Site Of Trauma Research Articles

Biocompatibility of a Marine Collagen-Based Scaffold In Vitro and In Vivo

Scaffold material is essential in providing mechanical support to tissue, allowing stem cells to improve their function in the healing and repair of trauma sites and tissue regeneration. The scaffold aids cell organization in the damaged tissue. It serves and allows bio mimicking the mechanical and biological properties of the target tissue and facilitates cell proliferation and differentiation at the regeneration site. In this study, the developed and assayed bio-composite made of unique collagen fibers and alginate hydrogel supports the function of cells around the implanted material. We used an in vivo rat model to study the scaffold effects when transplanted subcutaneously and as an augment for tendon repair. Animals’ well-being was measured by their weight and daily activity post scaffold transplantation during their recovery. At the end of the experiment, the bio-composite was histologically examined, and the surrounding tissues around the implant were evaluated for inflammation reaction and scarring tissue. In the histology, the formation of granulation tissue and fibroblasts that were part of the inclusion process of the implanted material were noted. At the transplanted sites, inflammatory cells, such as plasma cells, macrophages, and giant cells, were also observed as expected at this time point post transplantation. This study demonstrated not only the collagen-alginate device biocompatibility, with no cytotoxic effects on the analyzed rats, but also that the 3D structure enables cell migration and new blood vessel formation needed for tissue repair. Overall, the results of the current study proved for the first time that the implantable scaffold for long-term confirms the well-being of these rats and is correspondence to biocompatibility ISO standards and can be further developed for medical devices application.

Physical diagnostics of arterial trauma in patients of various ages

Aim. To evaluate the effectiveness of physical methods for diagnosing arterial trauma (AT) in patients of various ages.Materials and methods. The hospital medical records data of 222 patients with AT of various ages who were on treatment in the Vascular Surgery Department of Lviv Regional Clinical Hospital in 1992–2019 were analyzed. The patients were divided into seven groups: infants (≤2 years, 4.05 %), early childhood (3–6 years, 0.9 %), childhood (7–12 years, 4.05 %), adolescents (13–18 years, 11.3 %), young adults (19–40 years, 48.6 %), adults (41–65 years, 24.8 %), elderly (≥66 years, 6.3 %). AT was determined from the hard (pulsatile bleeding, absent pulsations distal to the trauma site, expanding hematoma, thrill or bruit over the trauma site, signs of ischemia) or soft (bleeding history, weakened pulsation on an injured side, nonpulsatile hematoma, bone fracture or wound in the projection of a vessel, neurological disorders) symptoms. Physical examination results were compared with intraoperative findings (n = 202, 91 %) or comprehensive instrumental examination.Results. Patients of all ages with AT had a combination of hard and soft symptoms in 44.6–68.8 % (95 % CI) of cases, 10.3–45.0 % (95 % CI) had soft symptoms, and 5.4–23.5 % (95 % CI) had hard symptoms of AT. According to the multiple regression model, the type of AT symptoms was influenced by the mechanism of injury, rather patient's age, etiology, topography, or type of pathomorphological changes in the vessels. Physical examination methods were sufficient to establish a clinical diagnosis of AT and to choose a treatment modality in 20.0–48.3 % (95 % CI) of patients of all ages. The method for diagnosing AT (physical or combination of physical with instrumental) was influenced by patient's age, year of hospitalization and mechanism of injury.Conclusions. Physical methods for diagnosing AT (hard and soft symptoms) have high diagnostic value in examining patients of all ages.

Light-Writing and Photography’s Bodies of Memory

ABSTRACT Photography has a history of being metaphorically understood as a second skin; it is also photo-graphia, or light-writing. A seemingly banal photograph of myself as a sleeping adolescent girl marks me with the sluicing experience of long-term chronic illness and my woman’s writing body responds to the physical trauma interior to the image. I explore what it means to write with photography when the affective force stirred by a visual medium is not visibly illuminated but is blindingly felt. How can photographic writing testify to memories of pain and yet acknowledge that bodily trauma escapes representation? Inspired by the work of Walter Benjamin, I experiment with an ‘aesthetics of the flash’: a fragmentary interplay between text and image enables past and present to spark around a site of trauma, and a female body in pain is evoked but evades complete capture. In the context of today’s networked media ecology where millions of photographed lives are co-present, this writing aesthetic is an ethics or responsibility towards what is not visible in the vernacular photographs of others. Photographs carry bodies of memory, invisible to the naked eye, and yet for their wounded beholders, these images are a second skin that makes the eye feel naked.

