Epidemiology, management and outcome of facial injuries

Dental injuries are common and the incidence of maxillofacial injuries has increased over the recent decades in Finland. Accidental injuries are the global leading cause of death among children over the age of one year and among adults under the age of 40 globally. Significant resources and costs are needed for the treatment of these patients. The prevention is the most economical way to reduce trauma rates and costs. For the prevention it is crucial to know the prevalences, incidences and risk factors related to injuries. To improve the quality of treatment, it is essential to explore the causes, trauma mechanisms and management of trauma. The above mentioned was the aim of this thesis. With a large epidemiological cohort study (5737 participants) it was possible to estimate lifetime prevalence of and risk factors for dental trauma in general population (Study I). The prevalence of dental fractures was 43% and the prevalence of dental luxations and avulsions was 14%. Male gender, a history of previous non-dental injuries, mental distress, overweight and high alcohol consumption were positively associated with the occurrence of dental injuries Study II was conducted to explore the differences in type and multiplicity of mandibular fractures in three different countries (Canada, Finland and Kuwait). This retrospective study showed that the differences in mandibular fracture multiplicity and location are based on different etiologies and demographic patterns. This data can be exploited for planning of measures to prevent traumatic facial fractures. The etiology, management and outcome of 63 pediatric skull base fracture (Study III) and 20 pediatric frontobasal fracture patients (Study IV) were explored. These retrospective studies showed that, both skull base fracture and frontobasa fracture are rare injuries in childhood and although intracranial injuries and morbidity are frequent, permanent neurological or neuropsychological deficits are infrequent. A systematic algorithm (Study V) for computer tomography (CT) image review was aimed at clinicians and radiologists to improve the assessment of patients with complex upper midface and cranial base trauma. The cohort study was cross sectional and data was collected in the Turku and Oulu University Hospitals. A novel image-reviewing algorithm was created to enhance the specificity of CT for the diagnosis of frontobasal fractures. The study showed that an image-viewing algorithm standardizes the frontobasal trauma detection procedure and leads to better control and assessment. The purpose of the retrospective subcranial craniotomy study (VI) was to review the types of frontobasal fractures and their management, complications and outcome when the fracture is approached subcranially. The subcranial approach appears to be successful and have a reasonably low complication rate. It may be recommended as the technique of choice in multiple and the most complicated frontal base fractures where the endoscopic endonasal approach is not feasible.

Anti-cyclic citrullinated peptide antibodies and rheumatoid factor in leprosy patients with articular involvement

The objective of the present research was to evaluate the usefulness of anti-cyclic citrullinated peptide (anti-CCP) antibodies and the IgM rheumatoid factor (IgM RF) test for the differential diagnosis of leprosy with articular involvement and rheumatoid arthritis (RA). Anti-CCP antibodies and IgM RF were measured in the sera of 158 leprosy patients (76 with and 82 without articular involvement), 69 RA patients and 89 healthy controls. Leprosy diagnosis was performed according to Ridley and Jopling classification criteria and clinical and demographic characteristics of leprosy patients were collected by a standard questionnaire. Leprosy patients with any concomitant rheumatic disease were excluded. Serum samples were obtained from all participants and frozen at _20°C. Measurement of anti-CCP antibodies and IgM RF were performed by ELISA, using a commercial second-generation kit, and the latex agglutination test, respectively. Anti-CCP antibodies and IgM RF were detected in low frequencies (2.6 and 1.3%, respectively) in leprosy patients and were not associated with articular involvement. Among healthy individuals both anti-CCP antibodies and IgM RF were each detected in 3.4% of the subjects. In contrast, in the RA group, anti-CCP antibodies were present in 81.2% and IgM RF in 62.3%. In the present study, both anti-CCP antibodies and IgM RF showed good positive predictive value for RA, helping to discriminate between RA and leprosy patients with articular involvement. However, anti-CCP antibodies were more specific for RA diagnosis in the population under study.

