Korean Red Ginseng Improves Astrocytic Mitochondrial Function by Upregulating HO-1-Mediated AMPKα–PGC-1α–ERRα Circuit after Traumatic Brain Injury

Heme oxygenase-1 (HO-1) exerts beneficial effects, including angiogenesis and energy metabolism via the peroxisome proliferator-activating receptor-γ coactivator-1α (PGC-1α)–estrogen-related receptor α (ERRα) pathway in astrocytes. However, the role of Korean red ginseng extract (KRGE) in HO-1-mediated mitochondrial function in traumatic brain injury (TBI) is not well-elucidated. We found that HO-1 was upregulated in astrocytes located in peri-injured brain regions after a TBI, following exposure to KRGE. Experiments with pharmacological inhibitors and target-specific siRNAs revealed that HO-1 levels highly correlated with increased AMP-activated protein kinase α (AMPKα) activation, which led to the PGC-1α-ERRα axis-induced increases in mitochondrial functions (detected based on expression of cytochrome c oxidase subunit 2 (MTCO2) and cytochrome c as well as O2 consumption and ATP production). Knockdown of ERRα significantly reduced the p-AMPKα/AMPKα ratio and PGC-1α expression, leading to AMPKα–PGC-1α–ERRα circuit formation. Inactivation of HO by injecting the HO inhibitor Sn(IV) protoporphyrin IX dichloride diminished the expression of p-AMPKα, PGC-1α, ERRα, MTCO2, and cytochrome c in the KRGE-administered peri-injured region of a brain subjected to TBI. These data suggest that KRGE enhanced astrocytic mitochondrial function via a HO-1-mediated AMPKα–PGC-1α–ERRα circuit and consequent oxidative phosphorylation, O2 consumption, and ATP production. This circuit may play an important role in repairing neurovascular function after TBI in the peri-injured region by stimulating astrocytic mitochondrial biogenesis.

Central Tendon Injury Impairs Regional Neuromuscular Activation of the Rectus Femoris Muscle

We aimed to uncover which rectus femoris strain injury types affect regional activation within the rectus femoris. The rectus femoris has a region-specific functional role; the proximal region of the rectus femoris contributes more than the middle and distal regions during hip flexion. Although a history of strain injury modifies the region-specific functional role within the rectus femoris, it was not obvious which rectus femoris strain injury types affect regional activation within it. We studied 12 soccer players with a history of rectus femoris strain injury. Injury data were obtained from a questionnaire survey and magnetic resonance imaging. To confirm the region-specific functional role of the rectus femoris, surface multichannel electromyographic signals were recorded. Accordingly, eight legs had a history of central tendon injury, four had a history of myofascial junction injury, and four had a healed strain injury. When the injury was limited to the central tendon, the region-specific functional role disappeared. The region-specific functional role was confirmed when the injury was outside the central part. The neuromuscular function was also inhibited when the longitudinal range of the injured region was long. Our findings suggest that a central tendon injury with a long injury length impairs regional neuromuscular activation of the rectus femoris muscle.

Chronic Sequelae After Muscle Strain Injuries: Influence of Heavy Resistance Training on Functional and Structural Characteristics in a Randomized Controlled Trial

Background: Muscle strain injury leads to a high risk of recurrent injury in sports and can cause long-term symptoms such as weakness and pain. Scar tissue formation after strain injuries has been described, yet what ultrastructural changes might occur in the chronic phase of this injury have not. It is also unknown if persistent symptoms and morphological abnormalities of the tissue can be mitigated by strength training. Purpose: To investigate if heavy resistance training improves symptoms and structural abnormalities after strain injuries. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 30 participants with long-term weakness and/or pain after a strain injury of the thigh or calf muscles were randomized to eccentric heavy resistance training of the injured region or control exercises of the back and abdominal muscle. Isokinetic (hamstring) or isometric (calf) muscle strength was determined, muscle cross-sectional area measured, and pain and function evaluated. Scar tissue ultrastructure was determined from biopsy specimens taken from the injured area before and after the training intervention. Results: Heavy resistance training over 3 months improved pain and function, normalized muscle strength deficits, and increased muscle cross-sectional area in the previously injured region. No systematic effect of training was found upon pathologic infiltration of fat and blood vessels into the previously injured area. Control exercises had no effect on strength, cross-sectional area, or scar tissue but a positive effect on patient-related outcome measures, such as pain and functional scores. Conclusion: Short-term strength training can improve sequelae symptoms and optimize muscle function even many years after a strain injury, but it does not seem to influence the overall structural abnormalities of the area with scar tissue. Registration: NCT02152098 (ClinicalTrials.gov identifier).

