports provide valuable insights for healthcare professionals, contributing to the understanding and management of uncommon medical conditions.

Associated injuries and complications in pediatric pelvic fractures requiring hospitalization: A series of 315 cases.

Pediatric pelvic fractures are uncommon. This study aimed to investigate the clinical characteristics of pediatric pelvic fractures requiring hospitalization and analyze their correlation with associated injuries and complications. Data from 315 pediatric pelvic fracture patients admitted to our hospital from January 2006 to December 2021 were retrospectively analyzed. Sex, age, modified Torode-Zieg classification, abbreviated injury scale score, injury severity score, mortality, and concomitant injuries were analyzed. Of the 285 (90.5%) cases of combined injuries, most injuries occurred in the abdomen (64.8%) and lower extremities (47.6%), followed by the chest (45.4%) and head (34.6%). A total of 78 patients (24.8%) were transferred to the intensive care unit. In total, 94 patients (29.8%) had complications during hospitalization. There were differences based on injury mechanism (p = 0.001), with the highest complication rate in the fall injury group (32 cases (46.4%)). Approximately 51.4% of patients received surgical treatment for problems that were not related to pelvic fractures. Among these, 30.2% necessitated surgical intervention on the lower limbs. Abdominal surgery was necessary in 19.0% of patients. Children who have pelvic fractures frequently require hospitalization due to the presence of severe injuries in other areas of their bodies. IIIB pelvic fractures frequently occur in conjunction with more severe abdominal injuries; therefore, the prompt management of cavity and organ injuries is of particular importance. Blood transfusion and injury severity score were associated risk factors for intensive care unit admission.

Multicentric development and validation of a multi-scale and multi-task deep learning model for comprehensive lower extremity alignment analysis

Osteoarthritis of the knee, a widespread cause of knee disability, is commonly treated in orthopedics due to its rising prevalence. Lower extremity misalignment, pivotal in knee injury etiology and management, necessitates comprehensive mechanical alignment evaluation via frequently-requested weight-bearing long leg radiographs (LLR). Despite LLR’s routine use, current analysis techniques are error-prone and time-consuming. To address this, we conducted a multicentric study to develop and validate a deep learning (DL) model for fully automated leg alignment assessment on anterior–posterior LLR, targeting enhanced reliability and efficiency. The DL model, developed using 594 patients’ LLR and a 60%/10%/30% data split for training, validation, and testing, executed alignment analyses via a multi-step process, employing a detection network and nine specialized networks. It was designed to assess all vital anatomical and mechanical parameters for standard clinical leg deformity analysis and preoperative planning. Accuracy, reliability, and assessment duration were compared with three specialized orthopedic surgeons across two distinct institutional datasets (136 and 143 radiographs). The algorithm exhibited equivalent performance to the surgeons in terms of alignment accuracy (DL: 0.21 ± 0.18°to 1.06 ± 1.3°vs. OS: 0.21 ± 0.16°to 1.72 ± 1.96°), interrater reliability (ICC DL: 0.90 ± 0.05 to 1.0 ± 0.0 vs. ICC OS: 0.90 ± 0.03 to 1.0 ± 0.0), and clinically acceptable accuracy (DL: 53.9%–100% vs OS 30.8%–100%). Further, automated analysis significantly reduced analysis time compared to manual annotation (DL: 22 ± 0.6 s vs. OS; 101.7 ± 7 s, p ≤ 0.01). By demonstrating that our algorithm not only matches the precision of expert surgeons but also significantly outpaces them in both speed and consistency of measurements, our research underscores a pivotal advancement in harnessing AI to enhance clinical efficiency and decision-making in orthopaedics.

Analyzing the Impact of Different Bonding Protocol Strategies to Improve the Fracture Resistance of Uncomplicated Crown Fractures on Tooth Fracture Reattachment in Permanent Anterior Teeth: An In-vitro Study.

