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Rheumatoid arthritis (RA) is an autoimmune disease that causes damage to joints. This review focuses on the possibility of influencing the disease through immunomodulation by mesenchymal stem cells (MSCs). There is an occurrence of rheumatoid factor and RA-specific autoantibodies to citrullinated proteins in most patients. Citrulline proteins have been identified in the joints of RA patients, and are considered to be the most suitable candidates for the stimulation of anti-citrulline protein antibodies production. Fibroblast-like proliferating active synoviocytes actively promote inflammation and destruction in the RA joint, in association with pro-inflammatory cells. The inflammatory process may be suppressed by MSCs, which are a population of adherent cells with the following characteristic phenotype: CD105+, CD73+, CD90+, CD45−, CD34− and HLA DR−. Following the stimulation process, MSCs are capable of immunomodulatory action through the release of bioactive molecules, as well as direct contact with the cells of the immune system. Furthermore, MSCs show the ability to suppress natural killer cell activation and dendritic cells maturation, inhibit T cell proliferation and function, and induce T regulatory cell formation. MSCs produce factors that suppress inflammatory processes, such as PGE2, TGF-β, HLA-G5, IDO, and IL-10. These properties suggest that MSCs may affect and suppress the excessive inflammation that occurs in RA. The effect of MSCs on rheumatoid arthritis has been proven to be a suitable alternative treatment thanks to successful experiments and clinical studies.

Background Currently, simulation programs are used for a technical analysis of accidents including pedestrians as they provide a great amount of data on the physical parameters of the pedestrian’s body movement and its contacts with the vehicle or the road. In order to be able to make use of the presented options, it is necessary to obtain additional information about detected injuries from forensic doctors in a way utilizable for technical experts. Methods This study includes the results of 250 traffic accidents and approximately 200 real accidents, as well as 255 simulations. The evaluations were based on the investigation of circumstances, accompanying documentation, autopsy findings, photo documentation, and the results of additional expert examinations. We further proceeded in line with the complete autopsy findings in accordance with the requirements of the international classification of diseases. Results Previous practice has shown that the modified forensic system FORTIS, due to its capability to parametrize through localization using the PC Fortis © program, is an important tool to supplement verbal descriptions and localizations of injuries that have been used so far. Conclusions The FORTIS system is a usable and universal means of supplementing verbal medical descriptions for the needs of traffic accident analysts with a scoring system of a high informative value. This, in combination with a video simulation of contacts with a pedestrian’s body during a collision and with values of physical parameters from simulation programs, makes it possible to significantly increase the value of evidence for the needs of the police and courts.

Individual tissues have significantly different resistance to ischemia–reperfusion damage. There is still no adequate treatment for the consequences of ischemia–reperfusion damage. By utilizing ischemic tolerance, it is possible to achieve a significant reduction in the extent of the cell damage due to ischemia–reperfusion injury. Since ischemia–reperfusion damage usually occurs unexpectedly, the use of preconditioning is extremely limited. In contrast, postconditioning has wider possibilities for use in practice. In both cases, the activation of ischemic tolerance can also be achieved by the application of sublethal stress on a remote organ. Despite very encouraging and successful results in animal experiments, the clinical results have been disappointing so far. To avoid the factors that prevent the activation of ischemic tolerance, the solution has been to use blood plasma containing tolerance effectors. This plasma is taken from healthy donors in which, after exposure to two sublethal stresses within 48 h, effectors of ischemic tolerance occur in the plasma. Application of this activated plasma to recipient animals after the end of lethal ischemia prevents cell death and significantly reduces the consequences of ischemia–reperfusion damage. Until there is a clear chemical identification of the end products of ischemic tolerance, the simplest way of enhancing ischemic tolerance will be the preparation of activated plasma from young healthy donors with the possibility of its immediate use in recipients during the initial treatment.