PREVALENCE AND CAUSES OF TRAUMATIC DENTAL INJURIES TO ANTERIOR TEETH AMONG PRIMARY SCHOOL CHILDREN IN SANA'A CITY, YEMEN

Objectives: The current study was conducted to reveal the prevalence and causes of traumatic dental injuries to permanent anterior teeth among mixed dentition of schoolchildren in Sana'a City, Yemen.
 Methods: A cross-sectional study was performed on 1252 schoolchildren aged 7-12 years in three districts of Sana'a city, Yemen. They numbered 700 males and 552 females from 26 randomly selected public and private schools. Clinical examination of permanent anterior teeth was done according to the classification of Ellis modified by Fried.
 Results: Prevalence of TDI was 10.30%, with a male ratio of 4.8: female 1, (P <0.05). Most of the children suffered only one damage to the tooth and most of them are in the maxillary central incisors. The TDI increased with older age (10-12 years old) (16.5%) with odds ratio 4.8, (p<0.05). Regarding the site of trauma, most injuries happened in males on the street (44.9%) while in females happened at home (31.81%) and falls were the main cause of TDI. In both sexes, the most common type of injury was class I (enamel fracture) followed by class II (enamel and dentine without pulp involvement).
 Conclusion: In conclusion, the prevalence of TDI in permanent anterior teeth among mixed dentition of school children in Sana’a was high, higher in males than in females, with a peak age of 10 to 12 years, falls was the common cause, and occurred mostly on the street for boys and home for females. Accordingly, educational programs should be developed that focus on ways to prevent dental trauma and the benefits of seeking urgent treatment to maintain avulsed and fractured teeth.
 Peer Review History: 
 Received 13 May 2020; Revised 15 June; Accepted 1 July, Available online 15 July 2020
 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency.
 Received file 
 
 Average Peer review marks at initial stage: 6.0/10
 Average Peer review marks at publication stage: 8.0/10
 Reviewer(s) detail:
 Name: Dr. Alfonso Alexander Aguileral 
 Affiliation: University of Veracruz, Mexico
 E-mail: aalexander_2000@yahoo.com
 
 Name: Dr. Mohamed Awad Mousnad
 Affiliation: Faculty of Pharmacy, International University of Africa (IUA), Khartoum, Sudan
 E-mail: m_abdalaziz@yahoo.com
 
 Name: Dr. Asia Selman Abdullah
 Affiliation: Al-Razi university, Department of Pharmacy, Yemen
 E-mail: asia_abdullah65@yahoo.com
 
 Comments of reviewer(s): 
 
 Similar Articles:
 SERO-PREVALENCE OF HEPATITIS C VIRUS AMONG DENTAL CLINIC WORKERS IN SANA’A CITY- YEMEN AND THE RISK FACTORS CONTRIBUTING FOR ITS INFECTION

Major elective abdominal surgery acutely impairs lower limb muscle pyruvate dehydrogenase complex activity and mitochondrial function

SummaryBackground & aimsThis post hoc study aimed to determine whether major elective abdominal surgery had any acute impact on mitochondrial pyruvate dehydrogenase complex (PDC) activity and maximal mitochondrial ATP production rates (MAPR) in a large muscle group (vastus lateralis -VL) distant to the site of surgical trauma.MethodsFifteen patients undergoing major elective open abdominal surgery were studied. Muscle biopsies were obtained after the induction of anesthesia from the VL immediately before and after surgery for the determination of PDC and maximal MAPR (utilizing a variety of energy substrates).ResultsMuscle PDC activity was reduced by >50% at the end of surgery compared with pre-surgery (p < 0.05). Muscle MAPR were comprehensively suppressed by surgery for the substrate combinations: glutamate + succinate; glutamate + malate; palmitoylcarnitine + malate; and pyruvate + malate (all p < 0.05), and could not be explained by a lower mitochondrial yield.ConclusionsPDC activity and mitochondrial ATP production capacity were acutely impaired in muscle distant to the site of surgical trauma. In keeping with the limited data available, we surmise these events resulted from the general anesthesia procedures employed and the surgery related trauma. These findings further the understanding of the acute dysregulation of mitochondrial function in muscle distant to the site of major surgical trauma in patients, and point to the combination of general anesthesia and trauma related inflammation as being drivers of muscle metabolic insult that warrants further investigation.Clinical trial registrationRegistered at (NCT01134809).

