TNF-α Induces Neutrophil Apoptosis Delay and Promotes Intestinal Ischemia-Reperfusion-Induced Lung Injury through Activating JNK/FoxO3a Pathway

Background. Intestinal ischemia is a common clinical critical illness. Intestinal ischemia-reperfusion (IIR) leads to acute lung injury (ALI), but the causative factors of ALI are unknown. The aim of this study was to reveal the causative factors and mechanisms of IIR-induced lung injury. Methods. A mouse model of IIR was developed using C57BL/6 mice, followed by detection of lung injury status and plasma levels of inflammatory factors in sham-operated mice and model mice. Some model mice were treated with a tumor necrosis factor-α (TNF-α) inhibitor lenalidomide (10 mg/kg), followed by observation of lung injury status through hematoxylin and eosin staining and detection of neutrophil infiltration levels through naphthol esterase and Ly6G immunohistochemical staining. Additionally, peripheral blood polymorphonuclear neutrophils (PMNs) were cultured in vitro and then stimulated by TNF-α to mimic in vivo inflammatory stimuli; this TNF-α stimulation was also performed on PMNs after knockdown of FoxO3a or treatment with the c-Jun N-terminal kinase (JNK) inhibitor SP600125. PMN apoptosis after stimulation was detected using flow cytometry. Finally, the role of PMN apoptosis in IIR-induced lung injury was evaluated in vivo by detecting the ALI status in the model mice administered with ABT-199, a Bcl-2 inhibitor. Results. IIR led to pulmonary histopathological injury and increased lung water content, which were accompanied by increased plasma levels of inflammatory factors, with the TNF-α plasma level showing the most pronounced increase. Inhibition of TNF-α led to effective reduction of lung tissue injury, especially that of the damaging infiltration of PMNs in the lung. In vitro knockdown of FoxO3a or inhibition of JNK activity could inhibit TNF-α-induced PMN apoptosis. Further in vivo experiments revealed that ABT-199 effectively alleviated lung injury and decreased inflammation levels by promoting PMN apoptosis during IIR-induced lung injury. Conclusion. TNF-α activates the JNK/FoxO3a pathway to induce a delay in PMN apoptosis, which promotes IIR-induced lung injury.

Objective Eye Tracking Metrics of Vision and Autonomic Dysfunction Distinguish Adolescents With Acute Concussion and Those with Persistent Post-Concussion Symptoms from Uninjured Controls

ObjectiveTo explore the utility of an eye-tracking assessment in distinguishing binocular alignment, saccadic movement, and pupillary dynamics among uninjured adolescents, acute cases (= 28 days since concussion), and persistent cases (>28 days since concussion).BackgroundVisual and autonomic system disturbances are common sequelae of concussion. Quantification of visual and autonomic dysfunction via an eye tracking device could provide an objective method of acute diagnosis and subacute identification of ongoing injury.Design/MethodsWe compared 347 eye tracking metrics, derived from a 220 seconds eye-tracking assessment, among 132 uninjured adolescents (mean age: 15.3, 56.2% female), 110 acute cases (mean days since injury: 12.5, mean age: 15.4, 46.4% female), and 95 persistent cases (mean days since injury: 53.6, mean age: 15.4, 70.2% female) using Kruskal-Wallis tests with Bonferroni corrections to account for multiple comparisons.ResultsNine eye-tracking metrics were significantly associated with injury status. One measure of binocular alignment (acute v. control: p = 0.003, persistent v. control: p = 0.001) and one measure of saccadic movement (acute v. persistent: p = 0.03, acute v. control: p = 0.03, persistent v. control: p < 0.001) were worse in cases. Cases had larger left and right mean and median pupil size than uninjured adolescents (acute v. control, p < 0.001; persistent v. control, p < 0.001). Cases had greater differences in mean (acute v. control: p < 0.001, persistent v. control: p < 0.001), median (acute v. control, p < 0.001, persistent v. control, p = 0.003), and variance of (acute v. control: p < 0.001, persistent v. control: p < 0.001) left and right pupil size. Eight of these metrics distinguished female cases from uninjured adolescents, but similar differences were not observed in male participants.ConclusionsObjective eye tracking technology can identify vision and pupillary disturbances after concussion. These metrics could be integrated into clinical practice to monitor recovery in a heterogeneous adolescent concussion population and may identify sex-specific differences in autonomic dysfunction.

An unusual case of anteroinferior paralabral cyst with axillary nerve compression: A case report

Paralabral cysts are an uncommon cause of shoulder pain in young adults. Their association with neurological symptoms is seldom reported in the literature. The cysts are believed to develop when there is a labral tear allowing synovial fluid entry into tissues causing one-way valve effect. This case report describes a case of anteroinferior paralabral cyst in a painful shoulder associated with axillary nerve palsy. MRI revealed an anteroinferior labral cyst. Electromyography revealed denervation of deltoid and teres minor muscles. Shoulder arthroscopy was performed with cyst decompression and labral repair. Shoulder function improved gradually and by the end of 1 year, power was back to pre-injury status. Paralabral cysts are a rare entity. When associated with nerve injury, prompt decompression is necessary to prevent irreversible nerve and muscle damage.

