Search Results (128)

Objective: To compare the effect of different bone augmentation procedures, namely, autogenous bone blocks (ABBs) versus guided bone regeneration (GBR), on patient-reported outcomes (PROMs). Methods: This systematic review was conducted according to the PRISMA guidelines. A MEDLINE, Embase, and Web of Science search was conducted by two independent reviewers in combination with a free-hand search in relevant journals until June 2025. Outcomes were PROMs to enhance our understanding of the evolution of these procedures. Results: The electronic search yielded 6291 articles. After title screening, 67 articles were further analyzed for abstract review, which resulted in 14 articles eligible for full-text reading. Six articles were finally included based on the exclusion and inclusion criteria with a total of 295 patients. The overall study quality was low, since only two RCTs could be included. One study demonstrated a high risk of bias. Different PROMs were examined and compared such as pain, edema, neurosensory disturbance, Patient-Reported Predominant Symptom, OHIP-14, postoperative analgesic usage, willingness to repeat, and likelihood to recommend. Meta-analysis was not achievable due to a lack of direct comparisons and heterogeneity in terms of PROMs. Evaluation points varied between pretreatment and up to nearly 10-years of follow-up. Conclusions: Despite significant heterogeneity and reporting, this systematic review concluded that ABB and GBR are well-tolerated procedures. Trends such as transient postoperative pain and swelling with a minor occurring of neurosensory disturbances were reported in a few studies. Overall, a good perception of postoperative recovery was reported for both treatment modalities. Good quality of life was noted related to GBR procedures. Patient-reported outcomes were only analyzed for patients who completed the entire follow-up period. This may introduce bias, as patients who dropped out and were more likely to experience complications were not represented, potentially resulting in a more favorable portrayal of the outcomes. Further well-conducted prospective studies with a long follow-up are needed for an evidence-based evaluation and comparison of PROMs for these procedures. Full article

Background/Objectives: Although MRI with fat-suppression sequences is the gold standard for diagnosis of bone marrow edema (BME), Dual-Layer Spectral CT (DL-SCT) with electron density (ED) provides a viable alternative, particularly in situations where an MRI is not accessible. Using MRI as the reference standard, this study analyzed how DL-SCT with ED reconstructions may be a valid alternative in the detection of BME. Methods: This retrospective study included 28 patients with a suspected diagnosis of BME via MRI conducted between March and September 2024. Patients underwent DL-SCT using ED reconstructions obtained through IntelliSpace software v. 12.1. Images were evaluated by two experienced radiologists and one young radiologist in a blinded way, giving a grade from 0 to 3 to classify BME (0 absence; 1 mild; 2 moderate; 3 severe). To reduce the recall bias effect, the order of image evaluations was set differently for each reader. p-Values were considered significant when <0.05. Fleiss’ Kappa was used to assess inter-rater reliability: agreement was considered poor for k < 0; slight for k 0.01–0.20; fair for 0.21–0.40; moderate for 0.41–0.60; substantial for 0.61–0.80; and almost perfect for 0.81–1.00. Results: All the readers detected the presence or absence of BME using DL-SCT. Inter-rater reliability for grade 0 resulted in 1 (p-value < 0.001); for grade 1: 0.21 (p-value < 0.001); for grade 2: 0.197 (p-value < 0.001); and for grade 3: 0.515 (p-value < 0.001). Conclusions: ED reconstructions allowed the identification of BME presence or absence in all analyzed cases, thus suggesting DL-SCT as a potentially effective method for its detection. Full article

