Search Results (7,903)

Harnessing the body’s intrinsic resources for wound healing is becoming a rapidly advancing field in regenerative medicine research. This study investigates the effects of the topical application of a novel porcine Hypoxia Preconditioned Serum Hydrogel (HPS-H) on wound healing using a minipig model over a 21-day period. Porcine HPS exhibited up to 2.8× elevated levels of key angiogenic growth factors (VEGF-A, PDGF-BB, and bFGF) and demonstrated a superior angiogenic effect in a tube formation assay with human umbilical endothelial cells (HUVECs) in comparison to porcine normal serum (NS). Incorporating HPS into a hydrogel carrier matrix (HPS-H) facilitated the sustained release of growth factors for up to 5 days. In the in vivo experiment, wounds treated with HPS-H were compared to those treated with normal serum hydrogel (NS-H), hydrogel only (H), and no treatment (NT). At day 10 post-wounding, the HPS-H group was observed to promote up to 1.7× faster wound closure as a result of accelerated epithelialization and wound contraction. Hyperspectral imaging revealed up to 12.9% higher superficial tissue oxygenation and deep perfusion in HPS-H-treated wounds at day 10. The immunohistochemical staining of wound biopsies detected increased formation of blood vessels (CD31), lymphatic vessels (LYVE-1), and myofibroblasts (alpha-SMA) in the HPS-H group. These findings suggest that the topical application of HPS-H can significantly accelerate dermal wound healing in an autologous porcine model. Full article

Background/Objectives: Tinnitus is a debilitating auditory disorder commonly described as a ringing in the ears in the absence of an external sound source. Sound trauma is considered a primary cause. Neuronal hyperactivity is one potential mechanism for the genesis of tinnitus and has been identified in the cochlear nucleus (CN) and the auditory cortex (AC), where there may be an imbalance of excitatory and inhibitory neurotransmissions. However, no study has directly correlated tinnitus with the extracellular levels of amino acids in the CN and the AC using microdialysis, which reflects the functions of these neurochemicals. In the present study, rats were exposed to acoustic trauma and then subjected to behavioural confirmation of tinnitus after one month, followed by microdialysis. Methods: Rats were divided into sham (aged, n = 6; young, n = 6); tinnitus-positive (aged, n = 7; young, n = 7); and tinnitus-negative (aged, n = 3; young, n = 3) groups. In vivo microdialysis was utilized to collect samples from the CN and the AC, simultaneously, in the same rat. Extracellular levels of amino acids were quantified using high-performance liquid chromatography (HPLC) coupled with an electrochemical detector (ECD). The effects of sound stimulation and age on neurochemical changes associated with tinnitus were also examined. Results: There were no significant differences in either the basal levels or the sound stimulation-evoked changes of any of the amino acids examined in the CN and the AC between the sham and tinnitus animals. However, the basal levels of serine and threonine exhibited age-related alterations in the AC, and significant differences in threonine and glycine levels were observed in the responses to 4 kHz and 16 kHz stimuli in the CN. Conclusions: These results demonstrate the lack of a direct link between extracellular levels of amino acids in the CN and the AC and tinnitus perception in a rat model of tinnitus. Full article

This narrative review evaluates the literature on the management of mandibular condyle fractures in growing patients. It aims to illustrate some fundamental biological principles and to offer a series of considerations applicable to clinical practice. The discussion is based on 116 papers published in PubMed and two relevant textbooks. Condylar fractures may be overlooked, especially in pre-scholar children, where compliance is usually reduced. However, these injuries can have disabling sequelae such as ankyloses, facial deformities, malocclusion, and chronic pain in some patients if not diagnosed and managed correctly. Due to their significance, mandibular condyle fractures in children are a subject of considerable clinical interest. As of today, there is consensus about their treatment. Four management options are available: expectative (analgesia, soft food and follow-up), functional protocols (guiding elastics, orthodontic appliances and exercises), maxillomandibular fixation (MMF), and open reduction and internal fixation (ORIF). Nondisplaced and minimally displaced fractures should be treated expectantly; severely displaced non-comminuted fractures can be safely operated on if the expertise is available, even in patients with deciduous dentition. Moderately displaced fractures can be managed with functional protocols or operatively, depending on the background and know-how of the specialist. Functional protocols can achieve good outcomes, especially in patients with deciduous dentition. MMF should be foregone in children due to its many drawbacks. Full article

