SCG10 is required for peripheral axon maintenance and regeneration in mice.

Proper microtubule dynamics are critical for neuronal morphogenesis and functions, and their dysregulation results in neurological disorders and regeneration failure. Superior cervical ganglion-10 (SCG10, also known as stathmin-2 or STMN2) is a well-known regulator of microtubule dynamics in neurons, but its functions in the peripheral nervous system remain largely unknown. Here, we show that Scg10 knockout mice exhibit severely progressive motor and sensory dysfunctions with significant sciatic nerve myelination deficits and neuromuscular degeneration. Additionally, increased microtubule stability, shown by a significant increase in tubulin acetylation and decrease in tubulin tyrosination, and decreased axonal transport were observed in Scg10 knockout dorsal root ganglion (DRG) neurons. Furthermore, SCG10 depletion impaired axon regeneration in both injured mouse sciatic nerve and cultured DRG neurons following replating, and the impaired axon regeneration was found to be induced by a lack of SCG10-mediated microtubule dynamics in the neurons. Thus, our results highlight the importance of SCG10 in peripheral axon maintenance and regeneration.

[Expert consensus on key indicators for quality control in trauma medicine center].

Trauma is recognized globally as a great public health challenge. It stands as the predominant cause of mortality among those under the age of 45 and is also ranked among the top five causes of death for both urban and rural populations within China. This stark reality underscores the critical urgency in establishing an efficient system for trauma care, which is pivotal for substantially enhancing the survival rates of patients. An optimally developed system for trauma care not only guarantees that patients promptly receive professional medical assistance but also facilitates significant improvements in the outcomes of trauma care through the strategic establishment of trauma centers. At present, a considerable variation exists in the quality of trauma care provided across various regions within China. The adoption of comprehensive quality management strategies for the medical processes involved in trauma care, alongside the standardized management of on-site rescue operations, pre-hospital emergency care, and in-hospital treatment protocols, stands as a fundamental approach to boost the capabilities of trauma care and, consequently, the survival rates of trauma patients. Serving as the cornerstone of comprehensive medical quality management, key quality control indicators possess the capacity to steer the development direction of trauma centers. In a concerted effort to further augment the medical quality management of trauma care, standardize clinical diagnosis and treatment methodologies, and advocate for the standardization and ho-mogenization of medical services, the Medical Quality Control Professional Committee of the National Center for Trauma Medicine has undertaken a detailed refinement and update of the 16 key quality control indicators for trauma centers. These were initially put forward in the "Notice on Further Enhancing Trauma Care Capabilities" disseminated by the National Health Commission in 2018.Consequent to this endeavor, a revised set of 19 quality control indicators has been devised. This comprehensive set, inclusive of the indicators' names, definitions, calculation methodologies, significance, and the subjects for quality control, is designed for utilization within the quality management and control operations of trauma centers across various levels. This initiative aims to furnish a concrete and executable roadmap for the quality control endeavors of trauma centers. Through the enactment of these quality control indicators, medical institutions are empowered to conduct more stringent monitoring and evaluative measures across all facets of trauma care. This not only facilitates the prompt identification and rectification of existing challenges but also substantially boosts the efficiency of internal collaboration. It enhances the synergy between different departments, thereby markedly improving the efficiency and quality of trauma care.

Outcomes of posterior malleolar fractures with intra-articular impacted fragment.

