Repeat Injury Research Articles

Hereditary hemorrhagic telangiectasia with liver cirrhosis: a case report

BackgroundHereditary hemorrhagic telangiectasia is an autosomal dominant hereditary hemorrhagic disease. Its main feature is an abnormal structure of the blood vessel wall. Cirrhosis of the liver is a common chronic progressive disease with one or more causes in which diffuse liver damage occurs after long-term or repeated injury. Liver cirrhosis can cause dilation of gastrointestinal capillaries. Many patients with hereditary hemorrhagic telangiectasia accompanied by gastrointestinal vascular malformations and liver cirrhosis may be diagnosed only with liver cirrhosis if the clinician does not pay attention to physical examination findings and family history. Moreover, general treatment measures, such as blood transfusion, iron supplementation, and application of hemostatic drugs, are less effective for bleeding in patients with hereditary hemorrhagic telangiectasia than in those with liver cirrhosis alone.Case presentationHere, we report the rare case of a 75-year-old Chinese man who was admitted to the hospital with repeated melena and epistaxis. He was diagnosed with unexplained liver cirrhosis, which was later confirmed as hereditary hemorrhagic telangiectasia. Subsequently, we implemented the treatment intervention of oral thalidomide combined with gastrointestinal argon plasma coagulation. A follow-up of more than 8 months showed that the treatment effect was excellent.ConclusionsIf patients with liver cirrhosis and gastrointestinal vascular malformations also have a family history of epistaxis, special attention should be paid to targeted physical examination results, and the possibility of hereditary hemorrhagic telangiectasia should be considered. Moreover, for patients with hereditary hemorrhagic telangiectasia and both gastrointestinal bleeding caused by gastrointestinal capillaries and repeated epistaxis, when other general treatment measures are ineffective, thalidomide combined with gastrointestinal argon plasma coagulation may be an effective intervention.

Trauma-Informed Acute Care of Patients With Violence-Related Injury.

Violently-injured individuals presenting to the emergency department (ED) have an elevated risk of repeat injury after being discharged from acute care settings and a high rate of unaddressed mental health and social needs. While there is a growing body of programmatic interventions to address these needs, including hospital-based violence intervention programs, there is a lack of data regarding physician perspectives of current practice for this patient population. Understanding current practice is critical for integrating new programs into workflow and developing evidence-based medical education to improve care. The aim of this study is to elucidate current trauma-informed care practices of emergency medicine and general surgery trainee physicians to inform future curriculum development surrounding care of violently injured patients. In this study, emergency medicine and surgical trainees with at least one year of residency experience participated in simulation-primed interviews in pairs or small groups. Interviews garnered perspectives on the physician role in treating violently injured youth, using simulation as a priming event focused on previously known patient concerns. Qualitative themes that emerged were participants (1) perceived their role as managing medical/surgical concerns and seek others to build trust and manage psychosocial and legal concerns, (2) had a high level of knowledge of ED stressors and de-escalation strategies, (3) perceived that patient distrust can negatively impact their ability to provide care, and (4) perceived that law enforcement can negatively impact care and are sometimes uncertain about how to interact with law enforcement. These findings support that medical education for providers should focus on medicolegal issues, particularly managing law enforcement presence in the ED, structural and interpersonal causes of distrust of medical providers and the medical system, and addressing postdischarge mental health and social needs.

Effects of intravitreal injection of siRNA against caspase-2 on retinal and optic nerve degeneration in air blast induced ocular trauma

