ABSTRACT
Objective: Major depressive disorder (MDD) constitutes a main risk factor for suicide. Suicide risk in psychiatric patients is primarily determined by often unreliable, self-reported information. We assessed serum levels of three microRNAs (miRNAs), previously demonstrated to be dysregulated in post-mortem brain samples of suicide victims, as potential peripheral biomarkers for suicidality. Methods: All study participants were diagnosed with MDD according to Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria. Suicidality, defined as acute suicide risk or suicide attempt within one week prior to study entry, was assessed by clinical interview. Relative serum levels of miR-30a, miR-30e, and miR-200a, normalized to U6, were measured by quantitative real-time PCR in MDD inpatients with (MDD/SI, N = 19) and without (MDD, N = 31) acute suicide risk. Median age and gender distribution were comparable in both groups. Results: Levels of miR-30a, miR-30e, and miR-200a were significantly elevated in MDD/SI compared to MDD. Subgroup analysis of the MDD/SI group showed that levels of miR-30e and miR-200a were significantly higher and miR-30a was increased by trend in patients admitted following a suicide attempt (N = 7) compared to patients with acute suicide risk but without recent suicide attempt (N = 12). Additionally, use of two databases for in silico transcription factor-miRNA interaction prediction indicated early growth response protein (EGR) 1 as potential transcriptional regulator for all three miRNAs. Conclusion: This study demonstrates suicide risk in MDD patients to be associated with increased levels of miR-30a, miR-30e, and miR-200a. Thus, these miRNAs might constitute potential biomarkers to predict suicidal behavior in MDD patients.
ABSTRACT
BACKGROUND: While the extended lateral approach was the gold standard for treatment of calcaneal fractures for decades, the mini-open approach through the sinus tarsi gained popularity in recent years. Although widely used, there are only a few reports available in the literature reporting on mid- to long-term results. Therefore, the purpose of the study was to report on mid- to long-term radiographic and clinical outcomes of calcaneal fractures treated surgically using a mini-open sinus tarsi approach. MATERIALS AND METHODS: In this retrospective review, radiographic and clinical outcome measures of 30 consecutive patients (34 fractures) were analyzed. Conventional radiographs were used to measure the Boehler's angle before and after surgical fixation. Computed tomography (CT) scans were analyzed to distinguish between joint depression and tongue-type calcaneal fractures. Each calcaneal fracture was additionally categorized according to the Sanders classification. The clinical outcome was measured using a 5-point Likert scale ranging from 0 (very unsatisfied) to 4 (very satisfied), the Visual Analog Scale (VAS) for pain, and the Maryland Foot Score. RESULTS: The Boehler's angle improved from 12.6 degrees preoperatively to 26.3 degrees postoperatively (P < 0.001). Loss of sagittal reduction (i.e., a decline of the Boehler's angle of > 5 degrees) from postoperative to the last follow-up was evident in nine (26%) fractures. Out of 29 patients with an available satisfaction score, 20 (69%) were very satisfied, 8 (28%) were satisfied, and one (3%) was moderately satisfied. Satisfaction at the last follow-up declined with higher age at surgery. An overall low complication rate was evident, with painful hardware needing removal being the most common complication. CONCLUSIONS: Approaching calcaneus fractures through the sinus tarsi provides satisfactory mid- to long-term radiographic and clinical outcomes, independent of the severity of the fractures according to the Sanders classification. LEVEL OF EVIDENCE: Level IV, Retrospective Case Series.
