Missed foot fractures in polytrauma patients: a retrospective cohort study

BACKGROUND: Missed foot fractures are a known problem in the care of the traumatized patient. They do not usually have an influence on the survival, but on the long-term result and the quality of the patient''s life. The aim of this study is to find out how many of these fractures are overlooked in a Level I trauma center and what the consequences for the patients are hypothesing that patients with a delayed diagnosis will have worse clinical results. METHODS: Forty-seven patients (7.3%) with foot fractures could be identified in 642 polytrauma patients, retrospectively. All patients were divided into two groups: early diagnosed fractures and delayed diagnosed fractures, the latter defined as diagnosed after Secondary Survey. Patients were evaluated according to the Hannover Outcome Score, the Short Form-36 Health Survey, the AOFAS Score and the Hannover Scoring System. The average follow-up was 5 years and 8 months. Reasons for overlooking a foot fracture were analyzed. RESULTS: The foot fracture was early diagnosed in 26 (55.3%) patients, but delayed in 21 (44.7%). There were no significant differences in the mean stay in the hospital or in the ICU. The fractures that were most often missed were those of the cuboid or the metarsalia. The highest risk factor for a delayed diagnosis was a fracture already diagnosed on the same foot. In 52.4% of the delayed diagosed fractures, an operative therapy was necessary. There were no significant differences between the two groups in the clinical results. CONCLUSIONS: In summary, the results of this study show that foot injuries can be a safety problem for the patient and the examination of the feet in the trauma room has to be a compulsory part of the algorithm. Although the majority of delayed diagnosed foot fractures demonstrated comparable results to the immediately diagnosed fractures, approximately 10% might have benefited from an earlier diagnosis. Even if there were no significant differences in the clinical results, we have to be aware that missing a fracture in the foot can lead to worse results in the complete polytrauma care

Non-equivalent role of TM2 gating hinges in heteromeric Kir4.1/Kir5.1 potassium channels

Comparison of the crystal structures of the KcsA and MthK potassium channels suggests that the process of opening a K+ channel involves pivoted bending of the inner pore-lining helices at a highly conserved glycine residue. This bending motion is proposed to splay the transmembrane domains outwards to widen the gate at the “helix-bundle crossing”. However, in the inwardly rectifying (Kir) potassium channel family, the role of this “hinge” residue in the second transmembrane domain (TM2) and that of another putative glycine gating hinge at the base of TM2 remain controversial. We investigated the role of these two positions in heteromeric Kir4.1/Kir5.1 channels, which are unique amongst Kir channels in that both subunits lack a conserved glycine at the upper hinge position. Contrary to the effect seen in other channels, increasing the potential flexibility of TM2 by glycine substitutions at the upper hinge position decreases channel opening. Furthermore, the contribution of the Kir4.1 subunit to this process is dominant compared to Kir5.1, demonstrating a non-equivalent contribution of these two subunits to the gating process. A homology model of heteromeric Kir4.1/Kir5.1 shows that these upper “hinge” residues are in close contact with the base of the pore α-helix that supports the selectivity filter. Our results also indicate that the highly conserved glycine at the “lower” gating hinge position is required for tight packing of the TM2 helices at the helix-bundle crossing, rather than acting as a hinge residue

An Alpha-Catulin Homologue Controls Neuromuscular Function through Localization of the Dystrophin Complex and BK Channels in Caenorhabditis elegans

The large conductance, voltage- and calcium-dependent potassium (BK) channel serves as a major negative feedback regulator of calcium-mediated physiological processes and has been implicated in muscle dysfunction and neurological disorders. In addition to membrane depolarization, activation of the BK channel requires a rise in cytosolic calcium. Localization of the BK channel near calcium channels is therefore critical for its function. In a genetic screen designed to isolate novel regulators of the Caenorhabditis elegans BK channel, SLO-1, we identified ctn-1, which encodes an α-catulin homologue with homology to the cytoskeletal proteins α-catenin and vinculin. ctn-1 mutants resemble slo-1 loss-of-function mutants, as well as mutants with a compromised dystrophin complex. We determined that CTN-1 uses two distinct mechanisms to localize SLO-1 in muscles and neurons. In muscles, CTN-1 utilizes the dystrophin complex to localize SLO-1 channels near L-type calcium channels. In neurons, CTN-1 is involved in localizing SLO-1 to a specific domain independent of the dystrophin complex. Our results demonstrate that CTN-1 ensures the localization of SLO-1 within calcium nanodomains, thereby playing a crucial role in muscles and neurons

AMPA Receptors Commandeer an Ancient Cargo Exporter for Use as an Auxiliary Subunit for Signaling