IntroductionThe purpose of this study was to determine factors that affect the early failure of femoral neck fracture healing after internal fixation with a dynamic locking plate implant.Patients and methodsRetrospective analysis of all cases of femoral neck fracture (FNF) primarily treated with dynamic locking plate implant from 04/2014 to 04/2017 with a minimum of 6 month follow-up. For the purpose of the study age, sex and time from admission to surgery were retrieved from the hospital medical database. Patient’s pre- and postoperative hip radiographs were reviewed by the authors. Radiographically detected fracture healing failure (non-union and screw cut-out) was recorded.ResultsFor the period of the study, there were 77 consecutive FNF (76 patients) treated with the dynamic locking plate implant. Eight (10%) patients were lost to follow-up, 13 (17%) patients died within 6 months after surgery. Healing failure was identified in 23 (41%) of remaining 56 cases. Three of four (75% failure rate) failures were observed in cases with fair-quality reduction and two of two (100% failure rate) failures were noticed in the case of none telescoping screw located within subchondral bone. Multiple logistic regression showed an increased risk of fracture failure in cases with at least one completely collapsed telescoping screw (OR = 73.2; 95% CI 9.4–568.5, p < 0.01), while telescoping screws’ location around centre of the femoral head reduces the risk of failure (OR = 14.7; 95% CI 1.6–135.1, p = 0.02).ConclusionIn our group of patients, fracture healing failure of the FNF treated with dynamic locking plate reached 41%. This high failure rate was associated with poor fracture reduction, not subchondrally and centrally placed telescoping screws and in the case of complete collapse on at least one of the telescoping screws.

Background. Pulmonary arterial dissection with chronic pulmonary arterial hypertension as its major cause is a very rare but life-threatening condition. In most cases the main pulmonary trunk is the affected site usually without involvement of its branches. Segmental or lobar pulmonary artery dissection is extremely rare. Case Presentation. We report a unique case of left lower lobe pulmonary artery dissection in a 70-year-old male, with confirmed chronic pulmonary hypertension. To confirm dissection MDCT pulmonary angiography was used. Multiplanar reformation (MPR) images in sagittal, coronal, oblique sagittal, and curved projections were generated. This case report presents morphologic CT features of rare chronic left lobar pulmonary artery dissection associated with chronic pulmonary hypertension at a place of localised pulmonary artery calcification. CT pulmonary angiography excluded signs of thromboembolism and potential motion or flow artefacts. Conclusion. To the best of our knowledge, no case of lower lobe pulmonary artery dissection with flap calcification has been reported yet. CT imaging of the chest is a key diagnostic tool that is able to detect an intimal flap and a false lumen within the pulmonary arterial tree and is preferred in differential diagnosis of rare complications of sustained pulmonary arterial hypertension.

IntroductionThe aim of this study was to determine factors that affect post-operative subsidence in split-depression lateral plateau tibial fracture (OTA/AO 41B3.1) which was treated with raft construct through a locking plate.Patients and methodsThe retrospective study evaluated all split-depression lateral plateau tibial fracture cases treated with raft construct through a locking plate between 01/2015 and 04/2020 with a minimum of 12-month follow-up. Data on the patients’ age, sex, time from injury to surgery, type of plate, and use of subchondral bone defect filler were retrieved from the hospital database. The measurements of total plateau area (TPA), depressed lateral plateau area (DPA), and maximal plateau depression (MPD) were performed on the patients’ pre-operative CT scans. The percentage of DPA to TPA (%DPA) was calculated. Post-operative radiographs were used for the evaluation of plateau subsidence. A subsidence greater than 2 mm was considered a failure.ResultsThere were 41 consecutive cases of split-depression lateral plateau tibial fracture in the reviewed period. Five cases were excluded, three of them were lost to follow up, 1 patient had no pre-operative CT scan and 1 had a history of cancer. A failure was identified in 11 (31%) cases. Patients in the failure group were older (61.0 vs 50.7 years, p = 0.01), and had a higher incidence of fractures extending into intercondylar eminence (100% vs 56%, p = 0.02). Multiple logistic regression identified DPA (OR = 3.6; 95%CI 1.4–9.5, p < 0.01) and age (OR = 1.2; 95% CI 1.0–1.4, p = 0.02) as predictive factors for plateau subsidence.DPA cut-off value for predicting subsidence greater than 2 mm was 5.8 cm2 [Area Under the ROC Curve 0.89 (95% CI 0.74–0.97), sensitivity 91%, specificity 80%, p < 0.01)].ConclusionAge and depressed lateral plateau area (DPA) in split-depression lateral plateau tibial fracture treated with raft construct through a locking plate are risk factors for post-operative subsidence greater than 2 mm.