Myositis ossificans-a rare tumor of the chest wall.

Myositis ossificans (MO) is the abnormal formation of benign heterotopic bone tissue in soft tissues or muscles, mostly in sites of trauma. Though it has been described in most parts of the body, less than a dozen cases involving the chest wall have been reported. It is known to resolve spontaneously and various medical treatments have been suggested to hasten its resolution. Large tumors, suspicion of malignancy, and presence of symptoms are indications for surgical intervention. The differential diagnoses include sarcomas, infections, callous, calcified hematomas, and cysts. We present the clinical, radiological, and pathological images of a posttraumatic MO of the chest wall, arising from under the medial third of the clavicle and growing into the deeper surface of the pectoralis major muscle. The patient is doing well eightmonths after the excision of the same.

In vivo volumetric monitoring of revascularization of traumatized skin using extended depth-of-field photoacoustic microscopy.

Faster and better wound healing is a critical medical issue. Because the repair process of wounds is closely related to revascularization, accurate early assessment and postoperative monitoring are very important for establishing an optimal treatment plan. Herein, we present an extended depth-of-field photoacoustic microscopy system (E-DOF-PAM) that can achieve a constant spatial resolution and relatively uniform excitation efficiency over a long axial range. The superior performance of the system was verified by phantom and in vivo experiments. Furthermore, the system was applied to the imaging of normal and trauma sites of volunteers, and the experimental results accurately revealed the morphological differences between the normal and traumatized skin of the epidermis and dermis. These results demonstrated that the E-DOF-PAM is a powerful tool for observing and understanding the pathophysiology of cutaneous wound healing.

Intelligent wound dressing for diagnostic &amp; therapeutic applications - critical to wound infection

A medical device comprising of biomaterials responsive to biochemical stimuli: channel for indicating the infective states of wounds and ensuring delivery of smart antimicrobial and antibiofilm agents to promote tissue regeneration and healing. The importance of providing diagnostic wound dressings that can inform healthcare professionals on the state of infection within wounds but also provide some of the treatment required in response to at risk or infected wounds is of key interest. The aim is to investigate an innovative proof of concept diagnostic and detection system, an intelligent hydrogel wound dressing that responds to specific biochemical stimuli in wounds (MMPs and pH) enabling the selective and triggered release of antibiofilm and antimicrobial agents (‘Detect and Treat’)to the trauma site. The dressing is made of a sterile alginate core material covered in a biocompatible dry or hydrated peptide-polymer-complex film and may include a fluorescent dye which upon release during the wound healing process indicates when a change in dressing is necessary. Efficacy studies of the hydrogel dressing were performed within a drip-flow bioreactor in which regression of Pseudomonas aeruginosa biofilm was observed. A 5-log reduction in biofilm was observed in comparison to an untreated control biofilm. The hydrogel dressing indicated a clear response when in contact with biofilms produced only by pathogenic strains of bacteria when analysed. This further confirmed the adequate release and function of the antimicrobial and antibiofilm agents within the peptide-polymer-complex formulation of the hydrogel wound dressing.

