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Preoperative radiotherapy (RT) for non-metastatic rectal cancer reduces local recurrence rates but can cause pelvic insufficiency fractures. Despite the high morbidity from RT-induced skeletal injuries, predictive and preventive measures are lacking. How these injuries are reflected by bone biomarkers are largely unknown. The aim was to assess longitudinal changes in bone biomarkers and their relation to RT-related bone injuries in women with rectal cancer. This longitudinal cohort study includes 47 women with non-metastatic rectal cancer treated with surgery ± preoperative RT with or without chemotherapy. Sclerostin, bioactive sclerostin, C-terminal telopeptide cross-links of collagen type I (CTX), bone-specific alkaline phosphatase (BALP), and type I procollagen intact N-terminal propeptide (PINP) were measured at baseline, after RT, and 1 yr postoperatively. Pelvic magnetic resonance imaging was used for detection of skeletal injury. Sixteen of 36 (44%) irradiated women had radiation-induced bone injuries and were compared to 11 women (RT-) and 20 women (RT+) without bone injuries. Serum CTX, BALP, and PINP increased during the first year after RT in women with radiation-induced bone injuries. The difference in mean change of CTX (p=.037) and BALP (p=.042) was conferred by longitudinal regression analyses adjusted for serum estradiol. Serum sclerostin and bioactive sclerostin remained stable over time. Taken together, bone markers may be of interest for future research on fracture prediction or preventive measures in women susceptible to radiation-induced bone injury. Due to few measure points, the full pattern cannot be captured regarding the relation over time between bone biomarkers and skeletal injury from irradiation.

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Osteonecrosis of the jaw (ONJ) is a relatively rare side effect after prolonged use of bisphosphonates, which are drugs used to treat bone resorption in osteoporosis and certain cancers. This study introduces a novel ONJ model in rats by combining exposure to bisphosphonates, oral surgery, and bacterial inoculation. Potential ONJ preventive effects of polyguanidine (GuaDex) or antibiotics were evaluated. The study consisted of twenty-four male Wistar rats were divided into four groups. Groups 1 to 3 were given weekly doses of i.v. Zoledronic acid (ZA), four weeks before and two weeks after an osteotomy procedure on their left mandibular first molar. Group 4 was a negative control. Streptococcus gordonii bacteria were introduced into the osteotomy pulp chamber and via the food for seven days. On day eight, the rats were given different treatments. Group 1 was given a GuaDex injection into the osteotomy socket, Group 2 was given an intramuscular (i.m.) injection of clindamycin, Group 3 (positive control) was given an i.m. injection of saline, and Group 4 was given an i.m. injection of saline. Blood samples were taken two weeks after the osteotomy procedure, after which the rats were euthanized. Bone healing, bone mineral density, histology, and blood status were analyzed. The results showed that Group 1 (GuaDex) had no ONJ, extensive ongoing bone regeneration, active healing activity, vascularization, and no presence of bacteria. Group 2 (clindamycin) showed early stages of ONJ, avascular areas, and bacteria. Group 3 showed stages of ONJ, inflammatory infiltrates, defective healing, and bacterial presence, and Group 4 had normal healing activity and no bacterial presence. Conclusion: ZA treatment and bacterial inoculation after tooth extraction inhibited bone remodeling/healing and induced ONJ characteristic lesions in the rats. Only GuaDex apparently prevented ONJ development, stimulated bone remodeling, and provided an antimicrobial effect.

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There are conflicting reports both within the lay media and scientific literature regarding the use and benefit of dietary practices that aim to reduce CHO intake in endurance athletes. This study aimed to determine the prevalence of intentional reduction of CHO intake and fasted training in elite endurance-based athletes using a semi-quantitative questionnaire. Bone is a nutritionally modulated tissue; therefore, this study also aimed to explore if these dietary practices are potentially associated with bone injury incidence. The reported reduction of CHO intake was prevalent (28%) with the primary motivation being maintenance or manipulation of body composition. However, discrepancies in athletes' awareness of CHO intake were identified providing a potential avenue of intervention especially within applied practice. The use of fasted training was more prevalent (38%) with athletes using this practice for both body composition manipulation and promoting a desired adaptive response. Forty-four per cent of participants had suffered a radiographically confirmed bone injury at some point in their career. There was no association between reduction in CHO intake and bone injury incidence; however, the incidence of bone injury was 1.61 times higher in those who currently use fasted training compared to those who have never used it or who have used it in the past. Although a direct causal link between these dietary practices and the incidence of bone injury cannot be drawn, it provides robust justification for future investigations of the potential mechanisms that could explain this finding.

