Effect of changes in serum levels of endogenous hydrogen sulfide on fracture healing: Study protocol clinical trial (SPIRIT compliant).

BACKGROUND: Fracture is a common disease; many factors affect fracture healing. Recent studies have confirmed that hydrogen sulfide (H2S) plays an essential role in bone formation, but most of these studies are drawing conclusions based on animal experiment; whether H2S could promote fracture healing in patients is still unclear. We aim to investigate the change of serum H2S in fracture patients, and analyze its effort on fracture healing. METHODS: This is a single-center, prospective cohort study. Patients with spinal or limb fracture will be recruited. Patient's serum and urine will be collected at baseline for examination (serum H2S, ß-CTX, OC, PINP, 25-OH-VitD3, S-CTX, urinary calcium, and urinary creatinine). All patients will be followed-up for 24 months in outpatients settings, the image of X-ray or CT will be reviewed and fracture healing will be judged by 2 experienced orthopedic physicians. The difference in serum parameters especially H2S will be compared between patients with fracture healed within 9 months and those with fracture unhealed at 9 months. DISCUSSION: Results of the trial could provide insight into influence of H2S on fracture healing. ETHICS AND DISSEMINATION: The study was approved by the ethics committee of School of Medicine UESTC & Sichuan Provincial People's Hospital Ethics Committee. All the participants will be asked to provide written informed consent before data collection. The findings of the study will be published in peer-reviewed journals and will be presented at national or international conferences.

Human serum mast cell tryptase levels in elbow fractures or dislocations and its association with injury severity.

Mast cells contain an abundance of tryptase, and preclinical models have shown elevated serum mast cell tryptase (SMCT) in the setting of posttraumatic joint contractures. Therefore, SMCT emerged as a potential biomarker to help recognize patients with more severe injuries and a higher likelihood of developing contractures. The objective of this study is to assess SMCT levels in participants with varying severity of elbow fractures and/or dislocations. A prospective cohort including 13 participants with more severe injuries that required an operation and 28 participants with less severe injuries managed nonoperatively were evaluated. A control group of eight individuals without elbow injuries was also evaluated. The SMCT levels were measured using an enzyme-linked immunosorbent assay kit specific for human mast cell tryptase. A one-way analysis of variance and Tukey's Honest Significance test was used to assess for statistical significance among and between the three groups. The average time from injury to the collection of the blood samples was 4 ± 2 days. Highly significant differences were identified between the operative, nonoperative, and control groups (P = .0005). In the operative group, SMCT levels were significantly higher than the nonoperative group (P = .0005) and the control group (P = .009), suggesting a correlation between SMCT levels and injury severity. There was no statistically significant difference in SMCT levels between the nonoperative and control groups. The SMCT levels were elevated in participants with acute elbow injuries requiring operative intervention, suggesting that SMCT levels were higher in injuries regarded as more severe.

Effect of Ultrasound Debridement on Serum Inflammatory Factors and bFGF, EGF Expression in Wound Tissues.

OBJECTIVE: To determine the effect of ultrasonic debridement on serum inflammatory factors of procalcitonin (PCT), highsensitivity C-reactive protein (hs-CRP), red blood cell deposition rate (ESR) content, and expression levels of wound tissue basic fibroblast growth factor (bFGF) and epidermal growth factor (EGF). STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Department of Emergency, Dongguan People's Hospital, China, from February 2016 to February 2018. METHODOLOGY: A total of 80 patients with limb flap repair were randomly divided into a control group and an observation group, with 40 cases in each group. Control group was treated with conventional surgical debridement, and the observation group was treated with ultrasound debridement technique. The effect was compared between two groups. RESULTS: On the 1st, 3rd, and 7th days after flap repair, Numeric Rating Scale (NRS) scores in observation group were lower than those in control group (all p <0.001). On the 7th day after the flap repair, serum levels of PCT, hs-CRP, and ESR were lower in observation group than those in control group (all p <0.001). On the 7th and 12th day after flap repair, expression levels of bFGF and EGF protein in the wound tissue of observation group were higher than those in control group (all p <0.001). Infection with sinus tract formed after the flap repair in observation group was lower than that in control group (p=0.048). CONCLUSION: Compared with conventional surgical debridement, ultrasound debridement technique can more effectively reduce postoperative inflammatory reactions, reduce postoperative wound infection, relieve pain in patients, promote the bFGF and EGF expression in the wound tissue.

A case of arm swelling and muscle Wii-kness.