INTRODUCTION: An intra-articular impacted fragment (IAIF) could lead to articular incongruity and malreduction in ankle fractures with posterior malleolar fractures (PMFs). No studies have been conducted to determine whether the presence of IAIF affects the outcome of ankle fractures with PMF. The aim of our retrospective study was to evaluate the effect of IAIF on postoperative outcomes in PMF and analyze the relationship between area of IAIF and outcomes. MATERIALS AND METHODS: We conducted a retrospective study of patients with a posterior malleolar fractures between June 2012 and January 2019 with a minimum follow-up of 2 years. Results of the Olerud-Molander ankle score (OMAS), EuroQol-5D (EQ-5D) index, EQ-5D visual analog scale (VAS), AOFAS (American orthopedic foot and ankle society ankle-hindfoot scale), visual analog scale (VAS) pain score and overall patient satisfaction scale were recorded. Outcomes of the PMF with IAIF group and PMF without IAIF group were compared. Sub-group analysis was given emphasis on the AIAIF > 40 mm2 group and AIAIF < 40 mm2 group in PMF with IAIF. RESULTS: A total of 128 patients were included in the study, consisting of 86 patients with IAIF and 42 patients without IAIF. Regarding the osteoarthritis grade (> 1, ≤ 1), the differences werestatistically significant between the two groups (P = 0.044). The risk of articular malreduction was higher in the PMF with IAIF group than in the PMF without IAIF group (P = 0.035). Osteoarthritis grade (> 1, ≤ 1) was closely related to articular malreduction (P < 0.001). There were 51 patients in the AIAIF > 40 mm2 group and 35 patients in the AIAIF < 40 mm2 group of 86 patients in PMF with IAIF. There were statistically significant differences in trimalleolar fracture (P = 0.004), malreduction (P = 0.022), osteoarthritis grade (> 1, ≤ 1; P = 0.027), EQ-5D VAS score (P = 0.031), and AOFAS score (P = 0.047) between the subgroups. CONCLUSION: The incidence of IAIF is associated with the area of the posterior malleolar fragment. Articular malreduction can lead to post-traumatic osteoarthritis, while IAIF is an important element for the quality of reduction, which is more likely to lead to articular malreduction. IAIF should be reduced if AIAIF is over 40 mm2. Otherwise, the patient will suffer a poor prognosis and post-traumatic osteoarthritis. Therefore, ankle fractures with PMF should undergo a CT scan preoperatively in order for providers to optimal treatment protocols. LEVEL OF EVIDENCE: Level III.

Mirabegron and antimuscarinic use in frail overactive bladder patients in the United States Medicare population.

INTRODUCTION: Overactive bladder (OAB) and frailty are independently associated with patient burden. However, economic burden and treatment-taking behavior have not been well characterized among frail patients with OAB, which, given the varying safety and tolerability profiles of available treatments, is crucial. OBJECTIVES: To assess costs, health care resource utilization, treatment-taking behavior (persistence and adherence) to OAB medication in older, frail OAB patients. METHODS: This was a retrospective cohort study using international business machines MarketScan Medicare Supplemental claims data. Eligible frail patients (per Claims-based Frailty Index score) initiating mirabegron were 1:2 propensity score matched (based on age, sex, and other characteristics) with those initiating antimuscarinics and were followed up to 1 year. All-cause, per-person, per-month costs, health care encounters, persistence (median days to discontinuation assessed using Kaplan-Meier methods) and adherence (≥80% of proportion of days covered at Day 365) were compared. RESULTS: From 2527 patients with incident mirabegron (21%) or antimuscarinic (79%) dispensations, 516 incident mirabegron users (median age: 82 years, 64% female) were matched to 1032 incident antimuscarinic users (median age: 81 years, 62% female). Median cost was higher in mirabegron group ($1581 vs. $1197 per month); this was primarily driven by medication cost. There was no difference in medical encounters. Adherence (39.1% vs. 33.8%) and persistence (103 vs. 90 days) were higher in mirabegron users. CONCLUSIONS: Among frail older adults with OAB, mirabegron use was associated with higher costs and potential improvements in treatment-taking behaviors, particularly with respect to treatment adherence, versus those initiating antimuscarinics.

Neutrophil peptide-1 promotes the repair of sciatic nerve injury through the expression of proteins related to nerve regeneration.

