Category: Injury & Trauma

Categories : Injury & Trauma Regenerative MedicineTags :

Transplanted Hair Follicles Successfully Reduced Scars

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By treating skin scars in three volunteers with hair follicle transplants, researchers found that the scarred skin began to behave more like uninjured skin. According to the results published in Nature Regenerative Medicine, the scarred skin harboured new cells and blood vessels, remodelled collagen to restore healthy patterns, and even expressed genes found in healthy unscarred skin.

The findings could lead to better treatments for scarring both on the skin and inside the body, leading to hope for patients with extensive scarring, which can impair organ function and cause disability.

Lead author Dr Claire Higgins, of Imperial’s Department of Bioengineering, said: “After scarring, the skin never truly regains its pre-wound functions, and until now all efforts to remodel scars have yielded poor results. Our findings lay the foundation for exciting new therapies that can rejuvenate even mature scars and restore the function of healthy skin.”

Hope in hair

Scar tissue in the skin lacks hair, sweat glands, blood vessels and nerves, impairing temperature regulation and sensation. Scarring can also hinder movement as well as potentially causing discomfort and emotional distress.

Compared to scar tissue, healthy skin undergoes constant remodelling by the hair follicle. Hairy skin heals faster and scars less than non-hairy skin- and hair transplants had previously been shown to aid wound healing. Inspired by this, the researchers hypothesised that transplanting growing hair follicles into scar tissue might induce scars to remodel themselves.

To test their hypothesis, Imperial researchers worked with Dr Francisco Jiménez, lead hair transplant surgeon at the Mediteknia Clinic and Associate Research Professor at University Fernando Pessoa Canarias, in Gran Canaria, Spain. They transplanted hair follicles into the mature scars on the scalp of three participants in 2017. The researchers selected the most common type of scar, called normotrophic scars, which usually form after surgery.

They took and microscope imaged 3mm-thick biopsies of the scars just before transplantation, and then again at two, four, and six months afterwards.

The researchers found that the follicles inspired profound architectural and genetic shifts in the scars towards a profile of healthy, uninjured skin.

Dr Jiménez said: “Around 100 million people per year acquire scars in high-income countries alone, primarily as a result of surgeries. The global incidence of scars is much higher and includes extensive scarring formed after burn and traumatic injuries. Our work opens new avenues for treating scars and could even change our approach to preventing them.”

Architects of skin

After transplantation, the follicles continued to produce hair and induced restoration across skin layers.

Scarring causes the epidermis to thin out, leaving it vulnerable to tears. At six months post-transplant, the epidermis had doubled in thickness alongside increased cell growth, bringing it to around the same thickness as uninjured skin.

The next skin layer down, the dermis, is populated with connective tissue, blood vessels, sweat glands, nerves, and hair follicles. Scar maturation leaves the dermis with fewer cells and blood vessels, but after transplantation the number of cells had doubled at six months, and the number of vessels had reached nearly healthy-skin levels by four months. This demonstrated that the follicles inspired the growth of new cells and blood vessels in the scars, which are unable to do this unaided.

Scarring also increases the density of collagen fibres, causing them to align and make the scar stiffer. The hair transplants reduced the fibre density, allowing them to form a healthier, ‘basket weave’ pattern, which reduced stiffness – a key factor in tears and discomfort.

The authors also found that after transplantation, the scars expressed 719 genes differently to before. Genes that promote cell and blood vessel growth were expressed more, while genes that promote scar-forming processes were expressed less.

Underling mechanism still unknown

It is not known how exactly the transplants brought about the change. Having of a hair follicle in the scar was cosmetically acceptable for the participants as the scars were on the scalp. The researchers are now working to uncover the underlying mechanisms so they can develop therapies that remodel scar tissue towards healthy skin, without the hair follicle transplant. They can then test their findings on non-hairy skin, or on organs like the heart, which can suffer scarring after heart attacks, and the liver, which can suffer scarring through fatty liver disease and cirrhosis.

Dr Higgins said: “This work has obvious applications in restoring people’s confidence, but our approach goes beyond the cosmetic as scar tissue can cause problems in all our organs.

“While current treatments for scars like growth factors focus on single contributors to scarring, our new approach tackles multiple aspects, as the hair follicle likely delivers multiple growth factors all at once that remodel scar tissue. This lends further support to the use of treatments like hair transplantation that alter the very architecture and genetic expression of scars to restore function.”