Demographic analysis of knee dislocation: A rare mechanism of injury

Purpose The aim of this study was to present to the literature a rare injury mechanism that causes knee dislocation (KD) and describe its characteristics. Methods A retrospective review of patients with KD who were treated between January 2014 and December 2019 at our hospital was performed. Patients with KD due to rotavator machine injury were included in Group 1 and all patients with KD due to other etiological reasons were included in Group 2. Patients’ age, gender, side, injury mechanism, time to surgery, length of stay (LOS), operation time, follow-up time, neurological injury status, vascular injury status, open injury status, and surgical interventions were evaluated. Results A total of 34 patients were evaluated in the study. There was no statistically significant difference between the groups in terms of age, gender, side, or follow-up time ( p = .915, p = 1.000, p = .682, p = .374, respectively). However, LOS and time to surgery were statistically significantly longer in Group 1 ( p = .037, p = .010, respectively). Moreover, neurovascular damage was statistically significantly more common in Group 1. Conclusion As a rare injury mechanism for KD, rotavator machine injuries cause more neurovascular injuries in patients compared to other injury mechanisms and increase the time to surgery and LOS due to preoperative soft tissue damage.

A-96 Stability of ImPACT’s Latent Structure from Baseline to Post Concussion Assessment

Objective ImPACT is commonly used for sport-concussion management. Baseline and post-concussion tests serve as within-athlete comparisons for return-to-play decision-making. Previous literature has questioned whether ImPACT’s five composites accurately represent the internal structure of its cognitive scores. A recent alternative four-factor structure has strong confirmatory evidence for baseline scores (Maietta et al., doi:10.1037/pas0001014). The present study examined the stability of these constructs post-concussion. Method The current study utilized a case-matched design (age, sex, sport category) to select a sample of 3560 high school athletes’ baseline (n = 1780) and post-concussion (n = 1780) assessments. Multi-group CFA of first-order, hierarchical, and bifactor models was conducted to assess measurement invariance (configural, metric, scalar, and residual invariance) between baseline and post-concussion samples. Change in comparative fit indices was interpreted as the primary indicator of model invariance. Results ImPACT’s five composite structure, as well as the hierarchical and bifactor models, exhibited inadequate fit to the baseline and post-concussion data. The four-factor model demonstrated superior fit in the baseline sample and good fit in the post-concussion sample. The four-factor structure demonstrated invariance across injury status (baseline to post-concussion). Conclusion Given that ImPACT’s scores are used for return-to-play decision-making, it is important that they are psychometrically sound. Recent literature suggests that ImPACT’s five composites are not an adequate representation of the cognitive constructs. Findings support validity of the four-factor structure despite injury status, suggesting these cognitive constructs are assessable at both pre- and post-concussion. Additional research is needed to determine implications of these findings for tracking cognitive change following sport-related concussion and making return-to-play decisions.

Interactions between Gene Variants within the COL1A1 and COL5A1 Genes and Musculoskeletal Injuries in Physically Active Caucasian

The COL1A1 and COL5A1 variants have been associated with the risk of musculoskeletal injuries. Therefore, the main aim of the study was to investigate the association between three polymorphisms within two genes (rs1800012 in COL1A1, as well as rs12722 and rs13946 in COL5A1) and the reported, yet rarely described in the literature, injuries of the joint and muscle area in a physically active Caucasian population. Polish students (n = 114) were recruited and divided into the following two groups: students with (n = 53) and without (n = 61) injures. Genotyping was carried out using real-time PCR. The results obtained revealed a statistically significant association between rs1800012 COL1A1 and injury under an overdominant model. Specifically, when adjusted for age and sex, the GT heterozygotes had a 2.2 times higher chance of being injured compared with both homozygotes (TT and GG, 95% CI 0.59–5.07, p = 0.040). However, no significant interaction between the COL5A1 variants, either individually or in haplotype combination, and susceptibility to injury were found. In addition, the gene–gene interaction analysis did not reveal important relationships with the musculoskeletal injury status. It was demonstrated that rs1800012 COL1A1 may be positively associated with physical activity-related injuries in a Caucasian population. Harboring the specific GT genotype may be linked to a higher risk of being injured.

Body Composition, Training Volume/Pattern and Injury Status of Slovenian Adolescent Female High-Performance Gymnasts

Body composition (BC), training volume/pattern, and injury status are a few important factors affecting training quality and sport performance in female artistic gymnastics. We aimed to examine BC status, training volume/pattern, and injury status during the first competition period. Our cross-sectional study included 17 female gymnasts (age: 17.4 ± 4.1 years, body height: 159.8 ± 6.2 cm, and body weight: 54.8 ± 5.3 kg) who were high performance at the international and national level. The BC (measured by dual-energy X-ray absorptiometry) parameters included body height and mass, body fat percentage (BF %), lean body mass (LBM), body mass index (BMI), total bone mineral density (BMD total), and total bone mineral content (BMC total). Training volume and pattern were assessed via an author-developed questionnaire, while injury status (i.e., anatomical location, symmetry and rate of injuries) was assessed via a modified questionnaire on overuse injuries used in sports injury epidemiology studies with elite-level athletes. Body composition parameters were as follows: the BMI was 21.5 ± 1.4 kg/m2, BF % was 21.9 ± 4.7%, LBM was 41.2 ± 3.4 kg, BMD total was 1.22 ± 0.08 g/cm2, and BMC total was 2486 ± 344 g. Furthermore, the average weekly volume of training was 23.5 ± 1.4 h, with the highest training volume occurring on Monday and Tuesday and high variability within gymnasts. Our study also revealed that the most frequently injured joints that had the most negative impact on training volume, sport performance and pain status were the ankles and low back, followed by the knees and shoulders. This kind of yearly screening method is warranted to allow more definitive conclusions to be made on adjusted training and preventive strategies.