The Use of the Low-Intensity Laser Therapy (LLLT) Technique for Face Burning

This work describes a case report by the Hospital Dentistry team of the Beneficent Association of Campo Grande Santa Casa MS, where a patient presented with a burn caused by the explosion of the carbon dioxide gas (Co2) through the inhalation of the vapor with acute physical changes, which resulted in burns that reached approximately 10% of the anterior area of the skull with involvement of the cervical and pharyngeal region. Admitted under Orotracheal Intubation, he was treated using the LLLT technique with the use of the InGaAIP low intensity laser on the injured tissues. Through a multi professional approach, using the Low Level Laser Therapy (LLLT) technique as a therapeutic alternative for the treatment of burn injuries of the periorbital region, lips and oral cavity, with the daily monitoring of the patient and regular on-site applications of laser therapy, there was a significant improvement in the injured region, and healing with rapid evolution, in addition to analgesia with reduced bleeding and site inflammation

Damage control of peripheral vascular trauma - Don’t be afraid of axillary or popliteal fosses

Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient’s life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed postoperatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. All permanent or temporary vascular procedures should be followed by a definitive repair within the first 8 hours. An early diagnosis and opportune intervention are fundamental to preserve the function and perfusion of the extremity.

Prospective Epidemiology of Sport Injuries in Boys and Girls Students, First Sport for All Olympiad of Universities and Institutions

Objectives: A prospective study of the epidemiology of sports injuries in boys and girls students participating in the first sport for all’s Olympiad in Iranian universities and institutes. Methods: The Olympiad attended 1123 athletes from 183 universities and higher education institutions for 6 days in 6 sports. In this study, the injury is referred to any musculoskeletal complaints that require medical intervention and people who referred to the clinic at the Olympics because of the injury were the samples. The information completed through the injury registration form. For analysis of data, SPSS software version 18 and χ2 test were used and the tables and charts were used to express the findings. Results: A total of 136 injuries were recorded in 190 competition. In boys, the 43 injuries at the rate of 0.07 were reported. In girls, 93 injuries were at the rate of 0.16 per person were reported. Boy’s injury region was more related to knees and shin (21.4%), in girls, thighs (28.3%), and ankle (20.7%) were the most injured. The most injuries in boys and girls were muscle cramps. The most injury severity of participants was mild. The reason for most injuries for boys, where the lack of warm-up (29.78%) and the girls was excessive exercise pressure (27%). Conclusions: The injury rate was significant compared to other studies and there were higher in girls than boys. Thighs were the most injured region in girls, shin and knee were the most injured in boys. The most severe type of injuries was mild.

Patterns, Management and Outcomes of Traumatic Pelvic Fracture: Insights from A Multicenter Study

Purpose we aimed to describe traumatic pelvic fracture in multinational level 1 trauma centers. Methods We conducted a retrospective analysis for all patients with traumatic pelvic fracture (TPF) between 2010 and 2016 at 2 trauma centers in Qatar and Germany. Results A total of 2112 patients presented with traumatic pelvic injuries of which 1814 (85.9%) sustained TPF, males dominated (76.5%) with a mean age of 41.2±21.1 years. Falls, motor vehicle crashes and pedestrians were the most frequent mechanisms involved. Chest (37.3%) was the most commonly associated injured region, with mean injury severity score (ISS) of 16.5±13.3. Hemodynamic instability was observed in 44%, blood was needed in a third, massive transfusion in a tenth and intensive care admission in a quarter of cases. Tile classification was possible in 1228 patients (type A in 60%, B in 30% and C in 10%). Patients with type C had higher rates of associated injuries, ISS, pelvis abbreviated injury score (AIS), more need for blood transfusion, massive transfusion protocol activation, prolonged hospital stay, higher rate for surgery, complications, and mortality (p<0.001). Two-thirds of patients were managed conservatively while a third needed surgical fixation. The median length of hospital and intensive care stay were 15 and 5 days, respectively. In-hospital complications were few and the overall mortality rate was 4.7% (86 patients). Conclusion pelvic fracture is a common injury. It needs a careful multidisciplinary and systematic approach to address the associated complexities and polytrauma nature in order to improve the associated outcomes both on a short and long-term basis.