Risks of venous thrombosis and bleeding in critically ill adolescents after trauma or major surgery

BackgroundThe risks of venous thromboembolism (VTE) and bleeding in critically ill adolescents based on interventions received and anatomic site of trauma or major surgery may identify a cohort eligible for enrollment in a trial of pharmacologic prophylaxis. MethodsThis retrospective cohort study using the Virtual Pediatric Systems database included adolescents admitted to pediatric intensive care units after trauma or major surgery between 2013 and 2017. Mixed effects logistic regression was used to determine the adjusted risks of VTE and bleeding with central venous catheterization (CVC), mechanical ventilation (MV) and anatomic site of trauma or major surgery. The adjusted risks were used to identify the cohort eligible for enrollment. Measurements and Main ResultsVTE developed in 212 (0.8%) of 27,647 adolescents. The adjusted risk of VTE was >2% with CVC and 2 or more of MV and trauma or major surgery to the brain or abdomen. Excluding those with bleeds present on admission or at high risk of bleeding, 375 (1.4%) adolescents would be eligible for enrollment. ConclusionsVTE is generally uncommon in adolescents after trauma or major surgery. The small proportion of adolescents who are at high risk of VTE and at low risk of bleeding impacts the feasibility of a trial. Level of EvidencePrognostic Study Level II.

Effects of photobiomodulation combined with MSCs transplantation on the repair of spinal cord injury in rat.

Stem cell transplantation has shown promising regenerative effects against neural injury, and photobiomodulation (PBM) can aid tissue recovery. This study aims to evaluate the therapeutic effect of human umbilical cord mesenchymal stem cells (hUCMSCs) and laser alone or combined on spinal cord injury (SCI). The animals were divided into SCI, hUCMSCs, laser treatment (LASER) and combination treatment (hUCMSCs + LASER) groups. Cell-enriched grafts of hUCMSCs (1 × 106 cells/ml) were injected at the site of antecedent trauma in SCI model rats. A 2 cm2 damaged area was irradiated with 630 nm laser at 100 mW/cm2 power for 20 min. Locomotion was evaluated using Basso-Beattie-Bresnahan (BBB) scores, and neurofilament repair were monitored by histological staining and diffusion tensor imaging (DTI). First, after SCI, the motor function of each group was restored with different degrees, the combination treatment significantly increased the BBB scores compared to either monotherapy. In addition, Nissl bodies were more numerous, and the nerve fibers were longer and thicker in the combination treatment group. Consistent with this, the in situ expression of NF-200 and glial fibrillary acidic protein in the damaged area was the highest in the combination treatment group. Finally, DTI showed that the combination therapy optimally improved neurofilament structure and arrangement. These results may show that the combination of PBM and hUCMSCs transplantation is a feasible strategy for reducing secondary damage and promoting functional recovery following SCI.

Maxillofacial trauma in the gulf countries: a systematic review.

The objective of this review was to determine the prevalence, major causative factors and the most common sites of Maxillofacial Trauma in the Gulf Cooperation Council (GCC) Countries. All articles that were published in the English language in the databases such as Google Scholar, EBSCO, PubMed, NCBI, Medline, COCHRANE, ELSEVIER and SCOPUS were reviewed for MFT from GCC during the last 23years. A total of 19,151 patients (16,567 males and 2584 females) (86-14%) with an age range between 0 and 97years were included in the study. In all of the Gulf countries males outnumber females in terms of maxillofacial injuries with a ratio of 6.4:1. The mandible was the most common site of trauma followed by the maxilla. Road Traffic Accidents (RTA) was the most common cause of injury in the GCC followed by falls. Maxillofacial injuries are highly prevalent, distributed among the Gulf countries, and is mainly caused by RTAs especially among males who are highly prone to MFT in the gulf. The reasons are due to lack of road safety culture and weak enactment of traffic legislation, other possible factors include intrinsic car safety features, high speed driving and the amount/use of highways in these societies.

Dynamic vital signs may predict in-hospital mortality in elderly trauma patients.