Co-culture of chondrocytes and bone marrow mesenchymal stem cells in vitro enhances the expression of cartilaginous extracellular matrix components

Chondrocytes and bone marrow mesenchymal stem cells (BMSCs) are frequently used as seed cells in cartilage tissue engineering. In the present study, we determined if the co-culture of rabbit articular chondrocytes and BMSCs in vitro promotes the expression of cartilaginous extracellular matrix and, if so, what is the optimal ratio of the two cell types. Cultures of rabbit articular chondrocytes and BMSCs were expanded in vitro and then cultured individually or at a chondrocyte:BMSC ratio of 4:1, 2:1, 1:1, 1:2, 1:4 for 21 days and cultured in DMEM/F12. BMSCs were cultured in chondrogenic induction medium. Quantitative real-time RT-PCR and Western blot were used to evaluate gene expression. In the co-cultures, type II collagen and aggrecan expression increased on days 14 and 21. At the mRNA level, the expression of type II collagen and aggrecan on day 21 was much higher in the 4:1, 2:1, and 1:1 groups than in either the articular chondrocyte group or the induced BMSC group, and the best ratio of co-culture groups seems to be 2:1. Also on day 21, the expression of type II collagen and aggrecan proteins in the 2:1 group was much higher than in all other groups. The results demonstrate that the co-culture of rabbit chondrocytes and rabbit BMSCs at defined ratios can promote the expression of cartilaginous extracellular matrix. The optimal cell ratio appears to be 2:1 (chondrocytes:BMSCs). This approach has potential applications in cartilage tissue engineering since it provides a protocol for maintaining and promoting seed-cell differentiation and function.

Psychological stress alters the ultrastructure and increases IL-1β and TNF-α in mandibular condylar cartilage

Psychological factors can be correlated with temporomandibular disorders (TMDs), but the mechanisms are unknown. In the present study, we examined the microstructural changes and expression of proinflammatory cytokines in mandibular condylar cartilage of the temporomandibular joint (TMJ) in a psychological stress animal model. Male Sprague-Dawley rats (8 weeks old, 210 ± 10 g) were randomly divided into 3 groups: psychological stress (PS, N = 48), foot shock (FS, N = 24), and control (N = 48). After inducing psychological stress using a communication box with the FS rats for 1, 3, or 5 weeks, PS rats were sacrificed and compared to their matched control littermates, which received no stress and were killed at the same times as the PS rats. Body and adrenal gland weight were measured and corticosterone and adrenocorticotropic hormone levels were determined by radioimmunoassay. After hematoxylin-eosin staining for histological observation, the ultrastructure of the TMJ was examined by scanning electron microscopy. Transcription and protein levels of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) were evaluated by ELISA and semi-quantitative RT-PCR. The PS group showed a significantly higher adrenal gland weight after 3 weeks of stress and higher hormone levels at weeks 1, 3, and 5. Histopathological changes and thinning cartilage were apparent at weeks 3 and 5. In the PS group, TNF-α increased at 1, 3, and 5 weeks and IL-1β increased significantly after 1 and 3 weeks of stress, and then decreased to normal levels by 5 weeks. Psychological stress increased plasma hormone levels and RT-PCR indicated increased IL-1β and TNF-α expression in the TMJ in a time-dependent manner. These results suggest that cytokine up-regulation was accompanied by stress-induced cartilage degeneration in the mandibular condyle. The proinflammatory cytokines play a potential role in initiating the cartilage destruction that eventually leads to the TMDs.

Chute Losses Aren't Accidents! Most Injuries can be Avoided. Here's How to Rate the Performance of Your Chute and Crew

The conclusion of the article reads "good handling during processing and re-implanting could mean the difference between a going operation and financial disaster. But it's up to you to make certain your crew understands and follows proper chute practices. When they do, it will mean more money in your pocket."