Traumatic brain injury (TBI) is one of the most common trauma-related diagnoses among the elderly population treated in emergency departments (ED). Identification of patients with increased or decreased risk of intracranial bleeding is of clinical importance. The objective of this study was to evaluate the implication of cutaneous impact location (CIL) on the prevalence of intracranial injury after suspected or confirmed TBI irrespective of its severity. This was a retrospective, single-center, descriptive observational study of geriatric patients aged 65 years and older treated for suspected or confirmed TBI in a trauma surgery ED. The primary outcome of the study was the assessment of a CIL of the injury and its association with the prevalence of intracranial lesions found on a head computed tomography scan. Among 381 patients included in the analysis, the CIL of interest (temporo-parietal and occipital impacts) was present among 178 (46.7%) cases. Thirty-six (9.5%) patients were diagnosed with intracranial bleeding. The prevalence of intracranial bleeding was higher in the CIL of interest group compared with other locations outside (12.9% vs 6.4%; p = 0.030). CIL of interest was a predictor of intracranial bleeding (p = 0.033; OR: 2.17; 95% CI: 1.06 to 4.42). The CIL of head injury is a predictor of intracranial lesions among geriatric patients with traumatic brain injury. Physicians should be aware of this association when assessing elderly patients with head injuries. More studies are needed to develop a clinical management tool incorporating CIL to guide the diagnosis of TBI in this population.

AbstractBackgroundFalls among older adults are now the leading cause of traumatic brain injury worldwide. We aimed to identify historical and clinical characteristics including the visible head impact location indicative of significant acute traumatic intracranial hemorrhage in older patients presenting to emergency department with mild traumatic brain injury subsequent to a ground-level fall.Methods and FindingsWe conducted a multicentre prospective cohort study across five university-affiliated emergency departments over a 2-year period (1 July 2023, to 30 June 2025) in Europe. We included patients aged 65 years or older who presented with mild traumatic brain injury (defined as head trauma with a Glasgow Coma Scale score of 13 to 15 upon emergency department presentation) following a ground-level fall and who underwent a computed tomography scan. The primary outcome was significant acute traumatic intracranial hemorrhage, defined as a neuroimaging radiological interpretation system (NIRIS) score > 1. Predictors were identified using logistic regression and recursive partitioning. A predictor was included in the decision rule if its association with the primary outcome and its interobserver reliability were strong. Internal validation was performed using bootstrapping. The study included 1,620 patients (mean age, 84.6 ± 8.5 years). A significant acute traumatic intracranial hemorrhage was identified in 72 patients (4.4%, 95% CI, 3.5–5.6) of which five (0.3%, 95 CI% 0.1–0.7) required neurosurgical intervention, performed within a median delay of 2 days (1–4). Eight criteria were identified as strong and reliable predictors: visible forehead-scalp impact, Glasgow Coma Scale score below baseline, focal neurological deficit, sign of basal skull fracture, acute confusion, vomiting, loss of consciousness, and headache. We then derived two clinical decision rules, which both showed 100% sensitivity (95% CI, 95–100) with specificities ranging from 25.3% (95% CI, 23.2–27.6) to 43.6% (95% CI, 41.1–46.1). Application of either clinical decision rule would have allowed reductions (41.7% or 24.2%) of the numbers of patients sent to the CT scan unit. Internal validation confirmed the strong performance of both rules, based on C-statistics of 0.84 (95% CI, 0.79–0.87) and 0.79 (95% CI, 0.74–0.84).ConclusionOur findings revealed that factors drawn from patient history and physical examination were associated with significant acute traumatic intracranial hemorrhage in older adults after a ground-level fall. Incorporating these factors into decision rules could provide a reliable strategy to stratify risk and reduce unnecessary CT scan. Such rules need to be validated externally and independently for their implementation in clinical practice, but may already be of aid for identifying high-risk patients.