Objectives Small-molecule polypeptide neutrophil peptide 1 (NP-1) was reported to promote the regeneration of the sciatic nerve after denervation, but the mechanisms underlying this effect of NP-1 are unclear. Here, we established a Sprague-Dawley rat model of crush injury to study the effect of a single intermuscular injection of NP-1 on the repair of injured peripheral nerves and elucidate the possible underlying mechanism.Methods 39 rats were randomly selected to join this study and divided into the blank control group (normal group, n=9), experimental group (NP-1 group, n=15), and negative control group (NS group, n=15). The dynamic expression of cytokines in different groups of nerve tissues during Wallerian degeneration was observed using protein chips at different time points after injury. Recovery of injured nerves was determined based on the general condition, local gross morphology of the nerve suture site, sciatic nerve function index, neuroelectrophysiology, and osmic acid staining at 6 weeks after the surgery. The recovery of effector function was determined based on wet weight, hematoxylin-eosin staining, modified Gomori staining, and nicotinamide adenine dinucleotide-tetrazolium reductase staining at 6 weeks after the surgery.Results It was found that a single topical administration of NP-1 promoted sciatic nerve regeneration after crush injury and affected the expression of proteins related to neurotrophy, inflammation, cell chemotaxis, and cell generation pathways.

Incidence and risk factors of acute kidney injury after femoral neck fracture in elderly patients: a retrospective case-control study.

BACKGROUND: Hip fracture is highly associated with disability and consequently, mortality in the elderly population. Postoperative acute kidney injury (AKI) is not unusual and is associated with considerable morbidity and mortality. We aimed to determine the incidences and potential risk factors for postoperative AKI in elderly patients with femoral neck fracture. METHODS: We retrospectively evaluated patients over 65 years of age who had been subjected to surgery for femoral neck fracture at Peking University People's Hospital from January 2015 to December 2019. Demographic characteristics and potential risk factors were collected. AKI was defined according to the Kidney Disease Improving Global Outcomes Guidelines (KDIGO). RESULTS: A total of 308 elderly patients with femoral neck fracture were included in the study. The overall incidence of postoperative AKI was 12% (37 cases). Through binary logistic regression analysis, adjusted for age, intraoperative blood loss and BMI, we identified that early postoperative albumin levels, hemoglobin changes and intraoperative hypotension are independent risk factors for postoperative AKI. The model considering the three factors can improve accuracy of predicting the possibility of developing AKI. The patients with AKI had a significantly higher mortality of 40.5% than those without AKI (24.0%, p < 0.001) CONCLUSION: The incidence of postoperative AKI in elderly patients with femoral neck fracture was 12%. Independent risk factors for postoperative AKI included hemoglobin changes, early postoperative hypoalbuminemia and intraoperative hypotension. At the same time, postoperative AKI significantly increased mortality in elderly patients with femoral neck fracture. Taking multiple possible factors into consideration can better predict the possibility of elderly patients developing AKI after surgery.

A subtle connection between crossed cerebellar diaschisis and supratentorial collateral circulation in subacute and chronic ischemic stroke.

OBJECTIVES: It has not been reported whether collateral circulation, a factor closely related to the prognosis of patients with cerebral infarction, is related to the occurrence of crossed cerebellar diaschisis(CCD) or not. Our research attempts to verify the relationship between the collateral circulation grade and the occurrence of CCD, mainly by means of CTA and CTP. MATERIALS AND METHODS: A total of 47 patients were divided into a CCD-positive (Kim et al., 2019) or a CCD-negative group Furlanis et al. (2018) by calculating the asymmetry index (AI) value (<10%) of bilateral cerebellar cerebral blood flow (CBF). A 4-scale grading method was used to evaluate collateral circulation in the supratentorial infarct area, and the four perfusion parameters of the supratentorial and subtentorial brain regions were analyzed and compared between the two groups. The extent of vascular lesions was evaluated by MR sequences including DWI and MRA. RESULTS: Among the four perfusion parameters, except for CBV, were significantly different between the bilateral cerebellum in the CCD-positive group, but only TTP in the supratentorial cerebral infarction area was statistically different in the two groups. Moreover, the collateral circulation sore in the CCD-positive group was significantly lower than that in the CCD-negative group. But no statistical difference was found in the comparison of DWI positive rates between the two groups. CONCLUSION: The collateral score in the supratentorial infarct area is correlated with the occurrence of CCD,which may be used to explain the effect of CCD on the prognosis of patients.

Epidemiology and outcomes of gastroparesis, as documented in general practice records, in the United Kingdom.

