Skeletal Surveys in Suspected Non-accidental Trauma: Examining the Yield and Current Clinical Practices at a Regional Referral Center in West Virginia

Introduction Non-accidental trauma (NAT) is a leading cause of pediatric injury and death. When NAT is suspected in children under the age of 24 months, the American Academy of Pediatrics (AAP) recommends using skeletal surveys (SS) to identify acute, healing, or old fractures and to repeat the SS approximately two weeks after initial imaging as acute fractures can sometimes not be seen on initial imaging. In this study, we determined the yield of initial and follow-up SS obtained for suspected NAT in children under the age of 24 months at a regional referral hospital. Methods We reviewed charts of children younger than 24 months who received SS imaging, due to physical abuse suspicion, at our hospital system between 2017 and 2022. We used convenient sampling to examine all SS occurring at the Charleston Area Medical Center Healthcare System. Results A total of 61 of the 126 initial SS showed fractures. Only 9% of children received follow-up SS. Repeat SS performed approximately two weeks after positive initial SS showed signs of healing, including new fractures not reported on the initial scan. Follow-up SS performed within eight weeks after initial negative scans continued to be negative. Lastly, consults from child abuse pediatricians were found to be underutilized as only 48% of patients received consultations. Conclusion Follow-up SS and child abuse pediatrician consults were found to be underutilized. Follow-up SS and consulting child abuse specialists should not be overlooked, irrespective of positive or negative initial SS, to provide optimal management of NAT.

TLE4 Is a Critical Mediator of Osteoblast and Runx2-Dependent Bone Development

Healthy bone homeostasis hinges upon a delicate balance and regulation of multiple processes that contribute to bone development and metabolism. While examining hematopoietic regulation by Tle4, we have uncovered a previously unappreciated role of Tle4 on bone calcification using a novel Tle4 null mouse model. Given the significance of osteoblasts in both hematopoiesis and bone development, this study investigated how loss of Tle4 affects osteoblast function. We used dynamic bone formation parameters and microCT to characterize the adverse effects of Tle4 loss on bone development. We further demonstrated loss of Tle4 impacts expression of several key osteoblastogenic genes, including Runx2, Oc, and Ap, pointing toward a potential novel mechanism for Tle4-dependent regulation of mammalian bone development in collaboration with the RUNX family members.

Association Between Diet, Physical Activity and Body Mass Index, Fat Mass Index and Bone Mineral Density of Soldiers of the Polish Air Cavalry Units

Research from recent years indicates a problem of excessive body weight among soldiers, who, due to the kind of work carried out, should possess good health and fitness levels. The aim of the study was to determine the association between diet and physical activity and the nutritional status of soldiers of the Polish Air Cavalry Units. One hundred and twenty male soldiers (aged 28 ± 5 years) completed a questionnaire (food frequency questionnaire, long-form International Physical Activity Questionnaire). Body composition was determined by bioelectrical impedance analysis, and bone calcification of the forearm was assessed by the DXA (Dual Energy X-ray Absorptiometry) densitometric method. This study confirmed the association between both the diet and physical activity and body mass index (BMI), fat mass index (FMI), and bone mineral density (BMD) expressed as T-score. Significant negative correlations were found between BMI and the frequency of consumption of cereal products, meat products and fish, and nonalcoholic beverages, between FMI and cereal products, and between BMD T-score and meat products and fish, fat, nuts, and grains, sweets and snacks, and nonalcoholic beverages. Physical activity expressed as metabolic equivalent (MET-minutes/week) negatively correlated with FMI (but not BMI) and positively correlated with the BMD T-score. This study confirmed numerous irregularities in eating behavior and in nutritional status indices; therefore, there is a need for nutritional education and further monitoring of both dietary behaviors and nutritional status of soldiers.