The photobiomodulation (658, 830 and 904nm) on wound healing in histomorphometric analysis

Introduction: Photobiomodulation (PBM) assists in the processes of angiogenesis and cellular mitosis after skin lesion, contributing to tissue repair. Objective: to investigate the effects of photobiomodulation (during the proliferative phase) of 658 nm, 830 nm and 904 nm in the repair of skin lesions in an animal model. Method: 658 nm (G658), 830 nm (G830), 904 nm (G904) PBM, and control group (CG) integrated the research. We submitted the animals to an excisional wound and treatment at different wavelengths for 14 days. On the seventh and 14-1485004059th postoperative days, we calculated the area and percentage of lesion contraction. The animals were sacrificed on the 14-1485004056th postoperative day and cutaneous section of the injured region was collected for histomorphometric evaluation of the cellularity, neovascularization, thickness of the epidermis and volume density of collagen fibers colored with H&E and Picross Sirius respectively. For the statistical analysis, we applied the ANOVA test. Results: the G658 presented higher cellularity than GC (p = 0.03). The animals in the G658 group showed a significant increase in the neovascularization in relation to the CG (p = 0.01). Type III collagen significantly increased in G904 compared to G830 (p < 0.0001) and CG (p < 0.0001). The G658 had a significant increase in type III collagen fibers compared to G830 (p < 0.0001) and GC (p < 0.0001). We found no significant difference in the thickness of the epidermis, wound area, and in the percentage wound of contraction between the analyzed groups. Conclusion: PBM was effective to stimulate the tissue repair process, with better results for the 658 nm wavelength.

Biomaterials for In Situ Tissue Regeneration: A Review

This review focuses on a somewhat unexplored strand of regenerative medicine, that is in situ tissue engineering. In this approach manufactured scaffolds are implanted in the injured region for regeneration within the patient. The scaffold is designed to attract cells to the required volume of regeneration to subsequently proliferate, differentiate, and as a consequence develop tissue within the scaffold which in time will degrade leaving just the regenerated tissue. This review highlights the wealth of information available from studies of ex-situ tissue engineering about the selection of materials for scaffolds. It is clear that there are great opportunities for the use of additive manufacturing to prepare complex personalized scaffolds and we speculate that by building on this knowledge and technology, the development of in situ tissue engineering could rapidly increase. Ex-situ tissue engineering is handicapped by the need to develop the tissue in a bioreactor where the conditions, however optimized, may not be optimum for accelerated growth and maintenance of the cell function. We identify that in both methodologies the prospect of tissue regeneration has created much promise but delivered little outside the scope of laboratory-based experiments. We propose that the design of the scaffolds and the materials selected remain at the heart of developments in this field and there is a clear need for predictive modelling which can be used in the design and optimization of materials and scaffolds.

Persistent fibrosis and decreased cardiac function following cardiac injury in theCtenopharyngodon idella(grass carp)

Following the discovery of heart regeneration in zebrafish, several more species within the Cyprinidae family have been found to have the same capability, suggesting heart regeneration may be conserved within this family. Although gonad regeneration has been observed in grass carp (Ctenopharyngodon idella), one of the largest cyprinid fish, the species’ response to cardiac injury has not been characterized. Surprisingly, we found cardiomyocytes do not repopulate the injured region following cryoinjury to the ventricle, instead exhibiting unresolved fibrosis and decreased cardiac function that persists for the 8-week duration of this study. Compared to other cyprinid fish studied, infiltration of macrophages is delayed and muted in this model. Additionally, fibroblasts are depleted following injury, a phenomenon not previously described in any cardiac model. This study shows that heart regeneration is not conserved among the Cyprinidae family and suggests the important role of non-fibroblasts in chronic fibrosis. Further study of these phenomenon may reveal the underlying differences between regeneration versus unresolved fibrosis in heart disease.Summary statementGrass carp, a member of the Cyprinidae family that includes regenerative zebrafish, do not regenerate functional cardiac tissue after cryoinjury. Instead, healing progresses through collagen deposition and scar formation.