Vital signs (VS) are dynamic parameters and understanding the significance of changes in VS in the acute setting may offer clinical meaning. We aimed to measure dynamic changes in vital signs (ΔVS) between site of trauma and presentation to hospital and investigate the association between ΔVS and in-hospital mortality among elderly with trauma.We conducted a retrospective cohort study between 2004 and 2015 using data from the nationwide trauma registry. Patients aged ≥75 years were included. Data were collected at scene of trauma and at arrival of emergency department (ED) in Japan with blunt or penetrating trauma. ΔVS scoring was defined based on clinical implications and previous reports. One point was given for each of the following criteria: systolic blood pressure reduction (-ΔSBP) of ≥30 mm Hg, heart rate increase (ΔHR) of ≥20/minute, and respiratory rate increase (ΔRR) of ≥10/minute between site of trauma and ED. The primary outcome was in-hospital mortality.Of 236,698 patients in the registry, data from 28,860 eligible patients (12.2%) were analyzed [mean age (SD), 83.2 (0.3); males, 57%]. Overall in-hospital mortality rate was 10.0%. In-hospital mortality increased from 9.0% to 16.5% for -ΔSBP; 9.2% to 22.2% for ΔHR; and 9.7% to 15.9% for ΔRR. ΔVS scores of 0, 1, 2, and 3 points were associated with in-hospital mortality of 8.2%, 14.9%, 30.1%, and 50.0%, respectively.A score based on the dynamic changes of VS, ΔVS score, may be helpful in predicting in-hospital mortality among elderly with trauma.

A Case of Leukemia Cutis in an Inguinal Herniorraphy Scar

Leukemia cutis refers to the infiltration of the skin with leukemia cells. It is a rare extramedullary manifestation of leukemia, but it is a specific sign of disease progression and bad prognosis. Cases of leukemia cutis in sites of skin trauma or surgical scars have been described, but there are very few cases reported in literature. We report a case of a 65-year-old male previously diagnosed with chronic myelomonocytic leukemia that was showing clinical signs of progression to acute myeloid leukemia. He underwent right inguinal herniorrhaphy three months before and was showing poor wound healing. Surgical site infection was suspected, since blood tests showed prolonged neutropenia, so surgical wound debridement was performed. Pathological findings of removed tissue indicated infiltration by leukemic cells, which led to the diagnosis of leukemia cutis, not suspected until that moment. Therefore, we conclude that an exhaustive skin examination (especially in the presence of skin trauma or surgical scars), should be performed in patients with confirmed or suspected diagnosis of leukemia. Moreover, the possible diagnosis of leukemia cutis should be considered in leukemia patients who present cutaneous infectious complications or suboptimal healing following accidental skin trauma or surgery. In these cases, complementary anatomopathological studies should be performed.

“Being on the walk put it somewhere in my body”: The meaning of place in health for Indigenous women

ABSTRACT Relationship to place is integral to Indigenous health. A qualitative, secondary phenomenological analysis of in-depth interviews with four non-Choctaw Indigenous women participating in an outdoor, experiential tribally specific Choctaw health leadership study uncovered culturally grounded narratives using thematic analysis as an analytic approach. Results revealed that physically being in historical trauma sites of other Indigenous groups involved a multi-faceted process that facilitated embodied stress by connecting participants with their own historical and contemporary traumas. Participants also experienced embodied resilience through connectedness to place and collective resistance. Implications point to the role of place in developing collective resistance and resilience through culturally and methodologically innovative approaches.

Technologies of Trauma: Flesh Witnessing to Livestreaming Online

This paper examines the trajectory of witnessing and testimony through modernity, utilizing the notion of ‘technologies of trauma’. Such a notion acknowledges humanity’s reliance on technologies to transmute history, trauma, or memory, transforming technologies from medium and machine into artefacts for circulation and exchange. The transcendence of medium into artefacts as sites of trauma equally highlights the socio-political frames within which testimony is extracted and witnessing is enacted, unleashing trauma as a cultural form and a resonant genre of popular consumption. This paper, in tracing the trajectory of these technologies of trauma and its cultural turn from the sensorial to mass witnessing to the aesthetic regimes of immediacy in the digital age, comes to term with our machinic bind in releasing trauma and its aestheticization as a cultural artefact and the unethical challenges, which unfold in such a proposition. The development of print, photography, television, and digital platforms as technologies of trauma reiterates the popularization of trauma, witnessing and testimony as cultural forms reiterating how these are intimately implicated in our emergence as active consuming communities of trauma and in tandem how these remake us as vulnerable subjects through the circulation of trauma as a cultural form.

Evaluation of the neuroprotective effects of ozone in an experimental spine injury model.