Mithramycin downregulates proinflammatory cytokine-induced matrix metalloproteinase gene expression in articular chondrocytes

Affiliation: Département de Médecine, Faculté de médecine, Université de Montréal & Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame du CHUM

Regulation of microsomal prostaglandin E2 synthase-1 and 5-lipoxygenase-activating protein/5-lipoxygenase by 4-hydroxynonenal in human osteoarthritic chondrocytes

L’arthrose (OA) est une maladie dégénérative et multifactorielle caractérisée par une destruction de cartilage, une formation d’ostéophytes et une inflammation au niveau de la membrane synoviale. Le 4-hydroxynonénal (HNE), un produit final de la peroxydation lipidique, a été identifié récemment comme un facteur catabolique et un médiateur inflammatoire dans le cartilage arthrosique humain. Notre projet vise à étudier l’effet du HNE sur la régulation de la prostaglandine E2 synthase-1 microsomale (mPGES-1) et de la protéine activante 5-lipoxygénase (FLAP)/5-lipoxygénase (5-LOX) dans les chondrocytes arthrosiques humains. Lorsque les cellules sont traitées une seule fois avec 10 µM HNE, les résultats de Western blot et de PCR en temps réel montrent que l’expression de la cyclooxygénase-2 (COX-2) et de la mPGES-1 augmente de manière significative et atteint respectivement le maximum après 8 et 16 heures d’incubation puis diminue graduellement. Cependant, lorsque les cellules sont traitées plusieurs fois avec 10 µM HNE à 2 heures d’intervalle, l’expression de la COX-2 et de la mPGES-1 augmente en fonction du temps sans subir une baisse après 24 heures d’incubation. Le HNE induit l’activité du promoteur de la mPGES-1 via l’activation du facteur de transcription Egr-1. L’investigation de la 2ème voie du métabolisme de l’acide arachidonique, à savoir 5-LOX/FLAP, montre que le HNE induit l’expression de FLAP après 24 heures de stimulation et celle de 5-LOX seulement après 48 heures. Ceci semble survenir à l’étape de transcription au cours de laquelle HNE induit l’expression de l’ARNm et l’activité du promoteur du gène 5-LOX. Nous avons démontré aussi que le niveau de leukotriène B4 (LTB4) augmente et suit le même profil que celui de la 5-LOX. L’étude des mécanismes moléculaires susceptibles d’être impliqués dans la régulation de la 5-LOX/FLAP par le HNE montre que ce dernier stimule leur expression via l’action de prostaglandine E2 (PGE2) et du facteur de croissance transformant-beta 1 (TGF-β1). En conclusion, notre étude démontre que le HNE induit à court-terme d’incubation la voie de COX-2/mPGES-1 puis par la suite stimule celle de FLAP/5-LOX à long-terme d’incubation dans les chondrocytes arthrosiques humains. Ces résultats suggèrent que la mPGES-1 et 5-LOX/FLAP sont des potentielles cibles thérapeutiques intéressantes pour contrôler la production de PGE2 et LTB4 dans OA.

Resilience and Individualized Community Integration Interventions for Persons with Traumatic Brain Injuries

Investigators, caregivers, administrators and service users in the field of rehabilitation are increasingly interested in the concept of resilience, but the literature has very little to offer on interventions aimed at supporting the resilience of persons and their loved ones. This article describes the Personnalized Accompagnement Community Integration (ICII), which is intended to support the resilience of persons with moderate to severe traumatic brain injuries (TBIs). An ICII implementation is currently underway and is expected to support social participation and stimulate the resilience of persons with TBIs. It is based on four frames of reference: community integration founded on the person’s perception of their community integration, the ecosystemic model, the handicap production process (HPP) model, and the goal-setting process. ICII adopts an intervention perspective centered on the life plan of the person with a TBI.

Eficacia del plasma rico en plaquetas en procedimientos médicos estéticos faciales . Evaluación en contorno de ojos.