Ocular repeated air blast injuries occur from low overpressure blast wave exposure, which are often repeated and in quick succession. We have shown that caspase-2 caused the death of retinal ganglion cells (RGC) after blunt ocular trauma. Here, we investigated if caspase-2 also mediates RGC apoptosis in a mouse model of air blast induced indirect traumatic optic neuropathy (b-ITON). C57BL/6 mice were exposed to repeated blasts of overpressure air (3 × 2 × 15 psi) and intravitreal injections of siRNA against caspase-2 (siCASP2) or against a control enhanced green fluorescent protein (siEGFP) at either 5 h after the first 2 × 15 psi (“post-blast”) or 48 h before the first blast exposure (“pre-blast”) and repeated every 7 days. RGC counts were unaffected by the b-ITON or intravitreal injections, despite increased degenerating ON axons, even in siCASP2 “post-blast” injection groups. Degenerating ON axons remained at sham levels after b-ITON and intravitreal siCASP2 “pre-blast” injections, but with less degenerating axons in siCASP2 compared to siEGFP-treated eyes. Intravitreal injections “post-blast” caused greater vitreous inflammation, potentiated by siCASP2, with less in “pre-blast” injected eyes, which was abrogated by siCASP2. We conclude that intravitreal injection timing after ocular trauma induced variable retinal and ON pathology, undermining our candidate neuroprotective therapy, siCASP2.

Pharmacognostical and Phytochemical Analysis of Rasayana Churna Vati for Quality Control - An Ayurveda Formulation

Rasayana churna was mentioned by Acharya Vagbhatta for rejuvenation of body tissue. Rasayana properties of this combination revitalize the unhealthy tissue on systemic level. Rasayana Churna is a polyherbal formulation contacting 3 ingredients i.e., Amalaki, Guduchi and Gokshura are well known drugs for its rich in antioxidant, immunomodulator and purifactory action. Repeated stress injury in visual system is major cause of Computer Vision Syndrome- a new milliner disorder. A study conducted as randomized clinical trial showed that Rasayan churana significantly improves a group of symptoms in Computer Vision Syndrome.
 The present study was carried out to standardize the finished product of Rasayana Churna Vati. It includes Authentication, Organoleptic properties, physic-chemical parameters, assay of active and qualitative HPTLC analysis to confirm entity, quality and purity. All results were compared with Ayurvedic Pharmacopoeial standard. The presence of rosette crystals of calcium oxalate, lignified tissues, prismatic crystals, reticulate vessels, starch grains oval, tannins, trichomes were the characteristic features observed in the microscopy of the prepared drug. Phyto-chemical analysis showed Loss on drying 1.87% w/w, Total ash 4.35% w/w, water soluble extract 34.73% w/w, Acid insoluble ash 0.73% w/w, Alcohol soluble extractive 14.34% w/w & pH 3.4. Identification of constituents of Rasayana Churna Vati was done by HPTLC scanning at 254 and 366mm gives positive test for Guduchi, Gokshura and Amalaki.

The cell cycle inhibitor P21 promotes the development of pulmonary fibrosis by suppressing lung alveolar regeneration

The cell cycle inhibitor P21 has been implicated in cell senescence and plays an important role in the injury–repair process following lung injury. Pulmonary fibrosis (PF) is a fibrotic lung disorder characterized by cell senescence in lung alveolar epithelial cells. In this study, we report that P21 expression was increased in alveolar epithelial type 2 cells (AEC2s) in a time-dependent manner following multiple bleomycin-induced PF. Repeated injury of AEC2s resulted in telomere shortening and triggered P21-dependent cell senescence. AEC2s with elevated expression of P21 lost their self-renewal and differentiation abilities. In particular, elevated P21 not only induced cell cycle arrest in AEC2s but also bound to P300 and β-catenin and inhibited AEC2 differentiation by disturbing the P300–β-catenin interaction. Meanwhile, senescent AEC2s triggered myofibroblast activation by releasing profibrotic cytokines. Knockdown of P21 restored AEC2-mediated lung alveolar regeneration in mice with chronic PF. The results of our study reveal a mechanism of P21-mediated lung regeneration failure during PF development, which suggests a potential strategy for the treatment of fibrotic lung diseases.