The pathophysiology of spine injury consists of primary and secondary damage mechanisms. The vast majority of treatments aim to prevent or at least stop the progression of secondary neurotoxic events during the acute period. Ozone has been found to have potent antiinflammatory effects, to activate the immune system, and to have a substantial impact on the antioxidant system. In this study the authors aimed to evaluate the neuroprotective effects of ozone and their possible roles in recovery from spine injury, assessed based on biochemical, histological, and neurological parameters using an experimental spine injury model in rats. The study included 31 female Wistar albino rats. The rats were divided randomly into 5 groups, with 7 rats in each group except the sham group, which contained 3 rats, as follows: group 1 (sham), laminectomy; group 2 (control), laminectomy and spinal trauma with no medical treatment (0.5 ml isotonic saline applied 1 hour postsurgery); group 3, single medical treatment with 30 mg/kg methylprednisolone applied intraperitoneally 1 hour after laminectomy and trauma; group 4, single medical treatment with 60 μg/ml ozone at 0.7 mg/kg applied intraperitoneally 1 hour after laminectomy and trauma; and group 5, double medical treatment with 30 mg/kg methylprednisolone and 60 μg/ml ozone at 0.7 mg/kg applied intraperitoneally 1 hour after laminectomy and trauma. After neurosurgery, neurobehavioral tests were performed in all groups. After 7 days of follow-up, all the rats were killed. Biopsy specimens obtained from trauma sites were examined using H & E, cresyl violet, immunohistochemical (anticonnexin-43), and TUNEL staining processes. Levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) and total oxidant status (TOS) and total antioxidant status (TAS) were measured in blood samples. The level of neurobehavioral healing was the highest in the double-treatment group (group 5), and the difference between the groups was significant. The minimum IL-6 level was found in group 5, indicating that the antiinflammatory impact was the most significant in this group (p = 0.01). Additionally, ozone was found to reduce oxidant stress more effectively than methylprednisolone (p = 0.03). Although methylprednisolone was superior to ozone in terms of the antiinflammatory effect, this effect was greater in group 5. Nevertheless, the number of neurons in group 5 was close to that of the control group, and the number of apoptotic cells was the least in group 5 (p < 0.001). In acute spinal injury, the combined application of methylprednisolone and ozone was found to have a greater antiinflammatory effect, hasten clinical recovery, and increase histological recovery compared with methylprednisolone therapy alone. This study showed that this combination therapy of methylprednisolone with the addition of ozone might have a more beneficial effect in the treatment of spinal injury than methylprednisolone therapy alone.

Audit of pediatric trauma in a secondary care urban public hospital

Objective: To study the demographic profile and outcomes of pediatric trauma victims.Methods: A prospective observational study was performed at a secondary care centre in urban India over 15 months. Permission from the local ethics body was obtained prior to the commencement of the study. Children under the age of 12 years admitted with trauma to the General Surgical department were included. Demographic data, history of events leading to trauma, clinical findings and treatment were recorded. Pediatric Trauma Score (PTS), Functional Independence Measure (FIM) and Pediatric Quality of Life Index (PQLI) were used to assess the outcomes.Results: A total of 178 patients were included in the study. Preschool age group (3-5 years) (45%) was the most commonly affected. Majority of traumas occurred at home (75%). These homes were informal slum houses where children stayed in lofts. Fall from height (49%) due to fall from lofts (44%) was observed to be the most common mode of injury at home. Majority of patients had minor trauma with PTS (9-12) presenting with head injury (88%). However, only 35% had positive radiologic findings. There was a significant difference in PQLI of all patients and in FIM of preschool age group patients, irrespective of severity of trauma before admission and at one month of follow up.Conclusion: Child’s home was found as the most common site of trauma. Physical, psychosocial and cognitive impairment were seen in all pediatric trauma patients and functional impairment was seen mainly in preschool age. Majority of pediatric injuries are preventable.