The Nintendo Wii is now the world's most popular home games console owing to its simple interface and replication of sports activities. Although safety advice is provided by the manufacturer, a number of injuries have previously been described. We describe a case of arm swelling with associated rise in serum creatine kinase to over 8000 U/L in a man, following unaccustomed and sustained strenuous muscle exertion through the use of the Nintendo Wii. His condition spontaneously resolved with rest and conservative measures. His presentation represents significant muscle injury through the use of this games console and the replication of sporting activities; physicians should be aware of the variety of musculoskeletal presentations such use of these devices can produce.

Alcohol related falls: an interesting pattern of injuries.

OBJECTIVE: To discover if there is a significant difference in the pattern and severity of injury sustained during falls in patients who have consumed alcohol and those who have not. To determine how pattern and severity of injury correlates with blood alcohol concentration. METHOD: A prospective quasi-randomised controlled study between November 2001 and July 2002. All healthy adults between 16 and 60 years who had fallen from standing height were included. A systematic history and examination permitted calculation of injury severity scores as per abbreviated injury scale update 1998. Blood alcohol concentrations were obtained from intoxicated patients with consent. RESULTS: 351 healthy adult patients were included in the study, there were 238 in the no alcohol group, 113 had consumed alcohol and blood alcohol intake were obtained for 47. The alcohol group had a higher incidence of head injuries (46 (48%) versus 22 (9%)) with a lower incidence of limb injuries (39 (39%) versus 183 (76%)) than the no alcohol group. There was a significant difference in the pattern of injury between the alcohol and no alcohol groups (chi(2), p<0.001) and there was a significant difference in the injury severity scores (p<0.001, Z = -2.5). In the alcohol group severity and pattern correlated with alcohol concentration at the time of injury. Patients with an alcohol concentration<2 g/l had mostly soft tissue limb injuries (58%), 2-2.5 mostly significant limb fractures (55%), and >2.5 mostly significant head injuries (90%). CONCLUSIONS: Alcohol related falls are more often associated with severe craniofacial injury. The severity of both limb and head injury is greater and correlates directly with blood alcohol concentration.

[Chronology of a homicide and an attempted suicide by DNA analysis of selected blood stains on the weapon (knife)]]. / Untersuchungen zur Chronologie eines Tötungsdeliktes und eines Suizidversuches durch DNA-Analyse von ausgewählten Blutspuren am Tatwerkzeug (Messer).

A five-year-old boy was fatally injured by a stab and a cut to the throat. The suspected offender, an acquaintance of the victim's mother, stated that he had been disturbed by the boy while attempting suicide and had therefore killed the boy. The suspect showed superficial cuts on both wrists and three shallow stabs on the right-hand side of the abdomen. The purpose of the forensic investigations was to answer the question if the suspect's statement could be confirmed or if the attempted suicide took place after killing the boy. The blood-smeared blade of the knife was divided into different sectors with the cutting edge and the tip of the blade being examined separately from the sides. The blood traces from the different blade sectors were then typed in 12 different DNA regions by PCR (polymerase-chain-reaction). It could be demonstrated that the strong blood traces on the sides of the blade originated from the victim alone, whereas in the area of the edge and the tip of the blade the amount of the victim's blood was negligible compared with that of the suspected offender. The explanation for this finding is that in the areas of the edge and the tip of the knife the blood of the victim must have been replaced by the blood of the suspected perpetrator, which means that the suicidal injuries were the last to be caused by the knife.

[Experience with physiotherapy in a posttraumatic neurodystrophic syndrome of the extremities]. / Opyt fizioterapii pri posttravmaticheskom neirodistroficheskom sindrome konechnostei.

Combined pathogenetic treatment including physiotherapy, drugs, massage, exercise was tested in 98 patients with posttraumatic neurodystrophic syndrome in phase II and III. The responses achieved made it possible to recommend the above regimen for wide application in rehabilitation centers and clinics.

Comparison of the postoperative fibrinogen, alpha-1-antitrypsin and alpha-2- macroglobulin concentrations in the blood of wounded soldiers of Croatian Army and peacetime injured civilians.

In 10 wounded Croatian Army soldiers and in 10 civilians with accidental musculosceletal traumatisation, blood concentrations of the 3 acute phase proteins: fibrinogen, alpha-1-antitrypsin and alpha-2-macroglobulin on the 1st, 5th and 10th postoperative day were assessed. On the 5th day after injury, increased concentrations of all 3 acute phase proteins (APP) were found in all patients. The rise of the fibrinogen concentrations in the wounded soldiers was the steepest. On the 10th day after wounding, fibrinogen concentrations in the gorup of wounded soldiers were significantly lower than those in the group of injured civilians. On the 10th day after wounding there were no differences between the 2 groups in the concentrations of alpha-1-antitrypsin and of alpha-2-macroglobulin. The lower fibrinogen concentrations in the wounded soldiers could be explained by the modulation of the general reactivity of the organism to injury, proposed by Woloski, which is induced by stress and microtrauma on battlefield before the wounding.