OBJECTIVE: To generate real-world evidence for the epidemiology of gastroparesis in the UK, we evaluated the prevalence, incidence, patient characteristics and outcomes of gastroparesis in the Clinical Practice Research Datalink (CPRD) database. DESIGN: This was a retrospective, cross-sectional study. Prevalence and incidence of gastroparesis were evaluated in the CPRD database, with linkage to Hospital Episodes Statistics Admitted Patient Care and Office for National Statistics mortality data. Prevalence and incidence were age and sex standardised to mid-2017 UK population estimates. Descriptive analyses of demographics, aetiologies, pharmacological therapies and mortality were conducted. RESULTS: Standardised prevalence of gastroparesis, as documented in general practice records, was 13.8 (95% CI 12.6 to 15.1) per 100 000 persons in 2016, and standardised incidence of gastroparesis rose from 1.5 (95% CI 1.1 to 1.8) per 100 000 person-years in 2004 to 1.9 (95% CI 1.4 to 2.3) per 100 000 person-years in 2016. The most common disease aetiologies were idiopathic (39.4%) and diabetic gastroparesis (37.5%), with a similar distribution of type 1 and type 2 diabetes among the 90% who had type of diabetes documented. Patients with diabetic gastroparesis had a significantly higher risk of mortality than those with idiopathic gastroparesis after diagnosis (adjusted HR 1.9, 95% CI 1.2 to 3.0). Of those with gastroparesis, 31.6% were not offered any recognised pharmacological therapy after diagnosis. CONCLUSION: This is, to our knowledge, the first population-based study providing data on epidemiology and outcomes of gastroparesis in Europe. Further research is required to fully understand the factors influencing outcomes and survival of patients with gastroparesis.

Management of severe trauma worldwide: implementation of trauma systems in emerging countries: China, Russia and South Africa.

As emerging countries, China, Russia, and South Africa are establishing and/or improving their trauma systems. China has recently established a trauma system named "the Chinese Regional Trauma Care System" and covered over 200 million populations. It includes paramedic-staffed pre-hospital care, in-hospital care in certified trauma centers, trauma registry, quality assurance, continuous improvement and ongoing coverage of the entire Chinese territory. The Russian trauma system was formed in the first decade of the twenty-first century. Pre-hospital care is region-based, with a regional coordination center that determines which team will go to the scene and the nearest hospital where the victim should be transported. Physician-staffed ambulances are organized according to three levels of trauma severity corresponding to three levels of trauma centers where in-hospital care is managed by a trauma team. No national trauma registry exists in Russia. Improvements to the Russian trauma system have been scheduled. There is no unified trauma system in South Africa, and trauma care is organized by public and private emergency medical service in each province. During the pre-hospital care, paramedics provide basic or advanced life support services and transport the patients to the nearest hospital because of the limited number of trauma centers. In-hospital care is inclusive with a limited number of accredited trauma centers. In-hospital care is managed by emergency medicine with multidisciplinary care by the various specialties. There is no national trauma registry in South Africa. The South African trauma system is facing multiple challenges. An increase in financial support, training for primary emergency trauma care, and coordination of private sector, need to be planned.

Morphological analysis of posterior malleolar fractures with intra-articular impacted fragment in computed tomography scans.