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Beyond the sensation of pain, peripheral nerves have been shown to play crucial roles in tissue regeneration and repair. As a highly innervated organ, bone can recover from injury without scar formation, making it an interesting model in which to study the role of nerves in tissue regeneration. As a comparison, tendon is a musculoskeletal tissue that is hypo-innervated, with repair often resulting in scar formation. Here, we reviewed the significance of innervation in 3 stages of injury repair (inflammatory, reparative, and remodeling) in 2 commonly injured musculoskeletal tissues: bone and tendon. Based on this focused review, we conclude that peripheral innervation is essential for phases of proper bone and tendon repair, and that nerves may dynamically regulate the repair process through interactions with the injury microenvironment via a variety of neuropeptides or neurotransmitters. A deeper understanding of neuronal regulation of musculoskeletal repair, and the crosstalk between nerves and the musculoskeletal system, will enable the development of future therapies for tissue healing.

Accumulating evidence has shown that, across organs systems, peripheral nerves regulate the process of tissue repair and regeneration. This is particularly relevant in the context of musculoskeletal injuries such as those affecting the bone and tendon. The question then arises: what is the function of peripheral innervation in the repair of bone and tendon injuries? This review offers an in-depth look at the ways in which nerves regulate the healing of bone and tendon injuries at various stages of recovery. A deeper comprehension of the influence of nerves on the repair of these tissues could pave the way for the development of future therapeutic strategies for tissue healing.

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Currently, crossbows are involved in some deaths, including suicides. These are rare events for which an accurate study of the body discovery site and reconstruction of the triggering mechanism of the crossbow represent crucial medicolegal elements. In this report, a unique case of suicide by crossbow is presented, in which the male victim constructed an elaborate scenario. He arranged two tripod stands to hold the crossbow at the height of his head, and a third to support a hollow tube positioned in front of the muzzle of the crossbow to direct the bolt. After positioning the center of the forehead in front of the hollow tube, the trigger was activated from a distance using a hooked metal rod. The methods used prompted a literature review on suicide by crossbow, which revealed only 14 reports from 1993 to 2023. The head and chest were the main target areas, and in almost all cases, the victims directly pulled the trigger with their finger. Only one case of indirect triggering was found, with the chest as the target. Therefore, in this scenario, the case presented stands as a unique report, due to the elaborate system devised to carry out the suicide and accurately strike the predetermined target.

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Sports-related knee injuries are a common presentation in general practice in Australia among patients of the adolescent age group. A complete understanding of the anatomy, mechanism of injury, history, focused clinical examination of the knee joint, and proper investigations can help make a proper diagnosis. Injuries can be prejudicial to ligaments, tendons, muscles, and bones. Here, we present a case of rupture of the anterior cruciate ligament (ACL) following a fall while playing football. The patient visited the emergency department where an initial radiography was performed, which was unremarkable, and was consequently discharged from the emergency department on painkillers. Later, he presented with swelling and worsening pain in general practice, and magnetic resonance imaging (MRI) confirmed a diagnosis of ACL rupture. Therefore, he was referred to an orthopedic surgeon for further treatment and management. The patient was managed conservatively and underwent physiotherapy.

