Analysis of compartment syndromes in lower extremity pediatric and adolescent trauma - are there predictors of a late onset?

INTRODUCTION: Purpose of the study was to answer the question, if there are common fracture or injury characteristics, which help to identify patient at risk for a secondary compartment syndrome. MATERIALS AND METHODS: Between 2003 and 2022 all children and adolescents who were treated for a traumatic compartment syndrome in a lower extremity were retrospectively evaluated. Patient's demographics were recorded, the underlying trauma mechanism identified. Fractures were classified, treatment and complications were analyzed. We differentiated two groups of patients (early onset vs. late onset) and compared trauma mechanism, fracture location, classification and treatment between those two entities. RESULTS: Our collective consisted of 56 children and adolescents with 67 compartment syndromes, with an average age of 14.1 years (5-17). 41 (73.2 %) of the patients were male and 15 (26.8 %) female. Most people in our sample had previously been involved in traffic accidents (64.3 %), with the most common mechanism of injury being "motorbike accident" (34.3 %) and "pedestrian/cyclist accident against car" (26.9 %). There was an accumulation of fractures of the lower leg, in particular tibial shaft fractures (AO 42 and 43A; 49.3 %). In our survey, dislocated fractures and fractures of the foot always led to an early onset of compartment syndrome. The tibial shaft fracture and the surgical treatment with intramedullary nailing showed a significant frequency in the late onset group. CONCLUSIONS: Special attention should be paid to pediatric and adolescent patients with tibial shaft fracture and surgical treatment with intramedullary nailing in order to detect and treat a possible late onset of a compartment syndrome at an early stage.

Career and life planning in the context of the postgraduate medical training - current challenges and opportunities.

Introduction: The possibility of balancing career and family is meanwhile a central concern for most physicians when choosing a job. The aim of this study was to identify current barriers and opportunities for physician education and career planning. Methods: This cross-sectional study was conducted as an online survey between 11/2021 and 02/2022 and targeted physicians at all career levels in Germany who were members of a clinical professional association. Alternative and consent questions were used to assess experiences/attitudes toward various aspects of life and career planning, as well as alternative work and parental leave models, depending on gender, specialty, and hierarchical level. Results: The majority of the 2060 participants were female (69%) and had children (66%). Many childless residents reported that they felt they had to choose between children and a career. The majority of female residents, specialists and attending physicians (Ø 55.5%) stated that they had experienced career losses as a result of taking parental leave, while most men did not share this experience (Ø 53.7%). 92% of all participants agreed with the statement that men and women have different career opportunities. Job-sharing models were considered feasible at all levels of the hierarchy by an average of 55.6% of all medical executives. Conclusion: Parenthood and the use of parental leave and part-time work appear to have a significant impact on the career paths of those surveyed. Although the majority of directors of medical training programs are open to job-sharing models, further measures are needed in order to equalize career opportunities for men and women.

Mimivirus-Encoded Nucleotide Translocator VMC1 Targets the Mitochondrial Inner Membrane.

Mimivirus (Acanthamoeba polyphaga mimivirus) was the first giant DNA virus identified in an amoeba species. Its genome contains at least 979 genes. One of these, L276, encodes a nucleotide translocator with similarities to mitochondrial metabolite carriers, provisionally named viral mitochondrial carrier 1 (VMC1). In this study, we investigated the intracellular distribution of VMC1 upon expression in HeLa cells and in the yeast Saccharomyces cerevisiae. We found that VMC1 is specifically targeted to mitochondria and to the inner mitochondrial membrane. Newly synthesized VMC1 binds to the mitochondrial outer-membrane protein Tom70 and translocates through the import channel formed by the ß-barrel protein Tom40. Derivatization of the four cysteine residues inside Tom40 by N-ethylmaleimide caused a delay in translocation but not a complete occlusion. Cell viability was not reduced by VMC1. Neither the mitochondrial membrane potential nor the intracellular production of reactive oxygen species was affected. Similar to endogenous metabolite carriers, mimivirus-encoded VMC1 appears to act as a specific translocator in the mitochondrial inner membrane. Due to its permeability for deoxyribonucleotides, VMC1 confers to the mitochondria an opportunity to contribute nucleotides for the replication of the large DNA genome of the virus.