Source: Imperial College London

Categories : Injury & Trauma Metabolic DisordersTags :

New Material Speeds up Diabetic Wound Healing

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University of Nottingham researchers have discovered a new class of polymer that can aid healing in hard-to-treat diabetic wounds by providing instructions to both immune and non-immune cells. This new material that can be applied to diabetic wounds to accelerated healing with just one application. The findings have been published in Advanced Materials.

Wound healing is a complex biological process that involves various cell types working together, with a cell type called fibroblasts playing a critical role in forming new tissue required for healing. Diabetes can disrupt these processes in cells making wound healing slow and difficult to treat. This can lead to infection and in extreme cases the need for amputation.

Experts from the School of Life Sciences and Pharmacy screened 315 different polymer surfaces, examining the different chemical make-up of each until they identified a polymer type that actively drives fibroblasts and immune cells to promote healing. A team from the School of Engineering made small particles that are decorated with this polymer on their surface. These particles could be directly applied to the wound area.

The long, repeating chain structure of polymers gives them unique properties that can be tailored for different uses. Using polymer microparticles the team showed how this new material, when delivered to a wound on an animal model, produces three times more fibroblast activity over a period of up to 96 hours and achieved more than 80% wound closure.

This new polymer could be applied as a coating to standard wound dressings to provide a fast and effective treatment.

Source: University of Nottingham

Categories : Injury & TraumaTags :

Elite Athletes Have an Osteoarthritis Risk from Sports-related Injuries

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Elite retired sportspeople who had experienced a sports-related injury had a higher chance of knee and hip osteoarthritis when compared with the general population, according to a two-part study reported in the British Journal of Sports Medicine.

One in four retired Olympians reported a diagnosis of osteoarthritis, researchers have found. The athletes – who had competed at an Olympic level in 57 sports including athletics, rowing and skiing – also had an increased risk of lower back pain overall, and shoulder osteoarthritis after a shoulder injury.

Researchers hope the findings will help develop new approaches in injury prevention for the benefit of athletes now and in retirement.

The study is the largest international survey of its kind, and the first to observe the consequences of osteoarthritis and pain in different joints from retired elite athletes across different summer and winter Olympic sports.

Researchers surveyed 3357 retired Olympians aged around 45 on injuries and the health of their bones, joints, muscles and spine. They were also asked if they were currently experiencing joint pain, and if they had an osteoarthritis diagnosis. A comparison group of 1735 people aged around 41 from the general population completed the same survey.

Researchers used statistical models to compare the prevalence of spine, upper limb and lower limb osteoarthritis and pain in retired Olympians with the general population.

The team considered factors that could influence the risk of pain and osteoarthritis such as injury, recurrent injury, age, sex and obesity.

They found that the knee, lumbar spine and shoulder were the most injury prone areas for Olympians. These were also among the most common locations for osteoarthritis and pain.

After a joint injury the Olympians were more likely to develop osteoarthritis than someone sustaining a similar injury in the general population, the research found

The sportspeople also had an increased risk of shoulder, knee, hip and ankle and upper and lower spine pain after injury, although this did not differ with the general population.

Dr Debbie Palmer, of the University of Edinburgh’s Moray House School of Education and Sport, said: “High performance sport is associated with an increased risk of sport-related injury and there is emerging evidence suggesting retired elite athletes have high rates of post-traumatic osteoarthritis.

“This study provides new evidence for specific factors associated with pain and osteoarthritis in retired elite athletes across the knee, hip, ankle, lumbar and cervical spine, and shoulder, and identifies differences in their occurrence that are specific to Olympians.”

Researchers say the study may help people make decisions about recovery and rehabilitation from injuries in order to prevent recurrences, and to inform prevention strategies to reduce the risk and progression of pain and OA in retirement.

Source: University of Edinburgh

Categories : Injury & TraumaTags :

Medical Glue Inspired by Marine Animals could Stop Haemorrhages

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Red blood cells
Source: Pixabay

Every year around two million people die worldwide from haemorrhage, which accounts for more than 30% of trauma deaths. Medical glue, often used to stop the bleeding, is ineffective if the site is too wet or if the site can’t be compressed. But marine animals like mussels and flatworms are able to bond to surfaces underwater, inspiring researchers to develop a medical adhesive, which they describe in Nature Communications.