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Transforming growth factor ß 1 (TGF-ß1), as the most abundant signaling molecule in bone matrix, is essential for bone homeostasis. However, the signaling transduction of TGF-ß1 in the bone-forming microenvironment remains unknown. Here, we showed that microRNA-191 (miR-191) was downregulated during osteogenesis and further decreased by osteo-favoring TGF-ß1 in bone marrow mesenchymal stem cells (BMSCs). MiR-191 was lower in bone tissues from children than in those from middle-aged individuals and it was negatively correlated with collagen type I alpha 1 chain (COL1A1). MiR-191 depletion significantly increased osteogenesis and bone formation in vivo. Hydrogels embedded with miR-191-low BMSCs displayed a powerful bone repair effect. Mechanistically, transcription factors BMI1 and SMAD2 coordinately controlled miR-191 level. In detail, BMI1 and pSMAD2 were both upregulated by TGF-ß1 under osteogenic condition. SMAD2 activated miR-191 transcription, while BMI1 competed with SMAD2 for binding to miR-191 promoter region, thus disturbing the activation of SMAD2 on miR-191 and reducing miR-191 level. Altogether, our findings reveal that miR-191 regulated by TGF-ß1-induced BMI1 and SMAD2 negatively modulated bone formation and regeneration, and inhibition of miR-191 might be therapeutically useful to enhance bone repair in clinic.

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Background: The application of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids is becoming increasingly widespread, and postoperative collateral thermal damage to adjacent tissue has become a prominent subject of discussion. However, there is limited research related to bone injury. Therefore, the aim of this study was to investigate the potential factors influencing unintentional pelvic bone injury after HIFU ablation of uterine fibroids with magnetic resonance imaging (MRI). Methods: A total of 635 patients with fibroids treated with HIFU in the First Affiliated Hospital of Chongqing Medical University were enrolled. All patients underwent contrast-enhanced MRI (CE-MRI) pre- and post-HIFU. Based on the post-treatment MRI, the patients were divided into two groups: pelvic bone injury group and non-injury group, while the specific site of pelvic bone injury of each patient was recorded. The univariate and multivariate analyses were used to assess the correlations between the factors of fibroid features and treatment parameters and pelvic bone injury, and to further analyze the factors influencing the site of injury. Results: Signal changes in the pelvis were observed on CE-MRI in 51% (324/635) of patients after HIFU. Among them, 269 (42.4%) patients developed sacral injuries and 135 (21.3%) had pubic bone injuries. Multivariate analyses showed that patients with higher age [P=0.003; odds ratio (OR), 1.692; 95% confidence interval (CI): 1.191-2.404], large anterior side-to-skin distance of fibroid (P<0.001; OR, 2.297; 95% CI: 1.567-3.365), posterior wall fibroid (P=0.006; OR, 1.897; 95% CI: 1.204-2.989), hyperintensity on T2-weighted imaging (T2WI, P=0.003; OR, 2.125; 95% CI: 1.283-3.518), and large therapeutic dose (TD, P<0.001; OR, 3.007; 95% CI: 2.093-4.319) were at higher risk of postoperative pelvic bone injury. Further analysis of the factors influencing the site of the pelvic bone injury showed that some of the fibroid features and treatment parameters were associated with it. Moreover, some postoperative pain-related adverse events were associated with the pelvic bone injury. Conclusions: Post-HIFU treatment, patients may experience pelvic injuries to the sacrum, pubis, or a combination of both, and some of them experienced adverse events. Some fibroid features and treatment parameters are associated with the injury. Taking its influencing factors into full consideration preoperatively, slowing down treatment, and prolonging intraoperative cooling phase can help optimize treatment decisions for HIFU.

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BACKGROUND: Although previous studies have demonstrated the advantages of early surgery for traumatic spinal cord injury (SCI), the appropriate surgical timing for cervical SCIs (CSCIs) without bone injury remains controversial. Here, we investigated the influence of relatively early surgery within 48 h of injury on the neurological recovery of elderly patients with CSCI and no bone injury. METHODS: In this retrospective multicenter study, we reviewed data from 159 consecutive patients aged ≥65 years with CSCI without bone injury who underwent surgery in participating centers between 2010 and 2020. Patients were followed up for at least 6 months following CSCI. We divided patients into relatively early (≤48 h after CSCI, n = 24) and late surgery (>48 h after CSCI, n = 135) groups, and baseline characteristics and neurological outcomes were compared between them. Multivariate analysis was performed to identify factors associated with neurological recovery. RESULTS: The relatively early surgery group demonstrated a lower prevalence of cardiac disease, poorer baseline American Spinal Injury Association (ASIA) impairment scale grade, and lower baseline ASIA motor score (AMS) than those of the late surgery group (P < 0.030, P < 0.001, and P < 0.001, respectively). Although the AMS was lower in the relatively early surgery group at 6 months following injury (P = 0.001), greater improvement in this score from baseline to 6-months post injury was observed (P = 0.010). Multiple linear regression analysis revealed that relatively early surgery did not affect postoperative improvement in AMS, rather, lower baseline AMS was associated with better AMS improvement (P < 0.001). Delirium (P = 0.006), pneumonia (P = 0.030), and diabetes mellitus (P = 0.039) negatively influenced postoperative improvement. CONCLUSIONS: Although further validation by future studies is required, relatively early surgery did not show a positive influence on neurological recovery after CSCI without bone injury in the elderly.