Objective This study aims to analyze three different bonding protocol strategies in determining the fracture resistance on the reattachment of fragments in permanent anterior teeth. Methodology This study evaluated the ability of three bonding methods (Group A, total-etch technique; Group B, selective-etch technique; and Group C, self-etch technique) to enhance the fracture resistance of reattached tooth fragments. Sixty permanent maxillary central incisors were chosen, segmented at 3 mm from the incisal edge, and randomly distributed among the three groups. Tooth fragments were stored for 24 hours in GC Tooth Mousse (GC Corporation, Tokyo, Japan), and then reattachment was done using respective bonding techniques. Fracture resistance was gauged using a universal testing machine. Results The mean fracture resistance values were as follows: total-etch (419.5995 N), selective-etch (359.1448 N), and self-etch (192.0887 N). One-way analysis of variance (ANOVA) and post hoc Tukey tests revealed a statistically significant difference between the groups. It was inferred that the total-etch technique exhibited the highest fracture resistance, while the self-etch technique resulted in the lowest fracture resistance (P < 0.05). Conclusions The choice of bonding technique for reattaching tooth fragments should be made based on clinical context and patient needs. Total-etch provided the highest fracture resistance, but selective etch can be preferred for anterior teeth with lower occlusal loads to prevent sensitivity.The self-etch technique may not provide sufficient strength and should be used cautiously. More clinical studies are required to validate these findings and guide clinical decision-making in traumatic dental injury management.

Endovascular Management of Iatrogenic Neck Vascular Injury after Central Venous Catheterisation

Endovascular Management of Iatrogenic Neck Vascular Injury after Central Venous Catheterisation

Role of point of care ultrasound and parathormone hormone in management of acute kidney injury in emergency department

ABSTRACT Background Role of point of care ultrasound in management of acute kidney injury (AKI) is still unclear. The discrimination between AKI and chronic kidney disease (CKD) in ED, especially in the absence of clear CKD history, represents a dilemma. Aim To test the accuracy of POCUS and intact parathormone hormone (iPTH) as differentiators between AKI and CKD, and to investigate the role of POCUS in management of AKI in the ED. Methods This prospective study involved 95 adult patients presented to ED of Alexandria Main University Hospital, with signs and/or symptoms suggesting renal impairment in the absence of prior renal functions tests from April 2022 to December 2022. POCUS was done and iPTH was measured for all enrolled patients. Validity of renal length and iPTH to discriminate AKI and CKD were tested. POCUS were used to identify different underlying causes of AKI. Results Renal length ≤ 9.62 cm could diagnose CKD (Area under curve-AUC 0.926) with 82.46% sensitivity, 92.11% specificity, 94.0% PPV and 77.8% NPV. Intact PTH level > 161 pg/ml could diagnose CKD (AUC 0.844) with 73.17% sensitivity, 92.11% specificity, 90.9% PPV and 76.1% NPV. Conclusion Both renal length and iPTH are accurate tests to differentiate AKI from CKD in ED. POCUS help identifying the different causes of AKI and reaching appropriate management decisions.

Prospective validation of the EASL management algorithm for acute kidney injury in cirrhosis

The management of acute kidney injury (AKI) in cirrhosis is challenging. The EASL guidelines proposed an algorithm for the management of AKI, but this has never been validated. We aimed to prospectively evaluate this algorithm in clinical practice. We performed a prospective cohort study in consecutive hospitalized patients with cirrhosis and AKI. The EASL management algorithm includes identification/treatment of precipitating factors, 2-day albumin infusion in patients with AKI ≥stage 1B, and treatment with terlipressin in patients with hepatorenal syndrome (HRS-AKI). The primary outcome was treatment response, which included both full and partial response. Secondary outcomes were survival and adverse events associated with terlipressin therapy. A total of 202 AKI episodes in 139 patients were included. Overall treatment response was 80%, while renal replacement therapy was required in only 8%. Response to albumin infusion was achieved in one-third of episodes. Of patients not responding to albumin, most (74%) did not meet the diagnostic criteria of HRS-AKI, with acute tubular necrosis (ATN) being the most common phenotype. The response rate in patients not meeting the criteria for HRS-AKI was 70%. Only 30 patients met the diagnostic criteria for HRS-AKI, and their response rate to terlipressin was 61%. Median time from AKI diagnosis to terlipressin initiation was only 2.5 days. While uNGAL (urinary neutrophil gelatinase-associated lipocalin) could differentiate ATN from other phenotypes (AUROC 0.78), it did not predict response to therapy in HRS-AKI. Ninety-day transplant-free survival was negatively associated with MELD-Na, ATN and HRS-AKI as well as uNGAL. Three patients treated with terlipressin developed pulmonary edema. The application of the EASL AKI algorithm is associated with very good response rates and does not significantly delay initiation of terlipressin therapy. The occurrence of acute kidney injury (AKI) in patients with cirrhosis is associated with poor short-term mortality. Improving its rapid identification and prompt management was the focus of the recently proposed EASL AKI algorithm. This is the first prospective study demonstrating that high AKI response rates are achieved with the use of this algorithm, which includes identification of AKI, treatment of precipitating factors, a 2-day albumin challenge in patients with AKI ≥1B, and supportive therapy in patients with persistent AKI not meeting HRS-AKI criteria or terlipressin with albumin in those with HRS-AKI. These findings support the use of this algorithm in clinical practice.