Objectives: The early detection of low bone mineral density (BMD) is essential for preventing osteoporosis and related complications. While dual-energy X-ray absorptiometry (DXA) remains the gold standard for diagnosis, its cost and limited availability restrict its use in large-scale screening. This study investigated whether raw bioelectrical impedance analysis (BIA) data combined with explainable machine learning (ML) models could accurately classify osteopenia in women aged 40 to 55. Methods: In a cross-sectional design, 138 women underwent same-day BIA and DXA assessments. Participants were categorized as osteopenic (T-score between −1.0 and −2.5; n = 33) or normal (T-score ≥ −1.0) based on DXA results. Overall, 24.1% of the sample were classified as osteopenic, and 32.85% were postmenopausal. Raw BIA outputs were used as input features, including impedance values, phase angles, and segmental tissue parameters. A sequential forward feature selection (SFFS) algorithm was employed to optimize input dimensionality. Four ML classifiers were trained using stratified five-fold cross-validation, and SHapley Additive exPlanations (SHAP) were applied to interpret feature contributions. Results: The neural network (NN) model achieved the highest classification accuracy (92.12%) using 34 selected features, including raw impedance measurements, derived body composition indices such as regional lean mass estimates and the edema index, as well as a limited number of categorical variables, including self-reported physical activity status. SHAP analysis identified muscle mass indices and fluid distribution metrics, features previously associated with bone health, as the most influential predictors in the current model. Other classifiers performed comparably but with lower precision or interpretability. Conclusions: ML models based on raw BIA data can classify osteopenia with high accuracy and clinical transparency. This approach provides a cost-effective and interpretable alternative for the early identification of individuals at risk for low BMD in resource-limited or primary care settings. Full article

Background: Osteomyelitis, particularly affecting the lower extremities, is a serious and increasingly common complication. Accurate diagnosis is essential for successful treatment, yet standardized evidence-based protocols are lacking and diagnostic knowledge remains limited. This study aimed to identify characteristic histological and MRI findings in osteomyelitis to support diagnostic accuracy and guide treatment decisions. Methods: In a prospective case-control pilot study conducted from February 2020 to January 2021, all patients with suspected osteomyelitis of the lower limbs were included. Each underwent contrast-enhanced MRI and sampling for microbiological and histological analysis. Findings from five confirmed osteomyelitis cases were compared to five controls where osteomyelitis was ruled out. Results: All osteomyelitis cases showed typical MRI signs, including contrast-enhancing bone edema. Two had early, and two had pronounced intramedullary abscesses. In three controls, contrast-enhancing edema was limited to soft tissue; two showed mild adjacent bone edema. Histologically, all osteomyelitis samples revealed bone fragmentation and inflammatory cell infiltration—absent in controls. Additionally, four showed medullary fibrosis and one fibrin deposits. Conclusions: A comprehensive understanding of both histological and radiological findings is key to effective osteomyelitis treatment. This pilot study is the first to systematically compare MRI and histology findings side by side, offering valuable insights that may enhance diagnostic precision and support evidence-based treatment decisions. Full article

Background/Objectives: T2 mapping is a quantitative magnetic resonance imaging (MRI) technique that provides information about tissue water content and molecular mobility. This study aimed to evaluate the diagnostic utility of T2 mapping in assessing sacroiliitis associated with spondyloarthropathy (SpA). Methods: A prospective study examined a total of 56 participants, comprising 31 SpA patients (n = 31) and 25 healthy controls (n = 25), who underwent sacroiliac joint MRI between August 2018 and August 2020. T2 mapping images were generated using multi-echo turbo spin echo (TSE) sequence, and quantitative T2 relaxation times were measured from bone and cartilage regions. Statistical analysis employed appropriate parametric and non-parametric tests with significance set at p < 0.05. Results: The mean T2 relaxation time measured from the areas with osteitis of SpA patients (100.23 ± 7.41 ms; 95% CI: 97.51–102.95) was significantly higher than that of the control group in normal bone (69.44 ± 4.37 ms; 95% CI: 67.64–71.24), and this difference was found to be statistically significant (p < 0.001). No significant difference was observed between cartilage T2 relaxation times in SpA patients and controls (p > 0.05). Conclusions: T2 mapping serves as a valuable quantitative imaging biomarker for diagnosing sacroiliitis associated with SpA, particularly by detecting bone marrow edema. The technique shows promise for objective disease assessment, though larger studies are needed to establish standardized reference values for T2 relaxation times in osteitis to enhance diagnostic accuracy and facilitate treatment monitoring. Full article