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The incidence of cervical spinal cord injury (CSCI) without major bone injury is increasing, possibly because older people typically have pre-existing cervical spinal canal stenosis. The demographics, neurological injury, treatment, and prognosis of this type of CSCI differ from those of CSCI with bone or central cord injury. Spine surgeons worldwide are debating on the optimal management of CSCI without major bone injury. Therefore, this narrative review aimed to address unresolved clinical questions related to CSCI without major bone injury and discuss treatment strategies based on current findings. The greatest divide among spine surgeons worldwide hinges on whether surgery is necessary for patients with CSCI without major bone injury. Certain studies have recommended early surgery within 24 h after injury; however, evidence regarding its superiority over conservative treatment remains limited. Delayed MRI may be beneficial; nevertheless, reliable factors and imaging findings that predict functional prognosis during the acute phase and ascertain the necessity of surgery should be identified to determine whether surgery/early surgery is better than conservative therapy/delayed surgery. Quality-of-life assessments, including neuropathic pain, spasticity, manual dexterity, and motor function, should be performed to examine the superiority of surgery/early surgery to conservative therapy/delayed surgery.

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The investigation of bone injuries is an essential topic in forensics. We sometimes have to deal with charred or dismembered human remains that have lost soft tissue, making it difficult to diagnose the mechanisms of injury that led to death. Our contribution aims to share with the scientific community how we approached two cases of very different bone injuries and the techniques used to differentiate relevant pathology findings of bone fragments. Two cases are analyzed from the case history of the forensic medicine institute of Palermo. PMCT made it possible to differentiate heat bone lesions from traumatic lesions. The stereomicroscope was superior to PMCT in being able to better characterize and evaluate shear injuries, allowing a more accurate measurement of acute lesions. Injury to bone remains can be appropriately investigated with rapid techniques such as PMCT and stereomicroscopy. The presented methodology shows the importance of a multidisciplinary approach when dealing with bone injuries in forensics that could find further applications in other circumstances to answer forensic questions.

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BACKGROUND: Increasing accessibility and advancements in computed tomographic (CT) imaging improve understanding of the contributors to poor performance in the Thoroughbred racehorse. OBJECTIVES: To characterise an unreported site of tarsal subchondral bone injury (SBI) in Thoroughbred racehorses. STUDY DESIGN: Retrospective, cross-sectional analytical study. METHODS: Tarsal CT scans of 108 horses were reviewed for evidence of SBI in the dorsodistolateral calcaneus (DDLC). Signalment, including age, breed, sex, and discipline of horses, was recorded. The association of DDLC SBI with Thoroughbred racehorse compared to other breeds/disciplines was calculated. Nuclear scintigraphic scans of the hindlimbs of Thoroughbreds between 2007 and 2022 were also reviewed for increased radiopharmaceutical uptake (IRU) suggestive of DDLC SBI. RESULTS: Tarsal CT scans of 108 horses were analysed and lesion location and type were recorded. DDLC SBI was identified in 8/108 (7.3%) horses. All lesions were found in racing Thoroughbreds (Fischer's exact test p = 0.002) and in 20% (8/40) of racing Thoroughbreds that underwent tarsal CT. DDLC SBI was determined to be the primary cause of lameness in 3/8. Third tarsal bone fracture was considered the primary cause of lameness in 3/8 horses. A total of 1663 nuclear scintigraphic scans of 1603 Thoroughbred horses were reviewed. Increased IRU in the DDLC was present in 13 horses (0.9%). MAIN LIMITATIONS: Study limitations include the retrospective nature of the study, incomplete medical records, lack of sensitivity/specificity data for lesion identification on various imaging modalities or comparison to histopathology, and limited substantive follow-up information. CONCLUSIONS: The DDLC is a previously unreported site of SBI in the Thoroughbred racehorse. The lesion can be the primary source of lameness but may also be found in horses with other clinically relevant osseous injuries. This lesion may be underestimated in the Thoroughbred population. Further investigation is required to determine the true prevalence, clinical relevance, and prognosis in Thoroughbred racehorses with this injury.