[Effects of combined therapy of traditional Chinese and Western medicine on C-reactive protein in post-debridement patients].

Closely monitoring whether the secondary infection in the patients of post-debridement occurred or not and appropriately treating these patients were the important ways to reduce the incidence of infection. Through estimating the level of the serum C-reactive protein (CRP) as the monitoring index of infection, dynamically observed the effect of the combined traditional Chinese and Western medicine therapy (TCM-WM) on CRP after debridement, as was compared with the effect of the Western medicine therapy (WM) group in which only the WM was administrated. The result showed that the levels of CRP decreased in both TCM-WM and WM group on 4th day after the operation, but the level of CRP in former group was lower than that in latter one, the difference was very significant (P < 0.001). So that, it was assumed that TCM-WM significantly excelled the WM on affecting the level of CRP and reducing the incidence of infection. It was suggested that CRP could be used as an effective and objective index to determine whether the secondary infection has happened and to assess the efficacy of some drugs.

Pulse oximetry in closed limb fractures.

Recent sporadic reports have described the role pulse oximetry might play in monitoring trauma victims, and specifically in the assessment of patients with limb fractures where doubt exists concerning the adequacy of limb blood flow distal to the fracture after manipulation. The results of a prospective study to determine the changes in arterial oxygen saturation as shown by pulse oximetry before and after manipulation are presented. The results suggest that the pulse oximeter may be of use in confirming the presence or absence of adequate blood flow distal to a fracture, but that this information should be considered in the light of the clinical findings. The role of pulse oximetry in the early detection of a compartment syndrome complicating a closed limb fracture has yet to be determined.

[Levels of C-reactive protein after surgery in fractures in children]. / Hladiny C-reaktivního proteinu po operacích detských zlomenin.

The authors investigated the levels of C-reactive protein (CRP) after operations of fractures in the area of the elbow in children. Regardless whether antibiotics were administered preventively or not, there was a rise of CRP levels with a maximum on the third day after operation. By the 7th day CRP levels were normal. In the control group of children with mere manual reposition of the fracture of the wrist there was no significant rise of the CRP level. If the elevated CRP level persists after the 7th postoperative day, a local inflammatory complication is suspected.

Outpatient treatment of upper extremity injuries in childhood using intravenous regional anaesthesia.

Intravenous (i.v.) regional anaesthesia was used in outpatient treatment of 400 upper extremity fractures and dislocations in children ranging in age from 3 to 16 years. All reductions were performed in the emergency department. Good analgesia was achieved in 90% of the patients, and only nine children (2.3%) had unacceptable reductions that required further treatment under general anaesthesia. Intravenous regional anaesthesia is a safe and effective procedure that facilitates outpatient treatment of upper extremity injuries in children.

Pulse oximetry for vascular monitoring in burned upper extremities.

The reliability and accuracy of pulse oximetry as a monitoring device in deep superficial and full-thickness circumferential burns of the upper extremity were evaluated clinically. Pulse oximetry was correlated with the laser Doppler flowmeter experimentally in healthy volunteers. By continuously monitoring oxygen saturation levels, the pulse oximeter detected extremity hypoxia before it resulted in an adverse outcome. Extremities exhibiting oxygen saturation above 95% were treated with early excision and skin grafting without escharotomy. Extremities with O2 saturations of less than 95% underwent immediate escharotomy with return to normal saturation levels. The pulse oximeter is easy to use by nursing personnel; is noninvasive and accurate; and displays the oxygen saturation level within seconds.

[Importance of determining the blood sulfhydryl groups in fractures of the long tubular bones complicated by infection]. / Znachenie opredeleniia sul'fgidril'nykh grupp krovi bol'nykh s perelomami dlinnykh trubchatykh kostei, oslozhnennymi infektsiei.

The work presents results of the investigation of the content of sulfhydryl groups in the blood of patients with fractures of long tubular bones. The content of sulfhydryl groups of blood was studied in 168 patients with open fractures. The author comes to a conclusion that the investigation of sulfhydryl groups of blood allows not only facilitating the evaluation of severity of patients in the pre- and postoperative period and detecting complications at early terms but also enables a timely correction of the disorders to be fulfilled.