Injury
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The repair of critical-sized bone defects represents significant clinical challenge. An alternative approach is the use of 3D composite scaffolds to support bone regeneration. Hydroxyapatite (HA) and tri-calcium phosphate (β-TCP), combined with polycaprolactone (PCL), offer promising mechanical resistance and biocompatibility. ⋯ The TGF-β/BMP pathway study showed the HA/TCP+ES group increased BMP-7 gene expression at 30 and 60 days, and also greater endothelial vascular formation. Moreover, the HA/TCP and HA/TCP+ES groups exhibited a bone remodeling profile, indicated by RANKL/OPG ratio. HA/TCP scaffolds with ES enhanced vascular formation and mineralization initially, while modulation of the BMP/TGF pathway maintained bone homeostasis, controlling resorption via ES with HA/TCP.
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Multicenter Study
Emergency centre thoracotomy for penetrating trauma: Insights from 2 South African district-level emergency centres.
Trauma is a major contributor to global disease burden, disproportionally affecting low- and middle-income countries, especially in the African Region. Emergency centre thoracotomy (ECT) is a potentially life-saving procedure for a sub-group of trauma patients in extremis. Most literature regarding ECT originated in high-income countries. This study aimed to describe patient, procedure and outcome characteristics of ECTs performed at two facilities in a resource-limited setting in South Africa. ⋯ The performance of ECT in this resource-limited district-level setting, followed by stabilisation and transfer of patients to tertiary hospitals seems to result in comparable or better survival rates than reported in international literature. Further research is needed to better describe the performance and outcomes of EC thoracotomies in a resource-limited setting. This study setting, with high incidence of trauma and ECT performed, provides an excellent opportunity for further research. Prospective studies may demonstrate correlations between specific patient and procedural characteristics and outcomes and may guide the development of local guidelines.
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Randomized Controlled Trial
Effects of medical training therapy on injury rehabilitation and sports-specific performance in elite rock climbers: A randomized controlled trial.
Medical training therapy (MTT) is an advanced, individualized rehabilitation approach that integrates multiple methods to improve physical function. It is widely applied to rehabilitate sports injuries. This randomized study evaluated MTT's effects on physical injury rehabilitation, mental function, and athletic performance in elite rock climbers. ⋯ MTT is an ideal method for the rehabilitation of injuries in elite rock climbers and for facilitating their early return to sport. It addresses the majority of athletes' physical injuries and reduces the concentration of injuries in high-risk areas. Additionally, it specifically improves athletes' performance in specialized tests to alleviate the symptom of anxiety.
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Clavicle fractures represent approximately 2.6∼4 % of all fractures. The management of midshaft clavicle fractures is a topic of debate. The evaluation of clavicular shortening relies on the assumption of clavicular symmetry. ⋯ Clavicle asymmetry is present with a positive correlation with male gender and height. Surgeons shall be aware of this asymmetry in managing midshaft clavicle fractures.
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Vascular surgery for war-related traumatic injuries represents 3 to 17.6 % of all emergency surgical procedures, and around 5 % in French Medical Treatment Facilities (MTFs). Most of these lesions are treated by open surgery, but the role of endovascular surgery in French MTFs has not been assessed yet. The aims of this study are to assess the possible role of endovascular surgery by describing vascular surgical management in recent conflicts, and identify potential gaps in vascular surgery training. ⋯ Peripheral vascular lesion requiring emergency surgery are relatively uncommon in French MTFs. However, they require specific surgical training to deal with their complexity. Endovascular surgery does not appear to offer sufficient benefit for systematic deployment in French MTFs, and pre- and post-operative arteriography may be of interest for diagnostic use. The establishment of a French vascular mobile unit for complex cases may be of interest.