Fast excitatory neurotransmission in the mammalian central nervous system is mainly mediated by ionotropic glutamate receptors of the AMPA subtype (AMPARs). AMPARs are protein complexes of the pore-lining α-subunits GluA1-4 and auxiliary β-subunits modulating their trafficking and gating. By a proteomic approach, two homologues of the cargo exporter cornichon, CNIH-2 and CNIH-3, have recently been identified as constituents of native AMPARs in mammalian brain. In heterologous reconstitution experiments, CNIH-2 promotes surface expression of GluAs and modulates their biophysical properties. However, its relevance in native AMPAR physiology remains controversial. Here, we have studied the role of CNIH-2 in GluA processing both in heterologous cells and primary rat neurons. Our data demonstrate that CNIH-2 serves an evolutionarily conserved role as a cargo exporter from the endoplasmic reticulum (ER). CNIH-2 cycles continuously between ER and Golgi complex to pick up cargo protein in the ER and then to mediate its preferential export in a coat protein complex (COP) II dependent manner. Interaction with GluA subunits breaks with this ancestral role of CNIH-2 confined to the early secretory pathway. While still taking advantage of being exported preferentially from the ER, GluAs recruit CNIH-2 to the cell surface. Thus, mammalian AMPARs commandeer CNIH-2 for use as a bona fide auxiliary subunit that is able to modify receptor signaling

Effect of garlic on blood pressure: A systematic review and meta-analysis

The electronic version of this article is the complete one and can be found online at the publisher's website.Background: Non-pharmacological treatment options for hypertension have the potential to reduce the risk of cardiovascular disease at a population level. Animal studies have suggested that garlic reduces blood pressure, but primary studies in humans and non-systematic reviews have reported mixed results. With interest in complementary medicine for hypertension increasing, it is timely to update a systematic review and meta-analysis from 1994 of studies investigating the effect of garlic preparations on blood pressure. Methods: We searched the Medline and Embase databases for studies published between 1955 and October 2007. Randomised controlled trials with true placebo groups, using garlic-only preparations, and reporting mean systolic and/or diastolic blood pressure (SBP/DBP) and standard deviations were included in the meta-analysis. We also conducted subgroup meta-analysis by baseline blood pressure (hypertensive/normotensive), for the first time. Meta-regression analysis was performed to test the associations between blood pressure outcomes and duration of treatment, dosage, and blood pressure at start of treatment. Results: Eleven of 25 studies included in the systematic review were suitable for meta-analysis. Meta-analysis of all studies showed a mean decrease of 4.6 ± 2.8 mm Hg for SBP in the garlic group compared to placebo (n = 10; p = 0.001), while the mean decrease in the hypertensive subgroup was 8.4 ± 2.8 mm Hg for SBP (n = 4; p < 0.001), and 7.3 ± 1.5 mm Hg for DBP (n = 3; p < 0.001). Regression analysis revealed a significant association between blood pressure at the start of the intervention and the level of blood pressure reduction (SBP: R = 0.057; p = 0.03; DBP: R = -0.315; p = 0.02). Conclusion: Our meta-analysis suggests that garlic preparations are superior to placebo in reducing blood pressure in individuals with hypertension.Karin Ried, Oliver R. Frank, Nigel P. Stocks, Peter Fakler and Thomas Sulliva

Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis

Patients with ankylosing spondylitis are at significant risk for sustaining cervical spine injuries following trauma predisposed by kyphosis, stiffness and osteoporotic bone quality of the spine. The risk of sustaining neurological deficits in this patient population is higher than average. The present review article provides an outline on the specific injury patterns in the cervical spine, diagnostic algorithms and specific treatment modalities dictated by the underlying disease in patients with ankylosing spondylitis. An emphasis is placed on the risks and complication patterns in the treatment of these rare, but challenging injuries

Missed foot fractures in polytrauma patients: a retrospective cohort study

BACKGROUND: Missed foot fractures are a known problem in the care of the traumatized patient. They do not usually have an influence on the survival, but on the long-term result and the quality of the patient''s life. The aim of this study is to find out how many of these fractures are overlooked in a Level I trauma center and what the consequences for the patients are hypothesing that patients with a delayed diagnosis will have worse clinical results. METHODS: Forty-seven patients (7.3%) with foot fractures could be identified in 642 polytrauma patients, retrospectively. All patients were divided into two groups: early diagnosed fractures and delayed diagnosed fractures, the latter defined as diagnosed after Secondary Survey. Patients were evaluated according to the Hannover Outcome Score, the Short Form-36 Health Survey, the AOFAS Score and the Hannover Scoring System. The average follow-up was 5 years and 8 months. Reasons for overlooking a foot fracture were analyzed. RESULTS: The foot fracture was early diagnosed in 26 (55.3%) patients, but delayed in 21 (44.7%). There were no significant differences in the mean stay in the hospital or in the ICU. The fractures that were most often missed were those of the cuboid or the metarsalia. The highest risk factor for a delayed diagnosis was a fracture already diagnosed on the same foot. In 52.4% of the delayed diagosed fractures, an operative therapy was necessary. There were no significant differences between the two groups in the clinical results. CONCLUSIONS: In summary, the results of this study show that foot injuries can be a safety problem for the patient and the examination of the feet in the trauma room has to be a compulsory part of the algorithm. Although the majority of delayed diagnosed foot fractures demonstrated comparable results to the immediately diagnosed fractures, approximately 10% might have benefited from an earlier diagnosis. Even if there were no significant differences in the clinical results, we have to be aware that missing a fracture in the foot can lead to worse results in the complete polytrauma care