BACKGROUND: Intraarticular impacted fragment (IAIF) of posterior malleolar fractures has been reported by a few studies. However its location, morphology, and the correlation of posterior malleolar fractures have not been described in detail. The aim of this study was to describe the morphology of IAIF in posterior malleolar fractures, to analyze the related factors between IAIF and posterior malleolar fragments, and explore the treatment of IAIF. MATERIALS AND METHODS: Between January 2013 and December 2018, 108 consecutive patients with unilateral posterior malleolar fractures were managed in our hospital. Basic demographic and computed tomography (CT) data were collected and classified by Lauge-Hansen, OTA/AO, Haraguchi, and Mason classification. Additional radiographic data, including the length and area of posterior malleolar fragment, IAIF, and stable tibial plafond were measured. The location of IAIF was described, and involvement of the fibular notch and medial malleolus was also observed. Statistics were analyzed based on univariate analysis (Chi-square test, t-test, Mann-Whitney U test, Fisher's test) and Spearman's correlation test. RESULTS: Among the 108 cases of posterior malleolar fractures, 75 (69.4%) were with IAIF and 33 (30.6%) cases were without. There were 74 (68.5%) females and 34 (31.5%) males, and the average age of the patients was 49 years (18-89 years). The average LIFN/(LIFN + LSFN) [length of involving fibular notch/(length of involving fibular + length of stable notch fibular notch)] was 32.9% (11.6-64.9%). The APMF/(APMF + ASTP + AIAIF) [area of posterior malleolar fragment/(area of posterior malleolar fragment + area of IAIF + area of stable tibial plafond)] and AIAIF/APMF (area of IAIF/area of posterior malleolar fragment) were 13.1% (0.8-39.7%) and 52.6% (1.2-235.4%), respectively. Involvement of medial malleolus (fracture line extended to medial malleolus, P = 0.022), involvement of fibular notch (P = 0.021), LIFN/(LIFN + LSFN) (P = 0.037), LMPMF (P = 0.004), and APMF were significantly related to the occurrence of IAIF. CONCLUSION: Our research indicates a high incidence of IAIF in posterior malleolar fractures. All IAIFs were found in posterior malleolar, and the most common location was within the lateral area A. Posterior malleolar fracture lines that extend to medial malleolus or fibular notch herald the incidence of IAIF. LIFN/(LIFN + LSFN), LMPMF and APMF are also associated with the incidence of IAIF. CT scans are useful for posterior malleolar fractures to determine the occurrence of IAIF and make operational plans. Operation approach selection should be based on the morphology of posterior malleolar fragments and the location of IAIF. LEVEL OF EVIDENCE: Level III, retrospective case analysis.

Effects of miR-34c-5p on Sodium, Potassium, and Calcium Channel Currents in C2C12 Myotubes.

The aim of this study was to investigate the effects of miR-34c-5p on the main voltage-dependent ion channels in skeletal muscle cells. This study focused on the effects of miR-34c-5p on sodium, potassium, and calcium currents in C2C12 myoblasts. The miR-34c-5p overexpression group, knockdown group, and control group were differentiated for 7 days, fused into myotubes, and used for the whole-cell patch clamp recording. Compared with the control group, the whole-cell sodium current density of the other two groups had no significant changes. In the knockdown group, the delayed rectifier potassium current density was increased (statistically significant), and the whole-cell calcium channel current density did not change. In the overexpression group, the change of rectifier potassium current density was not obvious, while the peak calcium channel current density increased (- 9.23 ± 0.95 pA/pF, n = 6 cells for the overexpression group vs. - 6.48 ± 0.64 pA/pF, n = 7 cells for the control; p < 0.05). Changes in the expression of miR-34c-5p can affect the electrophysiological characteristics of calcium and potassium voltage-gated channels in C2C12 myotubes. Overexpression of miR-34c-5p increased whole-cell L-type calcium channel current (ICa,L), while miR-34c-5p knockdown increased whole-cell delayed rectifier potassium current (IKd).

Heparin-induced thrombocytopenia and acute colonic pseudo-obstruction after therapeutic anticoagulation in a very elderly patient with hip fracture: a case report.

BACKGROUND: Hip fractures have become a severe public health problem, especially in very elderly patients. Most of them are treated with low molecular weight heparin as prophylaxis or treatment of venous thromboembolism. Heparin-induced thrombocytopenia is one of the complications induced by low molecular weight heparin, which may cause poor prognosis. However, there is not enough awareness for heparin-induced thrombocytopenia in very elderly trauma patients. CASE PRESENTATION: We report a case of hip fracture with heparin-induced thrombocytopenia in a very elderly patient. The patient developed heparin-induced thrombocytopenia, digestive hemorrhage and acute colonic pseudo-obstruction after the use of low molecular weight heparin, which eventually led to death. CONCLUSIONS: This is the first case report of digestive hemorrhage and acute colonic pseudo-obstruction in heparin-induced thrombocytopenia patients with major trauma. This case highlights the severity of HIT in very elderly patients with hip fractures using low molecular weight heparin, and the need for platelet monitoring in these patients. We indicate that there may be a correlation of pathogenesis between digestive hemorrhage and acute colonic pseudo-obstruction in heparin-induced thrombocytopenia patients.