“When applied to the bleeding site, the new adhesive uses suction to absorb blood, clear the surface for adhesion, and bond to the tissue providing a physical seal. The entire application process is quick and pressure-free, which is suitable for non-compressible haemorrhage situations, which are often life-threatening,” says lead author Guangyu Bao, a recently graduated PhD student under the supervision of Professor Jianyu Li of Department of Mechanical Engineering.

Testing out the their new technology, the researchers found that the adhesive promotes blood coagulation. The adhesive can also be removed without causing re-bleeding or even left inside the body to be absorbed. “Our material showed much better-improved safety and bleeding control efficiency than other commercial products. Beyond bleeding control, our material could one day replace wound sutures or deliver drugs to provide therapeutic effects,” said senior author Professor Jianyu Li.

Source: McGill University

Categories : Injury & Trauma PaediatricsTags :

e-Scooter Injuries among Children on The Increase

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Standing electric scooters, typically termed e-scooters, have been increasing in popularity over the past decade. According to a new research abstract presented during the 2022 American Academy of Pediatrics National Conference & Exhibition, e-scooter injuries among children are becoming much more common and increasingly severe.

The authors found hundreds of e-scooter injuries in the US between 2011-2020. The rate of hospital admittance for patients increased from fewer than 1 out of every 20 e-scooter injuries in 2011 to 1 out of every 8 requiring admittance into a hospital for care in 2020.

“The number of annual e-scooter injuries has increased from 2011 to 2020, likely due in some part to the rise in popularity of rideshare e-scooter apps,” said lead author Harrison Hayward, MD, Emergency Medicine fellow at Children’s National Hospital. “Our study has characterised the spectrum of injuries that occur in children, which helps emergency room doctors prepare for taking care of them and helps parents and families to practice better safety.”

Researchers examined a national database of paediatric e-scooter injuries that were seen in emergency departments at over 100 US hospitals from 2011–2020 to find out what kinds of injuries children were sustaining and if any trends existed. Over 10% of all patients had a head injury, including a concussion, skull fractures, and internal bleeding. The most common injuries were arm fractures (27%), followed by minor abrasions (22%) and lacerations needing stitches (17%). The average age was 11.1 years and 59% of patients were male. Admittance to a hospital rose from 4.2% in 2011 to 12.9% in 2020.

“Parents whose children are riding e-scooters need to know how best to be safe. To that end, helmets are a must, since over 10% of the reported cases were head injuries,” said Dr Hayward. “Children should absolutely be wearing helmets while riding an e-scooter. Research has broadly demonstrated that helmets save lives for bicycle riders, and we should think similarly about e-scooters.”

Source: American Academy of Pediatrics

Categories : Injury & Trauma PaediatricsTags :

Behavioural Problems in Kids after Traumatic Brain Injuries

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Boy hanging from tree
Photo by Annie Spratt on Pexels

Kids who experience a traumatic brain injury (TBI), even a mild one, have more emotional and behavioural problems than kids who do not, according to a study published in NeuroImage.

“These hits to the head are hard to study because much of it depends on recall of an injury since the impacts do not all require a visit to a doctor,” said study first author Daniel Lopez, a PhD candidate at Del Monte Institute for Neuroscience. “But being able to analyse longitudinal data from a large cohort and ask important questions like this gives us valuable information into how a TBI, even a mild one, impacts a developing brain.”

Researchers used MRI and behavioural data collected from thousands of children who participated in the Adolescence Brain Cognitive Development (ABCD) Study. They revealed children with a mild TBI experienced a 15-percent increased risk of an emotional or behavioural problem. The risk was the highest in children around ten years old. Researchers found that children who had a significant hit to the head but did not meet diagnostic criteria for a mild TBI also had an increased risk of these behavioural and emotional problems.

The University of Rochester Medical Center is one of 21 research sites collecting data for the National Institutes of Health ABCD Study. Since 2017, 340 children have been part of the 10-year study that is following 11 750 children through early adulthood. It looks at how biological development, behaviours, and experiences impact brain maturation and other aspects of their lives, including academic achievement, social development, and overall health.

Researchers hope future ABCD Study data will better reveal the impact these head hits have on mental health and psychiatric problems. “We know some of the brain regions associated with increased risk of mental health problems are impacted during a TBI,” said Ed Freedman, PhD, associate professor of Neuroscience and co-principal investigator of the ABCD Study at the University of Rochester. Freedman also led this study. “With more time and data, we hope to gain a better understanding of the long-term impact of even a mild TBI.”