CONTEXTO: A maior acessibilidade à tomografia computadorizada (TC) está aprimorando o conhecimento de fatores contribuintes à baixa performance de cavalos puro sangue inglês (PSI) de corrida. OBJETIVOS: Caracterizar um local não previamente descrito de lesão óssea subcondral (LOS) no tarso de cavalos PSI de corrida. DELINEAMENTO DO ESTUDO: Estudo analítico transversal retrospectivo. METODOLOGIA: TC do tarso de 108 cavalos foram revisadas para detectar evidência de LOS na região dorso-distal-lateral do calcâneo (DDLC). Informações de idade, raça, sexo e modalidade esportiva dos cavalos foram revisados. A presença de LOS na região DDLC em cavalos PSI de corrida foi comparada com a presença da mesma lesão em outras raças e modalidades esportivas. Cintilografia nuclear dos membros pélvicos de cavalos PSI de corrida entre 2007 e 2020 também foram revisadas para a presença de evidência de aumento de captação radiofarmacêutica (CRF) sugestiva de LOS na região DDLC. RESULTADOS: LOS na região DDLC for identificada em 8/108 (7.3%) dos equinos. Todas as lesões foram encontradas em PSI de corrida (teste exato de Fischer p = 0.002), e em 20% (8/40) dos PSI de corrida que tiveram o exame de TC feito. LOS na região DDLC foi determinada como a causa primária da claudicação em 3/8 dos casos. Fratura do terceiro osso do tarso foi considerada a causa primária de claudicação em 3/8 dos cavalos. 1663 exames de cintilografia de 1603 cavalos PSI de corrida foram revisados. Aumento da CRF na região DDLC estava presente em 13 equinos (0.9%). PRINCIPAIS LIMITAÇÕES: As limitações deste estudo incluem a natureza retrospectiva do mesmo, prontuários médicos incompletos, falta de dados de sensibilidade e especificidade da lesão nos métodos diagnósticos e comparação histológica, e informação de acompanhamento dos casos limitada. CONCLUSÕES: A região DDLC é um local de LOS não previamente descrito em cavalos PSI de corrida. A lesão pode ser a causa primária de claudicação, mas também pode ser encontrada em casos que apresentam outras lesões relevantes. Essa lesão pode ser subestimada em cavalos PSI de corrida. Mais investigações são necessárias para determinar a prevalência real, a relevância clínica e o prognóstico dessas lesões em cavalos PSI de corrida.

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Complex bone injuries in the hand and forearm pose considerable physical and psychological challenges to patients. However, there is limited research on the psychological effects of these injuries. This study seeks to clarify the psychological impact and frequency of injuries in various hand bones. This cross-sectional study included 166 patients with complex hand and forearm injuries. Injuries were classified based on amputations and fractures involving phalanges, fingers, and other bones. Psychological assessments utilised standardised tools to gauge post-traumatic stress disorder (PTSD) levels. Our findings suggest that injury rates differ among the phalanges and individual fingers. The intermediate phalanx (P2) of the thumb had the most injuries, while no injuries were found in the proximal phalanx (P1) of the small finger. Amputations and fractures were found to be positively associated with increased symptoms of PTSD. This study emphasises the importance of recognising the psychological effects of hand and forearm bone injuries. The data indicate the need for a multi-disciplinary treatment approach that includes psychological interventions for optimal patient care. The study emphasises the necessity for additional research to further investigate these matters.

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[This corrects the article DOI: 10.3389/fbioe.2022.823933.].