Evaluation of Injury Recidivism Using the Electronic Medical Record

BackgroundTraumatic injuries remain one of the leading causes of death in the United States. Patients who survive traumatic injuries but return to the emergency department with repeat injuries are said to suffer from injury recidivism. Numerous studies have described trends in injury recidivism using trauma registry and survey data. To our knowledge, no prior study has leveraged electronic medical record (EMR) data to characterize injury recidivism. The EMR is potentially more comprehensive as it contains details of patients who visited the emergency department after injury but did not meet the criteria for inclusion in the trauma registry. Such injuries could be predictive of future recidivism. We therefore aimed to describe patterns of injury recidivism seen at a Level 1 trauma center using the EMR. MethodsA retrospective review was conducted of all injury-related encounters between January 2016 and December 2019. Manual review was conducted of all recidivistic encounters with < 11 months between encounters to ensure the recidivistic encounter was not a sequela of the index visit. A general estimating equation logistic regression adjusted for age, race, sex, and insurance payor, estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between injury mechanism and odds of recidivistic encounter. ResultsA total of 20,566 index encounters was included during the study period. Of the 20,566 encounters, 7.6% (n = 1570) had a recidivistic encounter during the study period, half of which (n = 781) occurred within the first year of the index encounter. An over two-fold increased odds of recidivism was observed for blunt assault encounters (OR 2.53, 95% CI 2.03-3.15) and unintentional falls (OR 2.10, 95% CI 1.76-2.52). For both mechanisms, this increase was observed across the three years following the index encounter. ConclusionsOur study found that patients with assault injuries have the highest odds of injury recidivism and assault-related recidivistic encounters. These results demonstrate the feasibility and utility of incorporating EMR data, and suggest that the development of targeted interventions focused on mitigating assault injuries, such as hospital-based violence intervention programs, should be considered in our region.

Analysis of Injuries and Pitching Performance Between Major League Baseball and Nippon Professional Baseball: A 2-Team Comparison Between 2015 to 2019.

Background:There has been minimal research investigating injury and pitching performance differences between Major League Baseball (MLB) and other professional leagues.Purpose/Hypothesis:This 2-team comparison between MLB and Japan’s Nippon Professional Baseball (NPB) involved affiliated players over 5 years. We hypothesized that teams would differ in the injury incidence, mechanism of injury, pitch velocity, and pitch type usage.Study Design:Descriptive epidemiology study.Methods:Between 2015 and 2019, pitching data as well as injury statistics for the highest level and minor league affiliates of the Los Angeles Angels (MLB) and the Hiroshima Toyo Carp (NPB) were reviewed for significant differences in the injury prevalence, injury type, mechanism of injury, and days missed. In total, 3781 MLB and 371 NPB injuries were studied.Results:MLB-affiliated players were significantly younger, taller, and heavier (P < .001) than were NPB-affiliated players. MLB-affiliated pitchers threw faster than did their NPB counterparts (P = .026). MLB minor league pitchers threw more curveballs than did NPB minor league pitchers (P = .004), and MLB minor league relief pitchers threw more sliders than did NPB minor league relief pitchers (P = .02). The MLB team had a 3.7-fold higher incidence of injuries versus the NPB team (0.030 vs 0.008 injuries per player-game, respectively) as well as more repeat injuries, with fewer days missed per injury (15.8 ± 54.7 vs 36.2 ± 55.1 days, respectively; P < .001). The MLB team also had a higher percentage of injuries that were throwing related (P < .001), were contact related (P < .001), and occurred outside of competition (P < .001) compared with the NPB team.Conclusion:This is the first empirical study examining injury trends and pitching characteristics between MLB and NPB athletes. MLB-affiliated pitchers threw faster and relied more on breaking pitches in comparison with NPB-affiliated pitchers. From injury data, MLB players were younger, taller, and heavier with a higher percentage of throwing-related injuries, contact injuries, and injuries sustained outside of competition. Overall, the MLB team indicated a 3.7-fold higher rate of reported injuries with fewer days missed per injury than did the NPB team. Competitive conditions are distinctly different between MLB and NPB, and thus, more extensive research collaborations in the future can identify best practices to advance health and performance for both leagues.