Source: University of Rochester Medical Center

Categories : General Interest Injury & TraumaTags :

Oldest Known Successful Amputation Dates Back 31 000 Years

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Mariano, Public domain, via Wikimedia Commons

At a site in Borneo, archaeologists have unearthed the oldest case of surgical amputation to date, a remarkable feat of prehistoric medical practice.

Published in Nature, the researchers describe the skeletal remains of a young adult found in a cave in Borneo, who had part of the left lower leg and left foot amputated, probably as a child, at least 31 000 years ago. The person lived for at least another six to nine years after the procedure, surviving into adulthood where they died from an unknown cause, possibly in their 20s.

The prehistoric surgery is a remarkable feat; preventing infections is difficult even in modern surgical amputations.

Study co-lead author, Dr Melandri Vlok, at University of Sydney said the find is “incredibly exciting and unexpected.”

“The discovery implies that at least some modern human foraging groups in tropical Asia had developed sophisticated medical knowledge and skills long before the Neolithic farming transition,” said bioarchaeologist Dr Vlok, an expert in ancient skeletons.

The skeleton of the young adult was carefully buried within LiangTebo cave – located Borneo in East Kalimantan, in a limestone karst area home to some of the world’s earliest dated rock art.

The bones were uncovered by archaeologists just days before borders closed for the COVID pandemic in March 2020. Dr Vlok was invited to study the bones when they were brought back to Australia.

“No one told me they had not found the left foot in the grave,” Dr Vlok said. “They kept it hidden from me to see what I would find.”

As Dr Vlok laid the bones out, the left leg looked withered, and was the size of a child’s, but the individual was an adult. She unwrapped the part of the leg that contained the stump and noticed the cut was clean, well healed and had no evidence of any infection. “The chances the amputation was an accident was so infinitely small,” Dr Vlok said. “The only conclusion was this was stone age surgery.”

Dr Vlok ran to the office to tell her research colleagues what she had found. “I told them I thought it looked like a surgical amputation,” she said. “It wasn’t until then that they said they already knew the foot was missing.” Dr Vlok had just confirmed their suspicions. The foot was never placed in the grave to begin with.

An accident in difficult terrain

While the cause for the amputation was unclear, the individual also had a very well healed neck fracture and trauma to their collar bone that may have occurred during the same event, said Dr Vlok.

“An accident, such as a rock fall may have caused the injuries, and it was clearly recognised by the community that the foot had to be taken off for the child to survive,” she said.

The location of the cave is surrounded by extremely rugged terrain, and accessing the site was challenging, making the individual’s survival after the the surgery even more remarkable. The finding will provide even more insight into prehistoric medicine, the researchers said.

Source: University of Sydney

Categories : Ageing Injury & TraumaTags :

A Biomarker for Male Hip Fracture Risk

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In new research published in the Journal of Bone and Mineral Research, elevated blood levels of a certain chemokine, or small signalling protein, that promotes osteoclast formation were linked with a higher risk of hip fracture in men.

To maintain bone health, a balanced activity of various bone cell types including bone-forming osteoblasts and bone-resorbing osteoclasts has to take place. When osteoclasts dominate without adequate bone formation to compensate, osteoporosis results.

The study included 55 men and 119 women who had experienced a hip fracture an average of 6.3 years after their blood was collected. The participants were matched individually to controls who did not develop hip fractures.

The researchers found higher levels of the chemokine CXCL9 in the pre-fracture blood samples of men with subsequent hip fractures compared with their non-fracture controls. In women, the researchers saw no such.

“The unexpected difference in the results between men and women in our study may be explained by how changes in sex hormone levels during aging could influence the level and effects of CXCL9 differently in older men and women,” explained corresponding author Woon-Puay Koh, MBBS, PhD, from the National University of Singapore (NUS).

“Our findings open the exciting possibility that early interventions targeting CXCL9 or CXCL9-CXCR3 signalling could be beneficial in preventing hip fractures in older men,” added co-corresponding author Christoph Winkler, PhD, also from NUS.