A Misleading Case: Lichtenberg Figures Caused by Illegal Use of Electricity from High-Voltage Transformer

Although injuries with high voltage are relatively rare in emergency services, their morbidity and mortality are high. Findings in the body after the event can guide the diagnosis and treatment. A 21-year-old female patient was brought by her relatives with the complaint of electric shock. Lichtenberg figures, which are known to occur because of high voltage, were observed in the body examination of the patient, who stated that the incident occurred after contact with an open cable at home. When the anamnesis was detailed again, it was learned that she entered the transformer for illegal use. Voltage information is key in electrical injury management. With criminal concerns, patients may describe events differently. The clues in the examination, like Lichtenberg figures, can change the management of the patient.

Elevating Precision in Kidney Injury Management: Unraveling the Impact of Serum Cystatin C Levels – A Cohort Study in Lahore Hospitals

Background: Chronic Kidney Disease (CKD) and Acute Kidney Injury (AKI) pose significant challenges in clinical diagnostics due to late presentation and the influence of non-renal factors on traditional biomarkers. Serum creatinine, while commonly used, lacks sensitivity in early-stage kidney dysfunction due to its delayed elevation post-reduction in glomerular filtration rate (GFR). Serum cystatin C, on the other hand, is not influenced by muscle mass, age, gender, or ethnicity, and thus presents as a potential early biomarker for kidney injury. Objective: The objective of this study was to evaluate the efficacy of serum cystatin C compared to serum creatinine in early detection of renal dysfunction in AKI patients, assessing its correlation with renal decline and potential as a predictor for patient outcomes. Methods: In a cohort study over two years at a tertiary care hospital, 200 healthy individuals and 130 AKI patients were assessed. Serum cystatin C and creatinine levels were measured using ELISA and chemiluminescent immunoassay (CLIA) respectively. Demographics, clinical statistics, and Pearson correlation coefficients were calculated, followed by multiple logistic regression analyses for GFR. Statistical significance was established at P&lt;0.001. Results: Results indicated that in the early phase of AKI, 56.2% of patients had normal serum creatinine levels, whereas serum cystatin C levels were elevated in all patients. The Pearson Correlation Coefficient between serum creatinine and cystatin C was significant (&lt;0.01). Multiple logistic regression revealed cystatin C-based GFR was a more reflective indicator of declining GFR than creatinine-based GFR (P&lt;0.001). Conclusion: Serum cystatin C is a superior biomarker to serum creatinine for early detection of kidney dysfunction in AKI patients, facilitating earlier and potentially more effective therapeutic interventions. This finding could lead to significant improvements in patient prognosis and the management of kidney disease.

Arthroscopic Evaluation of Association of Meniscus Injuries in Patients with Anterior Cruciate Ligament Injuries

Background: The knee joint's stability relies significantly on the integrity of the meniscus and the anterior cruciate ligament (ACL). Chronic ACL tears can compromise knee stability, making the meniscus a crucial stabilizer. Understanding the prevalence and patterns of meniscus injuries associated with chronic ACL tears is essential for effective management. Objective: This study aimed to assess the arthroscopic evaluation of association of meniscus injuries in patients with anterior cruciate ligament injuries. Method: A retrospective analysis was conducted on thirty-three patients diagnosed with ACL injuries at MuMCH between January 2021 and December 2023. Patients aged 18-50 with ACL injuries, with or without meniscus damage, were included. Clinical evaluations, knee MRI scans, and diagnostic knee arthroscopies were performed. The study evaluated meniscus injuries associated with chronic ACL injuries and assessed outcomes using the modified Lysholm score. Results: The study revealed a predominant occurrence of meniscus injuries (70%) among participants, with a majority falling within the 38-47 years age bracket (45.45%) and a male majority (60%). Sports and accidental injuries accounted for 40% each, while road traffic accidents contributed 20%. Lateral meniscus tears were the most prevalent (30.30%), followed by combined medial and lateral meniscus tears (33.33%). Posterior horn tears were predominant, particularly in the medial meniscus. Conclusion: The study highlights a high incidence of meniscus injuries associated with chronic ACL tears, with medial meniscus injuries prevailing over lateral tears. Posterior horn tears were predominant, emphasizing the medial meniscus's significant role in knee stability. These findings underscore the importance of early detection and appropriate management of meniscus injuries in chronic ACL-deficient knees to prevent degenerative changes and optimize patient outcomes.