AWARENESS AND EFFECTS OF TEXT NECK SYNDROME IN PHYSIOTHERAPY STUDENTS IN DEHRADUN

Background: Text neck is a repeated stress injury and pain sustained from excessive watching or texting on handheld devices for long periods of time. This study was designed to guide us through occurrence, awareness and consequences of text neck syndrome in physiotherapy students. Method: The study design was an observational study with a sample size of 258 healthy physiotherapy students of the age group 18-24 years. Students were asked to ll the questionnaires of Awareness of text neck syndrome (ATNS), NDI, SPADI and Headache. The questionnaire collected the awareness of Text Neck Syndrome and its affects in the selected sample. CVA was obtained and recorded photographically and was measured using Coral Draw X7 software. Conclusion: The study demonstrated a low level of awareness of text neck syndrome amongst young physiotherapy students in Dehradun. The study also depicted that daily mobile phone use for more than 2 hours resulted in mild pain and disability in the neck and shoulder along with forward head posture. In addition the result depicted that subjects using phone more than 6 hours were at higher risk of Text neck Syndrome

Ddx41 loss R-loops in cGAS to fuel inflammatory HSPC production

In this issue of Developmental Cell, Weinreb etal. reveal that loss of the DEAD-box helicase Ddx41 unexpectedly triggers an R-loop-mediated sterile inflammatory cascade which drives HSPC production during embryonic development. Human studies suggest mechanistic conservation for inflammation in DDX41-associated hematologic disease, uncovering a potential route for future therapeutic intervention.

Are Postcast Removal X-rays and a Second Follow-up Necessary in the Treatment of Nondisplaced Supracondylar Humerus Fractures?

The utility of routine follow-up radiographs for the treatment of nondisplaced pediatric supracondylar humerus fractures has not been established. The purpose of this study is to (1) determine the frequency that postcast removal x-rays change patient management and (2) determine the role of routine follow-up for range of motion evaluation after cast removal in the treatment of nondisplaced supracondylar humerus fractures. We conducted a single center retrospective chart review of patients under the age of 18 years old that sustained nondisplaced supracondylar humerus fractures between January 1, 2010 and July 1, 2018. Demographic information, fracture characteristics, time to follow-up and each appointment outcome were recorded. A change in patient management after postcast removal x-ray was defined as a need for an additional period of immobilization, a delay in initiation of range of motion exercises, or need for operative intervention. In addition, the appointment for range of motion evaluation was considered to alter management if further activity restriction was required, a formal physical therapy program was recommended or an additional office visit required. Unscheduled appointments were also noted. A total of 489 patients met inclusion criteria. The average age was 4.90±2.68 years and 51.8% were female. A total of 487 patients had routine follow-up x-rays after cast removal. No patient had a change of management based on postcast removal radiographs. In all, 290 patients returned for range of motion follow-up with 94.8% of patients being discharged from care. There were 14 patients whose management changed based on this evaluation (4.8%). The most common reason was an additional appointment for range of motion evaluation (12/14 patients, 86%). There were 13 patients with unscheduled evaluation after discharge from care, 77% were secondary to repeat injury. This study suggests that postcast removal x-rays and routine follow-up after cast removal rarely change patient management and may not be necessary in the treatment of nondisplaced pediatric supracondylar humerus fractures. Level IV-case series.

Repeat injuries in childhood.

Injury remains a leading cause of childhood morbidity and mortality in the developing world. The probability of injury occurrence is influenced by agent, host and environmental factors. Studies of repeat injuries in childhood therefore provide insight into factors in the epidemiological triad predisposing children to injury. To determine the proportion of children and the factors associated with repeat presentations to the Red Cross War Memorial Children's Hospital Trauma Unit (RCWMCH TU) in Cape Town, South Africa, for all non-transport-related injuries in childhood. This was a retrospective cohort study using data from the RCWMCH TU. We included children aged 0 - 10 years with first presentation from January 1997 to June 2013 and followed up until the earlier of age 13 years or June 2016. We assessed individual and population-level factors associated with repeat injury using multilevel Poisson regression analysis. Child dependency ratios were derived from the 2011 National Census. Between 1997 and 2013, 72 490 children aged &lt;10 years (59% male) presented to the RCWMCH TU for the first time with injuries. After the initial injury, 9 417 (13%) presented with a repeat injury by 2016 and before age 13 years. After adjusting for health subdistrict, distance from RCWMCH TU and age at first presentation, factors associated with reduced repeat presentation were injury identified as due to abuse (adjusted incidence rate ratio (aIRR) 0.6; 95% confidence interval (CI) 0.4 - 0.7), fluid burn (aIRR 0.6; 95% CI 0.6 - 0.7), foreign body ingestion (aIRR 0.7; 95% CI 0.7 - 0.9), and moderate and severe (v. minor) initial injury (aIRR 0.9; 95% CI 0.8 - 0.9 and aIRR 0.7; 95% CI 0.6 - 0.8, respectively), while boys were more likely to have repeat injury presentations (aIRR 1.4; 95% CI 1.4 - 1.5). Repeat presentations were substantial and associated with male gender. They occurred less commonly after fluid burn injuries, foreign body ingestion and moderate to severe injuries. Children with intentional injuries were also less likely to have a repeat presentation. Further research is indicated for childhood injuries with greater propensity to repeat, including non-height falls and sport-related injuries. Secondary injury prevention education should not neglect patients with unintentional and minor injuries. These results strengthen the hypothesis that injuries arise as a result of sustained exposure to agent, host and environmental risk factors.