Risk factors for cement leakage and nomogram for predicting the intradiscal cement leakage after the vertebra augmented surgery.

BACKGROUND: Vertebral augmentation is the first-line treatment for the osteoporosis vertebral compression fractures. Bone cement leakage is the most common complication of this surgery. This study aims to assess the risk factors for different types of cement leakage and provides a nomogram for predicting the cement intradiscal leakage. METHODS: We retrospectively reviewed 268 patients who underwent vertebral augmentation procedure between January 2015 and March 2019. The cement leakage risk factors were evaluated by univariate analysis. Different types of cement leakage risk factors were identified by the stepwise logistic analysis. We provided a nomogram for predicting the cement intradiscal leakage and used the concordance index to assess the prediction ability. RESULTS: A total of 295 levels of vertebrae were included, with a leakage rate of 32.5%. Univariate analysis showed delayed surgery and lower vertebral compression ratio were the independent risk factors of cement leakage. The stepwise logistic analysis revealed percutaneous vertebroplasty was a risk factor in vein cement leakage; delayed surgery, preoperative compression ratio, and upper endplate disruption were in intradiscal cement leakage; age, preoperative fracture severity, and intravertebral vacuum cleft were in perivertebral soft tissue cement leakage; no factor was in spinal canal cement leakage. The nomogram for intradiscal cement leakage had a precise prediction ability with an original concordance index of 0.75. CONCLUSIONS: Delayed surgery and more vertebral compression increase the risk of cement leakage. Different types of cement leakage have different risk factors. We provided a nomogram for precise predicting the intradiscal cement leakage.

WITHDRAWN: Fracture line morphology of greater tuberosity fragments of Neer 3 and 4 part proximal humerus fractures.

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Transport and public health in China: the road to a healthy future.

Transportation-related risk factors are a major source of morbidity and mortality in China, where the expansion of road networks and surges in personal vehicle ownership are having profound effects on public health. Road traffic injuries and fatalities have increased alongside increased use of motorised transport in China, and accident injury risk is aggravated by inadequate emergency response systems and trauma care. National air quality standards and emission control technologies are having a positive effect on air quality, but persistent air pollution is increasingly attributable to a growing and outdated vehicle fleet and to famously congested roads. Urban design favours motorised transport, and physical activity and its associated health benefits are hindered by poor urban infrastructure. Transport emissions of greenhouse gases contribute substantially to regional and global climate change, which compound public health risks from multiple factors. Despite these complex challenges, technological advances and innovations in planning and policy stand to make China a leader in sustainable, healthy transportation.

A Modified Foot and Ankle Score for Assessing Patient Outcomes After First Metatarsophalangeal Arthrodesis.

First metatarsophalangeal (MTP) arthrodesis is commonly used to treat many end-stage first MTP diseases. The most widely used scale for measuring the clinical outcomes after this procedure, the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal scale, has not been adequately validated and does not measure specific foot functions. Another outcome measure, the patient-reported Foot and Ankle Outcome Score (FAOS) has acceptable construct validity but poor content validity. The FAOS scale has 42 questions, many of which are unrelated to the hallux. We designed a short-form FAOS (sf-FAOS) consisting of 11 questions that are more relevant to first MTP arthrodesis. The sf-FAOS includes a pain subscale and a function subscale, and the score of each subscale ranges from 0 (worst outcome) to 100 (best outcome). Our study has shown that the sf-FAOS scale has acceptable validity, reliability, and responsiveness. In 21 feet (16 patients) with hallux valgus after >1 year of follow-up, the mean sf-FAOS pain score had improved by 44.9 points after surgery (from 51.2 to 96.0; p < .001), and the mean sf-FAOS function score had improved by 22.5 points (from 47.3 to 69.8; p <.001). The improvement in the function score for running and jumping was limited.