Introducción: En la actualidad se están implementando nuevas técnicas, para el tratamiento de líneas de expresión facial. El Plasma Rico en Plaquetas (PRP) utiliza factores de crecimiento humano autólogos con fines médicos estéticos. El objetivo de este trabajo fue evaluar el tratamiento con plasma rico en plaquetas en el manejo del rejuvenecimiento periocular. Materiales y métodos: Estudio descriptivo retrospectivo en una cohorte de 27 pacientes entre 30 a 70 años de ambos sexos,tratados con PRP sin tratamientos médicos estéticos previos . Se compararon fotografías del sistema VISIA®, previo y posterior el PRP, para determinar los cambios del área periocular. Con análisis comparativo de medias utilizando pruebas t de student. Resultados: De 27 historias clínicas revisadas 96,3% eran mujeres, la edad promedio fue de 52.67 años. Se observaron cambios clínicos satisfactorios en el manejo del foto envejecimiento periocular con mejoría estadísticamente significativa entre el promedio inicial y el post tratamiento en arrugas, textura y porfirinas (p: 0.000). No se observaron diferencias estadísticamente significativas entre los grupos de edad (p = 0,62). Los pacientes analizados posterior al tratamiento se encuentran en mejor estado que el 63,78% de la población de su mismo sexo, edad y fototipo de piel. Los eventos adversos fueron disminuyendo en su frecuencia en cada una de las sesiones siguientes. Discusión: El PRP proporciona una mejoría global en los parámetros de envejecimiento periocular lo cual se correlaciono con los estudios previos in vitro. Conclusiones: El PRP es seguro y eficaz en contorno de ojos.

The Ergonomic Analysis and Back Injuries in Flexible Production System

Back injuries identification and diagnoses in the transition of the Taylor model to the flexiblemodel of production organization, demands a parallel intervention of prevention actors at work. This study uses simultaneously three intervention models (structured action analysis, muscle skeletal symptoms questionnaires and muscle skeletal assessment) for work activities in a packaging plant. In this study seventy and two (72) operative workers participated (28 workers with muscle skeletal evaluation). In an intervention period of 10 months, the physical, cognitive, organizational components and productive process dynamics were evaluated from the muscle skeletal demands issues. The differences established between objective exposure at risk, back injury risk perception, appreciation and a vertebral spine evaluation, in prior and post intervention, determines the structure for a muscle skeletal risk management system. This study explains that back injury symptoms can be more efficiently reduced among operative workers combining measures registered and the adjustment between dynamics, the changes at work and efficient gestures development. Relevance: the results of this study can be used to pre ent back injuries in workers of flexible production processes.

Desmite dos Ligamentos Colaterais da Articulação Interfalângica Distal em Equinos

Os objectivos deste estudo basearam-se na análise dos aspectos clínicos de cavalos de desporto, aos quais foi diagnosticado através de ecografia, desmite dos Ligamentos Colaterais (LCs) da articulação Interfalângica Distal (IFD). Os cavalos incluídos na amostra foram examinados entre Setembro de 2011 e Junho de 2012 tendo sido selecionados aqueles que apresentaram os critérios de inclusão requeridos, nomeadamente o diagnóstico de desmite em pelo menos um dos LCs da articulação IFD. Foram incluídos 8 animais no estudo, sendo que o diagnóstico foi feito através de um cuidadoso exame ortopédico e de ecografia, tendo-se verificado as lesões nos membros anteriores. O LC Lateral foi o mais afectado (5 cavalos) seguido do Medial (2 cavalos). Apenas em 1 dos casos as lesões eram bilaterais. A maioria dos animais apresentavam distensão da articulação IFD confirmada ecograficamente. A claudicação foi invariavelmente exacerbada em círculo no piso duro, sendo que 7 dos 8 (87.5%) animais aumentaram o grau de claudicação quando o membro afectado estava no interior do círculo. Após o bloqueio digital palmar a claudicação foi atenuada em 7 dos 8 animais (87.5%) sendo totalmente abolida em 3 (37.5%) deles. O bloqueio da articulação IFD foi positivo em todos os animais, e o bloqueio da bursa podotroclear negativa em 7 dos 8 cavalos. Metade dos animais (50%) apresentaram alterações radiográficas como osteoartrite da articulação IFD, remodelação óssea da origem/inserção do LC afectado e um deles apresentava ossificação de uma cartilagem ungular. Todos os animais apresentaram sinais evidentes de lesão na ecografia, sendo que alguns demostraram sinais de desmite crónica e outros aguda. Os tratamentos instituídos variaram de acordo com a história, sinais clínicos, sinais radiográficos e severidade das lesões ecográficas. A desmite dos LC da articulação IFD deve ser considerada como uma causa de claudicação que afecta a performance dos cavalos de desporto. Mais estudos são necessários, de modo a caraterizar melhor estas lesões e avaliar as melhorias após a terapia por forma a determinar os factores que mais influenciam o prognóstico. Palavras-Chave: Equinos, Ligamentos colaterais, Desmite, articulação Interfalângica distal