Pulmonary injury risk curves and behavioral changes from blast overpressure exposures of varying frequency and intensity in rats

At present, there are no set guidelines establishing cumulative limits for blast exposure numbers and intensities in military personnel, in combat or training operations. The objective of the current study was to define lung injury, pathology, and associated behavioral changes from primary repeated blast lung injury under appropriate exposure conditions and combinations (i.e. blast overpressure (BOP) intensity and exposure frequency) using an advanced blast simulator. Male Sprague Dawley rats were exposed to BOP frontally and laterally at a pressure range of ~ 8.5–19 psi, for up to 30 daily exposures. The extent of lung injury was identified at 24 h following BOP by assessing the extent of surface hemorrhage/contusion, Hematoxylin and Eosin staining, and behavioral deficits with open field activity. Lung injury was mathematically modeled to define the military standard 1% lung injury threshold. Significant levels of histiocytosis and inflammation were observed in pressures ≥ 10 psi and orientation effects were observed at pressures ≥ 13 psi. Experimental data demonstrated ~ 8.5 psi is the threshold for hemorrhage/contusion, up to 30 exposures. Modeling the data predicted injury risk up to 50 exposures with intensity thresholds at 8 psi for front exposure and 6psi for side exposures, which needs to be validated further.

Low-Dose Repeated Cisplatin-Induced Renal Injury Promotes Cyst Formation in Both Cilia Mutant and PC2 Mutant Mouse Models

Low-Dose Repeated Cisplatin-Induced Renal Injury Promotes Cyst Formation in Both Cilia Mutant and PC2 Mutant Mouse Models

Vatakantaka and its management through Ayurveda- A Case review.

Vatakantaka is characterized by pain in the heel region and included in Vatavyadhi by Acharya Sushruta. It causes due to silent and repeated injury resulting into inflammation of plantar fascia which results in the painful heel. It is a common cause of heel pain occurs in about 10% of the general population. Women are twice more prevalent than men. Vatakantaka is mainly caused due to vitiation of Vatadosha and continuous pressure on the heel region. It can be correlated with Chronic planter fasciitis or Calcaneal spur. It is more prevalent in female gender and having Sthul akruti (obesity). Various chikitsa measures for management of Vatakantaka are given in classics of Ayurveda. Here bahya and abhyantar chikitsa with Agnikarma gives improvement in subjective criteria like vedana (pain), stambha (stiffness), shotha (swelling) and kriyahani (restricted movements) in short duration of time.

Impact of Socioeconomic Status on Concomitant Injuries and Access to Care following Anterior Cruciate Ligament Rupture