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Maxillofacial trauma patients comprise a significant subset of patients presenting to emergency departments. Before evaluating for facial trauma, an emergency or trauma physician must perform a primary survey to ensure patient stabilization. Following this primary survey, this document discusses the following clinical scenarios for facial trauma: tenderness to palpation or contusion or edema over frontal bone (suspected frontal bone injury); pain with upper jaw manipulation or pain overlying zygoma or zygomatic deformity or facial elongation or malocclusion or infraorbital nerve paresthesia (suspected midface injury); visible nasal deformity or palpable nasal deformity or tenderness to palpation of the nose or epistaxis (suspected nasal bone injury); and trismus or malocclusion or gingival hemorrhage or mucosal hemorrhage or loose teeth or fractured teeth or displaced teeth (suspected mandibular injury). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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BACKGROUND AND AIM: This work was conducted to compare the therapeutic potential of undifferentiated and osteogenic differentiated canine (xenogeneic) and guinea pig (allogeneic) BMSCs in fracture healing using guinea pig as a model. MATERIALS AND METHODS: A well-characterized homogenous population of third passage mesenchymal stem cells of bone marrow origin was used in all the experiments. MSCs from both the species, i.e., canine and guinea pigs, were differentiated and characterized. Expression of MHC I and II along with co-stimulatory molecules was assessed based on relative mRNA expression. The osteogenic differentiated and undifferentiated MSCs from both species were used for evaluating fracture healing in the guinea pig model. The healing potential was assessed based on radiographic, histopathology, and clinical observations. RESULTS: BMSCs from both species expressed MSC surface antigens and successfully differentiated to osteogenic, chondrogenic, and adipogenic lineages. The mRNA expression of class I and II MHC molecules in all the three lineages showed no significant (p > 0.05) differences after differentiating to adipogenic, chondrogenic, and osteogenic lineages. Radiographic and clinical examination revealed that MSCs therapy significantly improved bone fracture healing with a non-significant (p > 0.05) difference between differentiated and undifferentiated BMSCs. In addition, allogeneic MSCs therapy performed better than xenogeneic therapy. CONCLUSION: MSCs remained hypo immunogenic after differentiation and have comparable fracture healing potential though allogeneic MSCs have better therapeutic potential than xenogenic MSCs.

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The communication between macrophages and tendon cells plays a critical role in regulating the tendon-healing process. However, the potential mechanisms through which macrophages can control peritendinous fibrosis are unknown. Our data showed a strong pro-inflammatory phenotype of macrophages after a mouse tendon-bone injury. Moreover, by using a small-molecule compound library, we identified an aldehyde dehydrogenase inhibitor, disulfiram (DSF), which can significantly promote the transition of macrophage from M1 to M2 phenotype and decrease macrophage pro-inflammatory phenotype. Mechanistically, DSF targets gasdermin D (GSDMD) to attenuate macrophage cell pyroptosis, interleukin-1ß, and high mobility group box 1 protein release. These pro-inflammatory cytokines and damage-associated molecular patterns are essential for regulating tenocyte and fibroblast proliferation, migration, and fibrotic activity. Deficiency or inhibition of GSDMD significantly suppressed peritendinous fibrosis formation around the injured tendon and was accompanied by increased regenerated bone and fibrocartilage compared with the wild-type littermates. Collectively, these findings reveal a novel pathway of GSDMD-dependent macrophage cell pyroptosis in remodeling fibrogenesis in tendon-bone injury. Thus, GSDMD may represent a potential therapeutic target in tendon-bone healing.