Self-sealing posterior scleral perforation in airgun ocular trauma, surgical tip: a case report

BackgroundIntraorbital metallic foreign bodies have varied clinical presentations. Here, we report the unusual case of intraoperative evidence of spontaneously healed posterior scleral perforation in a severe ballistic trauma without previous instrumental signs of penetrating wound and complete visual restoration after surgery.Case presentationThe patient was hit by several lead hunting pellets in the chest, abdomen, limbs, face and orbit. Computed Tomography (CT) images revealed the presence of a pellet within the orbitary cavity, close to the optic nerve, with no signs of penetrating ocular wound. While performing vitrectomy for severe vitreous hemorrhage, a point of strong adherence between a old hemorrhage and retinal surface was identified and managed conservatively, as it was attributed to trauma related-impact area. So, lead foreign body took an unusual trajectory impacting the globe and finally lodging back in the deep orbitary cavity, in absence of significant ocular injury and with visual prognosis preservation.ConclusionsOur findings provide further information on orbital injuries from airguns, a theme of growing popularity and concern. Intraoperative recognition of hardly removable old hemorrhagic clot as self-blockage site of posterior scleral penetrating trauma, allowed for surgical stabilization and minimal solicitation of the area to avoid inadvertent perforation.

The Role of the Fibrotic Scar in Repair Following Neuroinflammation

Multiple sclerosis (MS) is a neuroinflammatory disease of the central nervous system (CNS) in which the body’s immune system attacks the myelin sheath that surrounds and insulates axons. In many cases this myelin is not repaired by myelinating oligodendrocytes, which decreases the efficiency of action potential conduction and leads to neural dysfunction. We hypothesized that a barrier preventing oligodendrocyte lineage cells from repairing damaged myelin is a fibrotic scar. Following CNS injury, a scar consisting of an outer glial scar made up of reactive astrocytes and an inner fibrotic scar made of proteins such as collagen I forms around the site of trauma. In MS the glial scar has also been characterized, but the presence of a fibrotic scar has not been investigated. I have shown that following induction of experimental autoimmune encephalomyelitis (EAE) in mice, which is used as a model of MS, an extensive fibrotic scar forms in the lesioned tissue. Scar‐forming cells were visualized in this tissue using a Col1a1GFP mouse model. The number of these cells increased rapidly in the lesion site following symptom onset and remained high throughout the course of the disease. Lineage tracing and single cell RNA sequencing determined that these cells arise from the proliferation of fibroblasts and not other cells such as pericytes turning on the production of collagen. The objective of this project is to determine the role of the fibrotic scar in tissue repair and to determine mechanisms of scar formation in the CNS. To determine the role of the fibrotic scar following EAE I used the herpes thymidine kinase system to ablate proliferating fibroblasts. Using this paradigm I was able to reduce scar formation by 60% in EAE and found that this reduction resulted in a decrease in motor symptoms in the later stages of disease concurrent with an increase in oligodendrocyte lineage cells in the inflammatory lesions. To understand the signaling pathways that play a role in CNS scar formation, I used FACS to purify Col1a1GFP+ fibroblasts from spinal cords of healthy mice and mice with EAE and analyzed their transcriptome by RNA sequencing. I found that these cells upregulate inflammatory signaling pathways in disease such as the interferon gamma pathway. Deleting the interferon gamma receptor in CNS fibroblasts resulted in a decrease in scar formation following EAE and may be a potential therapeutic target for CNS disorders with fibrotic scarring. In conclusion I identified a fibrotic scar forms following neuroinflammation that arises from the proliferation of CNS fibroblasts, plays a role in disease recovery and forms in part through interferon gamma signaling.Support or Funding InformationThis work was funded by a NIH T32 Pharmacological Sciences Training Grant

A Novel Unidirectional Porous β-tricalcium Phosphate Bone Substitute in Orthopedic Surgery: A Technical Note and Case Illustrations.

Bone grafting is frequently performed in orthopedic surgeries. Artificial bone is a common grafting material. We have developed an absorbable material for bone regeneration with a unique structure: unidirectional porous β-tricalcium phosphate (AffinosⓇ; Kuraray Co., Ltd., Tokyo, Japan). The most distinctive feature of this material is the ease with which blood can rapidly reach its depths by capillary action due to the unidirectional porous structure. It is also characterized by the presence of micropores, which are known to be beneficial for osteoconductivity both on the surface and inside the material. Favorable artificial bone absorption and regeneration with natural bone were observed in cases of clinical bone graft applications in the spine, extremities, benign bone tumor, trauma, and donor sites. Affinos is useful as a novel absorbable material for bone regeneration in various orthopedic surgeries.