Objectives:The primary aim of this study was to further define the impact of socioeconomic factors on the timing of ACL reconstruction. The secondary goal was to determine if these variables were associated with bucket handle tears of the meniscus at the time of surgery.Methods:All patients undergoing ACL reconstruction at our institution from October 2015 through November 2018 were sent a survey to determine socioeconomic variables, income, primary language, and education level. A chart review was then performed for insurance status, dates of injury, first visit with orthopeadics, and surgery, intraoperative pathology, and length of follow-up. Univariate analysis was performed, as well as multivariate regression analysis to select independent predictors of outcome variables. A multiple linear regression model with stepwise backward elimination was used for continuous outcome variables. Multivariate logistic analysis was used for the presence of a bucket handle meniscal tear at the time of surgery.Results:Univariate analysis was utilized to determine how insurance type, language spoken, education level, and family income affected: (1) the time from initial injury to clinic visit, (2) number of repeat injuries, and (3) frequency of bucket-handle meniscal tears (Table 1). Speaking a language other than English was associated with significantly longer times to seeing an orthopedic surgeon, more repeat injuries, and a higher likelihood of bucket-handle meniscal tears. Lower educational level correlated with longer wait times and more bucket-handle meniscal tears. Family income level less than $100,000 per year was also associated with a greater incidence of bucket-handle meniscal tears. Multivariate regression analysis was performed to further assess for independent predictors of outcomes. Patients on Medicaid saw an orthopaedic surgeon 39.4 weeks later than those on private insurance (P=0.012). English speakers saw an orthopaedic surgeon 55.68 weeks earlier than Spanish speakers (P=0.027), and patients with a college degree saw a surgeon 36 weeks earlier than patients without a college degree (P=0.023). Non-English speakers had an increased risk of having a bucket handle tear at the time of surgery (OR=4.62; 95CI%=1.677-21.33). Patients with an annual household income less than $100,000 were more likely to have a bucket handle tear (OR=7.37; 95CI%=1.20-53.39). English speakers had an average of 0.8 less instability episodes before surgery (P<0.001); income greater than $100,000/year had 0.25 less instability episodes before surgery (P=.040).Conclusions:Patients with government insurance and who were non-English-speaking experienced later access to care and later surgery after orthopaedic surgery evaluation. Non-English-speaking patients also experienced higher rates of repeat injury, instability, and bucket handle medial meniscus tears. Patients without a college degree also experienced later access to care. Patients with a household income less than $100,000 per year experienced higher rates of instability and bucket handle medial meniscus tears. Delayed access to orthopaedic care longer than 13 weeks was associated with higher rates of meniscus tears, and after 30 weeks bucket handle meniscus tears were significantly increased. These findings may inform the orthopaedic and broader medical communities of the impact of lower socioeconomic status on patients’ access to care and higher rates of concomitant injuries.

Assessment of necroptosis in the retina in a repeated primary ocular blast injury mouse model

Primary blast injury (caused by the initial rapid increase in pressure following an explosive blast) to the retina and optic nerve (ON) causes progressive visual loss and neurodegeneration. Military personnel are exposed to multiple low-overpressure blast waves, which may be in quick succession, such as during breacher training or in combat. We investigated the necroptotic cell death pathway in the retina in a mouse repeated primary ocular blast injury (rPBI) model using immunohistochemistry. We further evaluated whether intravitreal injections of a potent necroptosis inhibitor, Necrostatin-1s (Nec-1s), protects the retina and ON axons by retinal ganglion cells (RGC) counts, ON axonal counting and optical coherence tomography (OCT) analysis of vitreous haze. Receptor interacting protein kinase (RIPK) 3, increased in the inner plexiform layer 2 days post injury (dpi) and persisted until 14 dpi, whilst RIPK1 protein expression did not change after injury. The number of degenerating ON axons was increased at 28 dpi but there was no evidence of a reduction in the number of intact ON axons or RNA-binding protein with multiple splicing (RBPMS)+ RGC in the retina by 28 dpi in animals not receiving any intravitreal injections. But, when intravitreal injections (vehicle or Nec-1s) were given there was a significant reduction in RBPMS+ RGC numbers, suggesting that rPBI with intraocular injections is damaging to RGC. There were fewer RGC lost after Nec-1s than vehicle injection, but there was no effect of Nec-1s or vehicle treatment on the number of degenerating axons. OCT analysis demonstrated no effect of rPBI on vitreous haze, but intravitreal injection combined with rPBI increased vitreous haze (P = 0.004). Whilst necroptosis may be an active cell death signalling pathway after rPBI, its inhibition did not prevent cell death, and intravitreal injections in combination with rPBI increased vitreous inflammation and reduced RBPMS+ RGC numbers, implying intravitreal injection is not an ideal method for drug delivery after rPBI.