Purpose Mild traumatic brain injury (mTBI) is one of the most common trauma-related diagnoses treated in emergency departments, especially among the geriatric population. Higher age alone is often an indication for a computed tomography (CT) scan, even when, approximately 90% of these scans do not reveal intracranial injuries. Incorporation of new diagnostic parameters into indication schemes for CT scans could improve the efficiency and reduce unnecessary imaging. The primary outcome of this study was to evaluate the association of acute behavioral changes among elderly patients treated for mTBI with the prevalence of intracranial injuries diagnosed by CT scans. Methods A retrospective cross-sectional study was conducted at Louis Pasteur University Hospital in Košice. All patients aged 65 and older who presented during the period of 12 months with suspected mTBI and underwent CT imaging were included in the study. Electronic health records were used as a data source. Results A total of 586 patients were included in the study. Acute behavioral changes were observed among 60 (10.2%) patients. Intracranial injury was diagnosed in 35 patients (6.0%). There was a statistically significant association between acute behavioral changes and the presence of intracranial injuries ( p  < 0.05), with those exhibiting behavioral changes having higher odds of injury (OR: 6.51; 3.01–13.7; p  < 0.001). Conclusion Elderly patients with mTBI who present with acute behavioral changes are more likely to have intracranial injuries detected by CT scans. Incorporating these symptoms into indication schemes for head CT scans may improve strategies aimed at more effective and judicious use of imaging. Trial registration Clinical trial number: Not applicable, retrospectively registered.

Background Mild traumatic brain injury (mTBI) is a common diagnosis among elderly patients treated in emergency departments. It is often complicated by age-related physiological changes such as brain atrophy, cognitive impairment, and frailty. While sex differences are increasingly recognized in TBI pathophysiology and clinical management, limited research has explored their impact on geriatric mTBI complicated by intracranial bleeding. This study aimed to investigate sex-stratified patterns in injury mechanisms, clinical presentation, and associated injuries among older adults with mTBI. Methods We conducted a retrospective, single-center cohort study of geriatric patients (≥ 65 years) hospitalized at the Louis Pasteur University Hospital in Košice, Slovakia with mTBI complicated by intracranial bleeding over a 30-month period (July 2022– December 2024). Patient data were extracted from electronic health records, including demographic characteristics, injury mechanisms, symptomatology, radiological findings, and clinical outcomes. Statistical analysis was performed using descriptive and comparative methods. Results A total of 117 patients (55 females, 62 males) met the inclusion criteria. The median age was 77.0 years (IQR: 12.0), with females presenting at a higher median age than males (80 vs. 75.5 years). Causes of injury differed significantly between sexes ( p  < 0.001); while mechanical falls were predominant in both groups, alcohol-related injuries were significantly more common in males (37.1% vs. 7.3%). Symptom presentation also varied, with females exhibiting a higher prevalence of multiple symptoms, while males more frequently reported amnesia or loss of consciousness ( p  = 0.029). Additional injuries showed sex-related differences, with skull fractures more prevalent in males (41.9% vs. 21.8%) and pelvic (0 vs. 7.3%) or upper limb fractures (0 vs. 12.7%) more common in females ( p  = 0.005). Conclusion Sex-based differences in the presentation and symptomatology of geriatric patients with mTBI and intracranial bleeding highlight the need for tailored diagnostic and management approaches. Recognizing these differences could improve clinical assessment and individualized care. Further research is needed to refine sex-specific diagnostic and therapeutic strategies in this vulnerable population.