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OBJECTIVE: The aim: Scientific work aims at determining the frequency and nature of disorders in psycho-emotional and autonomic systems in patients with combined trauma of the middle face. PATIENTS AND METHODS: Materials and methods: Examination included 112 patients with combined trauma of the middle face.Their psycho-emotional state was assessed using the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS). All patients were tested using questionnaires developed by Wayne A.M.. The Kerdo index was used to assess autonomic tone, while autonomic reactivity was determined using a Czermak-Gering carotid sinus test. Biochemical markers of stress - adrenocorticotropic hormone (ACTH), cortisol and anti-stress system - ß-endorphins,and Garkavi L.Kh. adaptation index. RESULTS: Results: Patients with severe traumatic brain injury - 26.78%, and severe fractures of the facial bones - 48.21%. The consequence of traumatic events is the appearance of post-traumatic stress disorders in their mental function. Post-traumatic stress is also manifested at the hematological level in the characteristic stress reactions: the growth in the blood of stress markers - ACTH and cortisol and anti-stress factors, including ß-endorphins. CONCLUSION: Conclusions: Middle facial injuries cause disorders of the psycho-emotional sphere, which are manifested in anxiety and depressive disorders. The post-traumatic period is accompanied by stress disorders, which are confirmed by hematological studies with a significant increase in stress markers (ACTH and cortisol) and an insignificant increase in anti-stress factors in the blood. Insufficient stress-limiting function of the hypothalamic-pituitary system slows down the healing process and requires appropriate correction.

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In the current aging society, there has been a marked increase in the incidence of cervical spinal cord injury (CSCI) without major bone injury. This multi-center study aimed to identify predictors of neurological improvement in elderly patients with CSCI without major bone injury. The participants were 591 patients aged ≥65 years with CSCI without major bone injury and a minimum follow-up period of three months. Neurologic status was defined using the American Spinal Injury Association (ASIA) impairment scale (AIS). Univariate and multi-variate analyses were performed to identify prognostic factors for walking recovery in AIS A-C cases and full upper extremity motor recovery in AIS D cases. In AIS A-C cases, body mass index (odds ratio (OR): 1.112), magnetic resonance imaging signal change (OR: 0.240), AIS on admission (OR: 3.497), comorbidity of dementia/delirium (OR: 0.365), and post-injury pneumonia (OR: 0.194) were identified as independent prognostic factors for walking recovery. The prevalence of ossification of the posterior longitudinal ligament (OR: 0.494) was also found to be an independent prognostic factor in AIS B and C cases only. In AIS D cases, age (OR: 0.937), upper extremity ASIA motor score on admission (OR: 1.230 [per 5 scores]), and operation (OR: 0.519) were independent prognostic factors for full motor recovery. The severity of AIS at admission was the strongest predictor of functional outcomes. Promoting rehabilitation, however, through measures to reduce cognitive changes, post-injury pneumonia, and unhealthy body weight changes can contribute to greater neurological improvement in AIS A-C cases.

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OBJECTIVE: Having vitamin D levels within normal limits is important for bone and muscle health and its deficiency may increase the risk of injury. The aim of this cross-sectional study was to investigate whether vitamin D levels are different in indoor and outdoor athletes and its levels increase the risk of injury. MATERIAL AND METHODS: Serum vitamin D levels were measured in Caucasian adolescent athletes, who admitted to the sports medicine polyclinic due to a routine health check or injury. The study was carried out at 38°26' north latitude in Izmir between June and September 2019. After the physical examination of the injured athletes, the diagnoses were made accompanied by the findings obtained by imaging methods in cases of necessity. RESULTS: A total of 256 athletes, including swimmers (n = 87), basketball players (n = 104), and football (n = 65) players aged 13.2 (± 2.2) years, were investigated. The average serum vitamin D (25(OH)D) level in athletes was 29.2 (±10.0) ng/mL (6.0-66.0 ng/mL). Forty-six of all athletes (18%) had vitamin D deficiency, with a mean value of 15.7 (±4.0) ng/mL, and 93 of them (36.3%) had vitamin D deficiency with a mean value of 25.2 (±2.4) ng/mL. While vitamin D levels were significantly higher in football players (32 ng/mL) than in other athletes (p < 0.05), it was similar in basketball players (27 ng/mL) and swimmers (26 ng/mL) (p > 0.05). Vitamin D levels (26 ng/mL) of the injured athletes were significantly lower than those of the non-injured athletes (30 ng/mL) (p = 0.001). Bone injuries were significantly related to Vitamin D levels (p < 0.001) but not with muscle injuries (p > 0.05). CONCLUSION: Frequency of vitamin D deficiency and insufficiency is higher in indoor athletes andis especially associated with risk of bone injuries . In order to examine the effect of vitamin D level on bone mineral density, comprehensive prospective studies are required.

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