A new model of repeat mTBI in adolescent rats

Sports-related injury is frequently associated with repeated diffuse and mild traumatic brain injury (mTBI). We combined two existing models for inducing TBI in rats, the Impact Acceleration and Controlled Cortical Impact models, to create a new method relevant to the study of cognitive sequelae of repeat mTBI in adolescent athletes. Repeated mTBI, such as those incurred in sports, can result in a wide range of outcomes, with many individuals experiencing no chronic sequela while others develop profound cognitive and behavioral impairments, typically in the absence of lasting motor symptoms or gross tissue loss appreciable antemortem. It is critical to develop models of mTBI and repeat mTBI that have the flexibility to assess multiple parameters related to injury (e.g. number and magnitude of impacts, inter-injury interval, etc) that are associated with brain vulnerability compared to normal recovery. We designed a 3D-printed plastic implant to permanently secure a metal disc to the skull of adolescent rats in order to induce multiple injuries without performing multiple survival surgeries and also to minimize pre-injury anesthesia time. Rats were randomly assigned to sham injury (n = 12), single injury (n = 12; injury on P41), or repeat injury (n = 14; injuries on P35, P38, and P41) groups. Compared to single injury and sham injury, repeat injuries caused increased toe pinch reflex latency (F(2,34) = 4.126, p < .05) and diminished weight gain (F(2, 34) = 4.767, p < .05). Spatial navigation was tested using Morris water maze, beginning one week after the final injury (P48). While there were no differences between groups during acquisition, both single and repeat injuries resulted in deficits on probe trial performance (p < .01 and p < .05 respectively). Single injury animals also exhibited a deficit in working memory deficit across three days of testing (p < .05). Neither injury group had neuronal loss in the hilus or CA3, according to stereological quantification of NeuN. Therefore, by implanting a helmet we have created a relevant model of sports-related injury and repeated mTBI that results in subtle but significant changes in cognitive outcome in the absence of significant hippocampal cell death.

Induction of Complete Transection-Type Spinal Cord Injury in Mice.

Spinal cord injury (SCI) largely leads to irreversible and permanent loss of function, most commonly as a result of trauma. Several treatment options, such as cell transplantation methods, are being researched to overcome the debilitating disabilities arising from SCI. Most pre-clinical animal trials are conducted in rodent models of SCI. While rat models of SCI have been widely used, mouse models have received less attention, even though mouse models can have significant advantages over rat models. The small size of mice equates to lower animal maintenance costs than for rats, and the availability of numerous transgenic mouse models is advantageous for many types of studies. Inducing repeatable and precise injury in the animals is the primary challenge for SCI research, which in small rodents requires high-precision surgery. The transection-type injury model has been a commonly used injury model over the last decade for transplantation-based therapeutic research, however a standardized method for inducing a complete transection-type injury in mice does not exist. We have developed a surgical protocol for inducing a complete transection type injury in C57BL/6 mice at thoracic vertebral level 10 (T10). The procedure uses a small tip drill instead of rongeurs to precisely remove the lamina, after which a thin blade with rounded cutting edge is used to induce the spinal cord transection. This method leads to reproducible transection-type injury in small rodents with minimal collateral muscle and bone damage and therefore minimizes confounding factors, specifically where behavioral functional outcomes are analyzed.

Investigating the Range of Symptom Endorsement at Initiation of a Graduated Return-to-Play Protocol After Concussion and Duration of the Protocol: A Study From the National Collegiate Athletic Association–Department of Defense Concussion, Assessment, Research, and Education (CARE) Consortium