Source: Wiley

Categories : Injury & TraumaTags :

Repeated Concussions can Result in Skull Thickening

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MRI images of the brain
Photo by Anna Shvets on Pexels

Published in the journal Scientific Reports, a study led by Associate Professor Bridgette Semple from Monash University, found that repeated concussions resulted in thicker, denser bones in the skull.

Although bones are considered a mostly structural component of the human body, bones are in fact active living tissues that can respond to applied mechanical forces. For example, martial arts training, with its kicks, punches and throws, has been shown to increase bone mineral density in the arms, legs and spines of practitioners.

At present, it is unclear whether this thickening of the skull is beneficial or detrimental: theoretically, a thicker skull is a stronger skull, suggesting that this may be the bone’s attempt to protect the brain from subsequent impacts.

“This is a bit of a conundrum,” Assoc Prof Semple said. “As we know, repeated concussions can have negative consequences for brain structure and function. Regardless, concussion is never a good thing.”

The team hopes that the microstructural skull alterations caused by concussion are now considered by researchers in the field to better understand how concussions affect the whole body.

A form of mild traumatic brain injury, concussion have been linked to long-term neurological consequences if they happen repetition.

While most studies focus on its effect on the brain and its function, they largely ignore the overlying skull bones.

Study collaborator Professor Melinda Fitzgerald, from Curtin University and the Perron Institute in Western Australia, has previously shown that repeated concussive impacts lead to subtle problems with memory, and evidence of brain damage.

In this new study, high-resolution neuroimaging and tissue staining techniques were used in a pre-clinical animal model, and revealed an increase in bone thickness and density, in close proximity to the site of injury.

“We have been ignoring the potential influence of the skull in how concussive impacts can affect the brain,” Associate Professor Semple said. “These new findings highlight that the skull may be an important factor that affects the consequences of repeated concussions for individuals.”

Future studies are planned, with collaborator and bone expert Professor Natalie Sims from St Vincent’s Institute of Medical Research in Melbourne, to understand if a thickened skull resulting from repeated concussions alters the transmission of impact force through the skull and into the vulnerable brain tissue underneath.

Source: Monash University

Categories : Diet and Nutrition Injury & TraumaTags :

Increased Risk of Hip Fractures for Women on Vegetarian Diets

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Source: Unsplash

Middle-aged women on vegetarian diets have a significantly higher risk of hip fractures than those on diets that include fish or meat, according to a long-term study publish in BMC Central. This risk remained even after accounting for the differences in available nutrient intake and body mass index.

Hip fractures greatly impact quality of life and and health outcomes, and carry a significant financial burden, with an average of $44 000 estimated to spent in the 12 months following a hip fracture. The growing trends of meat-free diets have prompted concern over their impact on hip fracture rates.

While increased intake of vegetable proteins has been associated with lower hip fracture risk, vegetarian diets have also been characterised by lower dietary intakes of nutrients that boost bone mineral density (BMD) and which are more abundant in animal products. Examples include total protein, calcium, vitamin D, vitamin B12, and ω-3 fatty acids, though the relationship with BMD is complex.

The researchers drew on data from the United Kingdom Women’s Cohort Study (UKWCS), and included 26 318 participants aged 35–69 who were classed into regular meat-eaters (> 5 servings/week), occasional meat-eaters (< 5 servings/week), pescatarians (eating fish but no meat) and vegetarians.

On average, vegetarians and pescetarians had a lower BMI (23.3 for both) than regular meat-eaters (25.2). At recruitment, regular meat-eaters had the highest prevalence of CVD, cancer, or diabetes (10.2%), and vegetarians the lowest (5.8%). A higher proportion of vegetarians reported never drinking alcohol. Regular meat-eaters reported the highest absolute dietary intakes of protein, vitamin D, and vitamin B12, whilst vegetarians reported the lowest. Calcium intakes were similar across the diet groups.

Before adjustments, compared with regular meat-eaters, vegetarians (hazard ratio 1.40) but not occasional meat-eaters (1.03) or pescatarians (1.04) had a greater hip fracture risk. Adjustment for confounders slightly attenuated these associations in the adjusted model, but the higher risk in vegetarians remained and was statistically significant: vegetarians 1.33; occasional meat-eaters 1.00; pescatarians 0.97.

However, even after adjustment for factors such as reported differences in nutrient intake and lower BMI, which is a known risk factor in hip fractures, the relative risk difference remained. This suggests that other, as yet unknown, factors related to the diets may be involved.