Knowledge, Attitude and Practice Towards Emergency Management of Avulsed Tooth among Dental Practionator in Pakistan: A Questionnaire-Based Survey

Background: The management of dental traumatic injuries, particularly avulsed permanent teeth, necessitates a comprehensive understanding and proficient clinical skills among dental practitioners. With the increasing prevalence of dental injuries due to various factors, the knowledge and practices of dentists in emergency and clinical management are pivotal for successful outcomes. This study aims to evaluate the current state of knowledge, attitudes, and practices among Pakistani dentists regarding the management of avulsed teeth, highlighting areas for improvement and adherence to international guidelines. Objective: To assess the knowledge, attitudes, and practices of dental practitioners in Pakistan concerning the emergency management of avulsed permanent teeth and to identify gaps in knowledge and practice compared to the International Association of Dental Traumatology (IADT) guidelines. Methods: A cross-sectional survey was conducted among 120 dental professionals in Pakistan, using an online questionnaire from August to September 2022. The survey comprised three sections: demographic information, knowledge and attitudes towards dental trauma education, and practices in the emergency management of avulsed teeth. Descriptive statistics were employed to analyze the data, utilizing SPSS version 25.0 for statistical analysis. Results: The survey revealed that 47.5% of respondents felt they received enough information during their undergraduate education, yet a significant proportion reported forgetting much of this knowledge over time. Regarding post-graduation knowledge sources, conferences and medical journals were the most cited (26.7% and 24.2%, respectively). In terms of practice, 79.2% correctly identified HBSS as the optimal storage medium for avulsed teeth, and 60% adhered to rinsing the tooth with saline before replantation. Awareness of the critical extra-oral dry time being under 60 minutes was noted in 59.2% of participants, and a majority were in favor of initiating root canal treatment 7 to 10 days post-replantation for teeth with a closed apex, aligning with IADT recommendations. However, a preference for rigid splints over flexible ones was observed in 54.2% of respondents, indicating a deviation from best practices. Conclusion: The study identified a satisfactory level of knowledge among Pakistani dentists regarding some aspects of avulsed tooth management but also highlighted significant gaps, particularly in the use of flexible splints and recollection of undergraduate training. Continuous education and adherence to IADT guidelines are essential for improving the management of dental traumatic injuries.

REMOVED: Successful management of an Iatrogenic portal vein and hepatic artery injury in a 4-month-old female patient: A case report and literature review

Serious iatrogenic vascular injuries are considered uncommon; however, they are underreported. There are limited studies discussing the proper management of these injuries; therefore, the management is often anecdotal. A 4-month-old female patient presented with elevated liver enzymes and cholecystitis with sludge. Her HIDA scan suggested biliary atresia. During the surgery, there was a bilateral iatrogenic injury to the hepato-duodenal ligament, including the portal vein, hepatic artery, and bile ducts. The patient underwent splenectomy and cholecystectomy, and the hepatic artery transection was successfully managed with a splenic artery jump graft and a portal vein bypass initiated with the SMV using a Gore-TexⓇ vascular graft. The management of iatrogenic vascular injury depends primarily on the assessment of the stage of the injury, which should be conducted by experienced surgeons using proper strategies in an established hepato-biliary surgical center. Additionally, there is little data provided in the literature, mostly case reports. Therefore, no preferred or specific approach can be found.