Background/Objectives: The number of seriously injured elderly patients is continuously rising. Several studies have underlined the benefit of orthogeriatric co-management in treating older patients with a proximal femur fracture. The basis of this orthogeriatric co-management is a certification as a Centre for Geriatric Trauma (ATZ). Data of seriously injured patients are collected in the TraumaRegister DGU^® (TR-DGU) from participating trauma centres. We hypothesise that if a certified trauma centre is also a certified Centre for Geriatric Trauma, a benefit can be measured. Methods: Retrospective cohort analysis was conducted from 1 January 2016 to 31 December 2021. The TraumaRegister DGU^® collected the data prospectively. This retrospective multicentre registry study included patients 70 years or older with an abbreviated injury scale of ≥3 and intensive care unit treatment from 700 certified Trauma Centres and 110 Centres for Geriatric Trauma in Germany, Austria and Switzerland. The primary outcome was mortality in in-hospital stays. Other outcome parameters were days of intubation, the length of stay in ICU, and in-hospital stays. Furthermore, the discharge target and the Glasgow Outcome Scale (GOS) were analysed. Results: The inclusion criteria were met by 27,531 patients. The majority of seriously injured patients (n = 23,007) were transported to certified trauma centres without certification as ATZ. A total of 4524 patients were transported to a trauma centre with additional ATZ certifications. Mortality and the Revised Injury Severity Classification II (RISC-II) model for prediction of mortality after trauma were higher in ATZ hospitals. Logistic regression analysis showed no effect on mortality by a certification as a centre for geriatric trauma in treating seriously injured elderly patients. Conclusions: We assume that the additional ATZ certification does not positively influence the treatment of seriously injured elderly patients. A potential side effect could not be measured. Full article

Military combat can result in the need for comprehensive care related to both physical and psychological trauma, most commonly chronic pain and post-traumatic stress disorder (PTSD). These conditions tend to co-occur and result in high levels of distress and interference in everyday life. Thus, it is imperative to develop effective, time-efficient treatments for these conditions before they become chronic and resistant to change. We developed and pilot-tested the Pain and Trauma Intensive Outpatient Treatment (PATRIOT) Program, a brief, intensive (3 weeks, six sessions) integrated chronic pain and PTSD treatment. An overview and session-by-session outline of the PATRIOT Program is provided, followed by results from the first pilot evaluation of the PATRIOT Program’s feasibility, acceptability, and preliminary efficacy in a sample of eight participating Veterans with comorbid chronic pain and PTSD. There were no treatment dropouts. At post-treatment, there were significant reductions in PTSD symptoms based on the Clinician-Administered Assessment of PTSD (CAPS). Pain and catastrophic thinking also decreased from pre- to post-treatment. With continued investigations and support, the PATRIOT Program may offer a brief, cost-effective, and more easily accessible treatment option for individuals who could benefit from learning skills to manage pain and PTSD more effectively. Full article

Objective: To evaluate the relationship between prenatal risk factors and developmental dysplasia of the hip using the Graf grade, and to identify the determinants of a higher Graf grade. Materials and Methods: A retrospective analysis of data from 112 newborns with DDH was conducted. The participants were selected on the basis of a DDH diagnosis using sonography. A total of 181 hips of patients with DDH were considered in our study group (Graf types IIa to IV), and the normal hips of those affected unilaterally were excluded from the analyses (43 participants were affected unilaterally). The risk factors considered included female sex, breech presentation, firstborn status, familiarity, association with other orthopedic abnormalities, and uterine packing, which includes factors such as twin pregnancy, macrosomia, and oligohydramnios. Binary logistic regression was used to analyze the relationship between these variables and the Graf type of DDH at presentation, which was defined using two groups: Graf types IIc–IV, which include unstable or decentered hips, and Graf types IIa and IIb, which encompass stable and centered hips. Results: The analyses revealed a significant protective role of the presence of other lower limb congenital malformations such as clubfoot, which was more closely associated with a stable form of DDH (OR = 0.26, p = 0.017), a significant association between the presence of mechanical risk factors in females with an unstable form of DDH (OR = 5.00, p = 0.042), a borderline significant protective role of breech presentation in females, which was more closely associated with a stable form of DDH (OR = 0.25, p = 0.054), and a borderline significant association between the presence of mechanical risk factors and an unstable form of DDH (OR = 4.28, p = 0.054). Conclusions: Prenatal risk factors may have a complex effect on the Graf grade in DDH. The protective effects of some factors in contrast with the increased risk associated with other factors suggest a possible relationship, with some prenatal risk factors affecting the severity of DDH. These findings may have implications for the early identification and management of DDH. Full article