Gaming and social interactions in the rehabilitation of brain injuries: a pilot study

Physical rehabilitation of brain injuries and strokes is a time consuming and costly process. Over the past decade several studies have emerged looking at the use of highly sophisticated technologies, such as robotics and virtual reality to tap into the needs of clinicians and patients. While such technologies can be a valuable tool to facilitate intensive movement practice in a motivating and engaging environment, success of therapy also depends on self-administered therapy beyond hospital stay. With the emergence of low-cost gaming consoles such as the Nintendo Wii, new opportunities arise for home-therapy paradigms centred on social interactions and values, which could reduce the sense of isolation and other depression related complications. In this paper we examine the potential, user acceptance and usability of an unmodified Nintendo Wii gaming console as a low-cost treatment alternative to complement current rehabilitation programmes.

Healing the wounds of war: memories of violence and the making of history in Zimbabwe's most recent past.

How does a society less than two decades after a liberation war which involved large sections of the population come to terms with the memories of violence and war — a war in which there was no clear distinction between insurgent and counter‐insurgent, liberator and oppressor and in which the majority of the casualties can be found among the rural civilian population? This was a predicament not exclusive to Zimbabwe, but one which also applies to Mozambique, South Africa and, more recently, to Rwanda. Since its independence Zimbabwe has been a prime example of successful reconciliation. Ranger has argued that spiritual healing has contributed importantly to coming to terms with the trauma of war through turning violence into history. Here it will be argued that an analysis of the intersections between memories of violence, healing, and history reveals a twofold process. Social healing is made possible by a shift from conviction and compensation to revealing without convicting. At the same time healing provides an arena for communities in which competing and contesting memories of violence are renegotiated. Through these processes sense is being made of the past; history is being made.

Mobius Sequence in a Girl and Arthrogryposis in her Half-Brother: Distinct Phenotypes Caused By Prenatal Injuries

Mobius sequence is a congenital facial and abducens nerve palsy, frequently associated to abnormalities of extremities. Arthrogryposis multiplex congenital is defined as a congenital fixation of multiple joints seldom of neurogenic origin. Both sequences must have a genetic origin, but usually are sporadic cases related to environmental factors such as drugs exposition and maternal trauma. A 5-year-old girl and a 1-year-old boy were born with Mobius sequence and arthrogryposis multiplex congenital, respectively. During pregnancies, the mother had vaginal bleeding at 7 weeks and used crack (free-based cocaine) in the first trimester, respectively. The girl also has equinovarus talipes and autistic behavior. The boy has arthrogryposis with flexion contractures of the feet and knees. A vascular disruption, due to hemorrhage and cocaine exposure, causing a transient ischemic insult to embryos in a critical period of development may be responsible for distinct phenotypes in these cases.

Occurrence and characterization of injuries caused by Mycotretus apicalis Lacordaire, 1842 (Coleoptera: Erotylidae) on cultivation of Pleurotus sajor-caju

When carrying out experiments on the production of the edible mushroom Pleurotus sajor-caju in the Laboratory of Edible Mushrooms, Universidade Federal de Lavras, Lavras, Brazil, in the second half of 2007, the presence of beetles later identified as belonging to the species Mycotretus apicalis was verified. This is the first recorded instance of this insect in cultures of P. sajor-caju in Brazil. The larvae and adults of this insect feed on the fruiting bodies of commercial harvests, resulting in reduction in mushroom quality. To provide evaluation of the injuries caused by these insects, substrates colonized by P. sajor-caju were infested with 4, 8, 16, 32 and 64 insects per block of substrate being the qualitative and quantitative losses then noted. Despite the lack of an observed decrease in biological efficiency, the injuries caused by these insects affected the commercial quality of the mushrooms, which may result in economic losses. The results showed that infestations of 32 insects per 0.8 kg of substrate led to a depreciation in the prices of mushrooms meant to be sold.