Comparison of Efficacy and Safety Profile of Conservative Versus Surgical Management of Meniscal Injuries

Background: Surgical management of meniscal tear carries financial implications in resource limited settings like ours. Conservative management could address this issue, if its safety and efficacy profile is better understood. Objectives: The objective of this study was to compare the efficacy and safety of conservative and surgical management of patients with meniscal tear with conservative management.Material and Methods: Descriptive comparative study of 80 patients with meniscal tear, recruited through non-probability convenient sampling technique, was carried out at Orthopedic unit MMC MTI Mardan, during 1st August 2022 and 31st July 2023. Patients were assigned to surgical and conservative group. International Knee Documentation Committee (IKDC) score at baseline and 3 months after treatment were compared for efficacy. Treatment related complications were noted.Results: A total of 80 patients were enrolled with 40 patients in each group (surgical versus conservative). The mean baseline and IKDC score at week 12 in surgical versus conservative group were 45.069±13.301 versus 51.873±17.90 and 79.52±7.40 versus 73.92±11.67 respectively. Surgical group showed treatment response in 37 patients (92.5%) versus 31 (77.5%) in conservative approach (p value 0.060). Surgical site infection was observed in 5 patients (12.5%) in surgical group. Medication related adverse effects were observed in 3 patients (7.5%) in conservative group.Conclusion: No appreciable differences in the clinical results, such as pain reduction or better knee function, between patients who received meniscal surgery and those who underwent conservative treatment for meniscal tears.Keywords: Conservative Approach, Meniscal Injury, Surgical Approach, Treatment Outcomes

Traumatic dental injuries: Knowledge assessment of dentists in the Norwegian Public Dental Service of Vestland.

Most children and adolescents in Norway attend the Public Dental Service (PDS) where they are treated free-of-charge until the age of 19 years. Thus, general dentists employed in the PDS are the primary care providers for traumatic dental injuries (TDI) in young patients. This cross-sectional study assessed the knowledge of PDS general dentists on the acute management and follow-up of TDI and its socio-demographic and attitudinal covariates. All general dentists employed in the Vestland County PDS, Western Norway, (N = 170) received an online questionnaire. Socio-demographic and professional profiles of respondents as well as attitudinal indicators were queried. Clinical case scenarios on emergency treatment and further follow-ups of TDI were used to calculate a dental trauma knowledge score (DTKS; range: 0-21). Mann-Whitney U tests and Kruskal-Wallis tests determined differences between the demographic subgroups. Logistic regressions determined the potential of single factors in explaining the variability in dental trauma knowledge. The response rate was 46%. Most participants (60.5%) had not participated in a TDI course after graduation but would like such a course (84.2%). Mean DTKS was 13.82 (±2.6). Knowledge scores differed significantly between age groups (p = .014) and years since graduation (p = .0018). Younger dentists and recently graduated dentists scored highest. Dentists under the age of 30 years scored higher than 30-39- and 40-49-year-old dentists in these areas: emergency treatment of crown fractures with pulp exposure, identification of complications after avulsion, and management of severe intrusive luxation injury. Younger dentists had a higher theoretical knowledge of TDI. Continuing professional development among dentists in the Norwegian PDS is needed for emergency treatment and complication management after TDI.

Cell-free fat extract promotes axon regeneration and retinal ganglion cells survival in traumatic optic neuropathy.

Injuries to axons within the central nervous system (CNS) pose a substantial clinical challenge due to their limited regenerative capacity. This study investigates the therapeutic potential of Cell-free fat extract (CEFFE) in CNS injury. CEFFE was injected intravitreally after the optic nerve was crushed. Two weeks post-injury, quantification of regenerated axons and survival rates of retinal ganglion cells (RGCs) were performed. Subsequently, comprehensive gene ontology (GO) an-notation elucidated the cellular origins and functional attributes of CEFFE components. Molecular mechanisms underlying CEFFE's therapeutic effects were explored through Western blotting (WB). Additionally, levels of inflammatory factors within CEFFE were determined using enzyme-linked immunosorbent assay (ELISA), and histological staining of microglia was conducted to assess its impact on neuroinflammation. CEFFE demonstrated a significant capacity to promote axon re-generation and enhance RGCs survival. GO annotation revealed the involvement of 146 proteins within CEFFE in axonogenesis and neurogenesis. WB analysis unveiled the multifaceted pathways through which CEFFE exerts its therapeutic effects. Elevated levels of inflammatory factors were detected through ELISA, and CEFFE exhibited a modulatory effect on microglial activation in the retinal tissue following optic nerve crush (ONC). The present study highlights the therapeutic promise of CEFFE in the management of CNS injuries, exemplified by its ability to foster axon regeneration and improve RGCs survival.