Background: Anterior knee pain is a prevalent issue post total knee arthroplasty, often necessitating revision surgery. Various factors contribute to this complication, including patellar maltracking and excessive patellofemoral load. Kinematic alignment has emerged as an alternative, showing promising outcomes in clinical studies. However, its impact on patellofemoral biomechanics needs to be more adequately understood. This study compared the effects of kinematically versus mechanically aligned total knee arthroplasty on patellofemoral joint biomechanics. Methods: Eight fresh-frozen human knee specimens underwent biomechanical testing in a knee rig setup, performing an active weight-loaded knee joint flexion of 30–130°. After the testing of native kinematics, kinematically and mechanically aligned total knee arthroplasty was performed using a medial pivot implant design without patellar resurfacing. Quadriceps force, retropatellar peak pressure and the retropatellar contact area were measured during knee flexion using a patellar pressure-sensitive film. Patella kinematics (shift and tilt) was tracked using an optoelectrical measurement system. Functional regressions were used to determine the influence of the alignment on the kinematics and loading of the knee joint. Results: Kinematically aligned total knee arthroplasty resulted in reduced quadriceps force during knee flexion compared to mechanically aligned total knee arthroplasty. Retropatellar peak pressure, retropatellar contact area and patella kinematics did not vary between the alignments. Conclusions: Kinematic alignment offers potential benefits in reducing quadriceps force during knee flexion, which may mitigate anterior knee pain risk. Further research is needed to elucidate its effects in varying anatomical conditions and alignment strategies. Full article

The Caretta caretta is the only known sea turtle that nests along the coasts of the Mediterranean Sea. It is considered a vulnerable species by the International Union for Conservation of Nature (IUCN) because it is threatened by human activities. The aim of this work was to analyze biochemical parameters in different age groups of C. caretta subjects recovered at the Centro di Referenza Nazionale sul Benessere, Monitoraggio e Diagnostica delle Malattie delle Tartarughe Marine (C.Re.Ta.M.), Sicily. Biometric parameters were recorded for each subject. Peripheral blood was collected and centrifuged, and 18 biochemical parameters were analyzed. Glucose and total proteins showed lower values in juvenile turtles than in sub-adult and adult subjects. Since blood biochemical parameters can be influenced by several factors (age, sex, infectious disease, or trauma), we evaluated differences in the values of some parameters between the reproductive and non-reproductive seasons of adult turtles whose sex and cause of stranding could be determined. Despite the small number of subjects, it would seem that, in adult turtles, the values of ALP, γ-GT, Fe, and LDH are higher during the reproductive season. These biochemical variations showed important differences in the parameters, underlining their importance in assessing the health status of turtles and better understanding their physiology during different stages of their lives. Full article

Borderline personality disorder (BPD) is a complex psychiatric disorder characterized by an unstable sense of self and identity, emotional dysregulation, impulsivity, and disturbed interpersonal relationships. This narrative review examines the interplay between dysregulation of the autonomic nervous system, metabolic changes, and cardiovascular risk in BPD. Altered heart rate variability (HRV), reflecting the dysregulation of the autonomic nervous system, is associated with some BPD core symptoms, such as emotional instability and impulsivity. Dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, often stemming from early trauma, contributes to chronic inflammation and elevated allostatic load, which further increases cardiovascular risk. Metabolic dysfunctions in BPD, such as elevated body mass index (BMI), high blood pressure, and inflammatory markers like C-reactive protein (CRP), exacerbate these risks. Speckle-tracking echocardiography, particularly global longitudinal strain (GLS) and biomarkers such as homocysteine and epicardial fat, could be considered early predictors of cardiovascular events in individuals with BPD. Chronic stress, inflammation, and maladaptive stress responses further heighten cardiovascular vulnerability, potentially accelerating biological aging and cognitive decline. A literature search covering the period from 2014 to 2024 on PubMed identified 189 studies on this topic, of which 37 articles were deemed eligible for this review. These included cross-sectional, longitudinal, case–control, randomised controlled trials (RCTs) , reviews, and meta-analysis designs, with sample sizes ranging from 14 to 5969 participants. The main limitations were that only one database was searched, the time of publications was limited, non-English manuscripts were excluded, and the quality of each paper was not commented on. This narrative review aims to provide an overview of recent evidence obtained on this topic, pointing out a direction for future research. Full article