Background: Organizations recommend that athletes should be asymptomatic or symptom-limited before initiating a graduated return-to-play (GRTP) protocol after sports-related concussion, although asymptomatic or symptom-limited is not well-defined. Hypotheses: (1) There will be a range (ie, beyond zero as indicator of “symptom-free”) in symptom severity endorsement when athletes are deemed ready to initiate a GRTP protocol. (2) Baseline symptom severity scores and demographic/preinjury medical history factors influence symptom severity scores at the commencement of the GRTP protocol. (3) Greater symptom severity scores at GRTP protocol initiation will result in longer protocol duration. (4) Symptom severity scores will not differ between those who did and did not sustain a repeat injury within 90 days of their initial injury. Study Design: Cohort study; Level of evidence, 2. Methods: Across 30 universities, athletes (N = 1531) completed assessments at baseline and before beginning the GRTP protocol, as determined by local medical staff. Symptom severity scores were recorded with the symptom checklist of the Sport Concussion Assessment Tool–3rd Edition. Nonparametric comparisons were used to examine the effect of medical, demographic, and injury factors on symptom endorsement at GRTP protocol initiation, as well as differences in symptom severity scores between those who did and did not sustain a repeat injury within 90 days. A Cox regression was used to examine the association between symptom severity scores at GRTP protocol initiation and protocol duration. Results: Symptom severity scores at the time when the GRTP protocol was initiated were as follows: 0 to 5 (n = 1378; 90.0%), 6 to 10 (n = 76; 5.0%), 11 to 20 (n = 42; 3.0%), and ≥21 (n = 35; 2.0%). Demographic (sex and age), medical (psychiatric disorders, attention-deficit/hyperactivity disorder, learning disorder), and other factors (baseline symptom endorsement and sleep) were significantly associated with higher symptom severity scores at the GRTP initiation (P < .05). The 4 GRTP initiation time point symptom severity score groups did not significantly differ in total time to unrestricted RTP, χ2(3) = 1.4; P = .73. When days until the initiation of the GRTP protocol was included as a covariate, symptom severity scores between 11 and 20 (P = .02; hazard ratio = 1.44; 95% CI, 1.06-1.96) and ≥21 (P < .001; hazard ratio = 1.88; 95% CI, 1.34-2.63) were significantly associated with a longer GRTP protocol duration as compared with symptom severity scores between 0 and 5. Symptom severity scores at GRTP initiation did not significantly differ between those who sustained a repeat injury within 90 days and those who did not (U = 29,893.5; P = .75). Conclusion: A range of symptom severity endorsement was observed at GRTP protocol initiation, with higher endorsement among those with higher baseline symptom endorsement and select demographic and medical history factors. Findings suggest that initiation of a GRTP protocol before an absolute absence of all symptoms is not associated with longer progression of the GRTP protocol, although symptom severity scores >10 were associated with longer duration of a GRTP protocol. Results can be utilized to guide clinicians toward optimal GRTP initiation (ie, balancing active recovery with avoidance of premature return to activity).

The Role of Agni karma in the management of Planter Fasciitis

Planter fasciitis is commonly found in 80% population in the society which is caused due to the affection of calcaneum. It is often seen in females and individuals over 35 years. It is one of the most troublesome complaints affecting the individuals in their routine work. Acharya Sushruta suggests the disease planter fasciitis can be correlated with Vatakantaka which is caused by vitiated Vata dosha due to constant standing and walking. Planter fasciitis can develop due to walking on uneven roads with ill fitting footwear which causes silent and repeated injury resulting into inflammation of planter fascia which results into painful heel, tenderness, early morning stiffness &amp; restricted movements of heel. Sushruta has mentioned different methods of management of diseases, such as Bheshaja karma, Kshara karma, Agni karma, Shastrakarma and Raktamokshana. Aim-To study the role of Agnikarma in the management of Planter Fascitis. Objectives: To study planter fasciitis.To study the role of Agnikarma in planter fasciitis. Results and Discussion: Chronic Planter fasciitis can develop due to use of walking on uneven roads with ill fitting footwear which causes silent and repeates injury resulting into inflammation of planter fascia which results into painful heel, tenderness, restricted movements of heel, During the use of Agnikarma chikitsa, we take the Agni in the shalaka by making it Red Hot on fire. The Agni from shalaka is to be transferred to the diseased part, the dhatoo (twacha). The Dhatu Agni gets utkleshit (Activated). The activated dhatoo Agni use to produce Dosh Pachan.&#x0D;