Objective: To review imaging findings of isolated tibiofibular interosseous membrane (IOM) injury and propose an injury mechanism. Case Report: A retrospective review was conducted on five patients who presented with lower leg pain following a traumatic athletic injury. MRI examinations revealed isolated tibiofibular IOM injury without associated fractures or distal syndesmotic disruption. The observed injury patterns, along with the blunt, non-rotational trauma reported in each case, suggest that the mechanism behind this unique presentation may involve sudden traction or direct impact to the lower leg. Conclusion: Isolated tibiofibular IOM injury should be considered in patients with lower leg pain after blunt trauma. MRI of the entire tibia and fibula can be instrumental in characterizing and confirming the injury and should be considered when clinical and injury mechanism indicators are present. Full article

Objective: Imaging biomarkers of bone, muscle, and fat by magnetic resonance imaging (MRI) may depict osteopenia, sarcopenia, and adiposity as the three different conditions of osteosarcopenic adiposity (OSA). Methods: Subjects from a prospective, population-based case–control study underwent a health assessment and 3 Tesla whole-body MRI scan. Imaging biomarkers of bone (bone marrow fat-fraction (BMFF)), skeletal muscle (skeletal muscle FF (SMFF)), and fat (total adipose tissue (TAT)) were determined. Participants were allocated to one phenotype according to the OSA complex. Results: Among 363 participants forming the study cohort, 81 (22.3%, 48.1% males, 62.4 ± 6.9 years) were allocated into the OSA subgroup. Participants with an OSA phenotype were significantly older compared to all remaining subjects and showed the highest grades of SMFF (all p < 0.005). Together with subjects from the osteopenic sarcopenia group, OSA subjects exhibited the highest amounts of BMFF and together with the three other adiposity-containing subgroups also exhibited the highest BMIs. The highest prevalence of an impaired glucose tolerance as well as significantly higher blood pressure, blood dyslipidemia, and hepatic steatosis was found in the OSA subgroup (all p < 0.005). Conclusions: MR biomarkers of bone, skeletal muscle and fat are feasible for body composition phenotyping and may allow for targeted risk stratification in suspected OSA syndrome. Full article

Extremity trauma, including ischemia (e.g., prolonged tourniquet application or crush), is common among battlefield injuries. Injured muscle releases toxins leading to rhabdomyolysis and, potentially, acute kidney injury (AKI). The goal of this study was to characterize sequelae of ischemic extremity injury over 72 h, focusing on time courses of rhabdomyolysis and AKI. Male Sprague Dawley rats were placed into two groups. Ischemic injury was produced in anesthetized rats using bilateral tourniquets (TK; n = 10) for 5 h; control (CON; n = 9) rats were treated identically without TK application. Indicators of rhabdomyolysis and renal function were measured in conscious rats 1 day preinjury (baseline, BL) and then at 1.5, 24, 48, and 72 h post-TK release. Prolonged TK application produced necrosis in both muscle and bone marrow but not in kidney. The wet/dry weights indicated edema in injured limbs at 72 h (4.1 (0.5) (TK) vs. 2.9 (0.1) (CON); p < 0.001). TK rats exhibited a 100-fold increase in creatine kinase activity compared to CON at 1.5 h (20,040 (7265) U/L vs. 195 (86) U/L (mean (SD); p < 0.0001). TK decreased the mean glomerular filtration rate (GFR; p < 0.001) at 1.5 h, but these values recovered by 24 h in concert with elevated urinary flow and alkalinization. Prolonged ischemic extremity injury therefore produced severe rhabdomyolysis without irreversible renal damage. Full article

Background: Low back pain is common. For patients with mechanic or non-specific chronic LBP (cLBP), the current guidelines suggest conservative, nonpharmacologic treatment as a first-line treatment. Among the available strategies, physiotherapy represents a common option offered to patients presenting with cLBP. The present systematic review investigates the prognostic factors of patients with mechanic or non-specific cLBP undergoing physiotherapy. Methods: In September 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which evaluated the efficacy of a physiotherapy programme in patients with LBP were accessed. All studies evaluating non-specific or mechanical LBP were included. Data concerning the following PROMs were collected: the pain scale, Roland Morris Disability Questionnaire (RMQ), and Oswestry Disability Index (ODI). A multiple linear model regression analysis was conducted using the Pearson Product–Moment Correlation Coefficient. Results: Data from 2773 patients were retrieved. The mean length of symptoms before the treatment was 61.2 months. Conclusions: Age and BMI might exert a limited influence on the outcomes of the physiotherapeutic management of cLBP. Pain and disability at baseline might represent important predictors of health-related quality of life at the six-month follow-up. Further studies on a larger population with a longer follow-up are required to validate these results. Full article

Background: The goal of the orthopedic treatment of fractures is to achieve bone union as rapidly as possible in the largest possible number of patients and to minimize the number of complications. The purpose of this study was to assess if the use of Osteogenon would have a positive effect on radiological and clinical parameters in patients with lower leg bone fractures treated with the Ilizarov method. Methods: We evaluated 26 patients who had their lower leg bone fractures treated with the Ilizarov method and received Osteogenon at our clinic in the years 2021–2023. The control group comprised 25 patients with lower leg bone fractures treated with the Ilizarov method who did not receive Osteogenon. We assessed the following parameters: time to achieving bone union, bone union rate, time to resuming normal physical activity, time to achieving pain relief, the number of patients reporting pain relief, and the rate of complications. Results: The median time to achieve bone union after lower leg bone fracture treated with the Ilizarov method was shorter in the Osteogenon group (108.5 days) compared to the control group (134 days), p < 0.001. Bone union was achieved in all the patients in the Osteogenon group and in 96% of the patients in the control group; the difference was not statistically significant. The median time to resuming normal physical activity was shorter in the Osteogenon group (22.5 weeks) compared to the control group (27 weeks), p < 0.001. The median time to achieving pain relief was shorter in the Osteogenon group (21 weeks) compared to the control group (30 weeks), p < 0.001. The proportion of patients who reported pain relief was 88.46% in the group receiving Osteogenon and 76% in the control group; this difference was not statistically significant. The number of complications was lower in the Osteogenon group (8 patients; 30.77%) compared to the control group (15 patients; 60%), p = 0.035. Conclusions: The use of Osteogenon has a beneficial impact on the treatment of lower leg bone fractures with the Ilizarov method. Osteogenon shortens the time to achieve bone union. Moreover, the use of the ossein–hydroxyapatite complex helps reduce the number of complications and shortens the time to achieve pain relief and to resume normal activities. Full article

Direct oral anticoagulants (DOACs) are increasingly being used due to their improved efficacy/safety ratio and lower clinical and economic burden when compared to vitamin K antagonists. However, bleeding is still the most frequent complication associated with DOACs, and although rare, bleeding episodes can be life-threatening or critical. The impact of DOAC anticoagulation activity during a bleeding event must be evaluated according to patient clinical assessment, dosage and time from last intake, the presence of comorbidities (especially kidney and liver dysfunction), and, whenever possible, coagulation tests. Unfortunately, DOACs’ anticoagulation activity is not easily or usually detectable in routine common coagulation testing. Specific DOAC tests allow for specific drug monitoring, but they are too time consuming, and are usually unavailable in routine emergency practice. If a clinically relevant DOAC plasma concentration is assumed or proven in a severe bleeding scenario, DOAC reversal is needed to restore hemostasis. This experts’ consensus provides a narrative review about DOAC reversal and practical life-threatening bleeding management in several scenarios (trauma, intracranial hemorrhage and gastrointestinal bleeding), focusing on the selection of patients to whom specific reversal agents should be given. Full article