Dual-energy computed tomography (DECT) is a promising advancement for detecting bone edema-like lesions (BME). However, its application in horses remains limited. The aim of this study was to evaluate DECT virtual-non-calcium (VNCa) imaging in the equine foot and establish which confounding factors could influence its applicability in clinical practice. The DECT VNCa map of 14 standing and 5 cadaveric (recumbent) cases with foot-related lameness was scored in consensus by two readers in comparison to MRI. Overall, 17/19 cases demonstrated BME on MRI, whereas 2 did not. Agreement between DECT VNCa and MRI was found in 15/19 feet (78.9%). Disagreement in 4/19 cases with BME was due to sclerosis (1/19), mild BME extent on MRI (2/19), or scan artifacts (1/19). The extent of BME was significantly underestimated using DECT VNCa compared to MRI (p = 0.016). No significant correlation was found between sclerosis score and the BME extent underestimation on DECT (p = 0.056). Between standing and post-mortem cases, there was no significant difference in the agreement between DECT and MRI (p = 0.53) or DECT VNCa image quality (p = 0.22). In conclusion, DECT VNCa effectively identified moderate and severe BME, and its use was feasible in standing positioning. In case of sclerosis, a case-by-case assessment is recommended. Full article

Background: Triangular fibrocartilage complex (TFCC) tears are a common source of ulnar-sided wrist pain. Surgery has to be performed in case of instability, pain, or if non-operative treatment fails. Overall, the results are very good. However, some patients still suffer from pain after surgery. Post-operative MR imaging can reveal potential pathologies but it needs to be assessed whether depicted changes are normal or whether these findings have a clinical significance. Therefore, the purpose of this study was to evaluate postoperative MR imaging and the function of the patients’ wrists in order to assess which postoperative changes are correlated with pain. Patients and Methods: All patients with a TFCC lesion who were treated arthroscopically at our hospital between January 2012 and December 2016 were retrospectively enrolled. Seventeen patients with complete data sets were enrolled. Post-operative MRI examinations needed to be performed within 24 months after arthroscopy. The mean magnet resonance imaging (MRI) follow-up was 22 months. The average clinical follow-up was 27.3 months. Age, gender, pain level, PROM scores (Munich Wrist Questionnaire, MWQ), follow-up interval, and TFCC classification (Palmer) were documented. The patients underwent a clinical examination and MR imaging. Results: Ten patients (59%) had scar tissue at the triangular fibrocartilaginous complex (TFCC) and nine (53%) had an effusion in the ulnar recess. These findings were not necessarily associated with pain, as six patients without pain and four with pain had scar tissue at the TFCC and six patients without pain and three with pain showed an effusion in the ulnar recessus. Bone marrow edema could be found in the lunate of five patients (29%) (three with pain, two without pain) and in the distal radial ulnar joint (DRUJ) of one patient (6%) with pain. However, typical degenerative changes were not necessarily associated with pain. Conclusions: This present study is the first study correlating postoperative MRI findings after arthroscopic assisted TFCC surgery with both pain and function. Bone edema seems to be associated with pain, whereas scarring at the TFCC is visible on MRI but is not necessarily associated with pain. Full article

Background: Some evidence suggests that combining hyaluronic acid (HA) with platelet-rich-plasma (PRP) may offer synergistic benefits by enhancing the biological and mechanical properties of joints. However, data on the combination of HA+PRP vs. HA alone in the management of knee osteoarthritis (OA) remain limited. Methods: A double-blinded randomized controlled trial was conducted at an outpatient clinic and enrolled 58 patients with Kellgren–Lawrence grade 2–3 knee OA. They were randomly allocated to receive either intra-articular PRP combined with HA (n = 29 knees) or HA alone (n = 29 knees). The primary outcome was pain, assessed using a visual analog scale (VAS). Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), health-related quality of life (EQ-5D-5L), and structural changes on MRI, measured by the Whole-Organ MRI Score (WORMS). The VAS, WOMAC, and EQ-5D-5L were evaluated at baseline and at months 1, 3, 6, and 12. MRI WORMS was assessed at baseline and 12 months. Results: The baseline characteristics were comparable between the HA+PRP and HA groups. Both interventions showed improvements in pain and function at 12 months. However, the between-group difference in VAS at 12 months—the primary outcome—was not statistically significant (p = 0.102) and did not exceed the minimal clinically important difference (MCID) of 20 mm. The HA group demonstrated significantly greater VAS score reductions at 1 month (−31.1 [95% CI: −38.9 to −23.2] vs. −14.3 [95% CI: −22.2 to −6.4], p = 0.003) and at 6 months (−32.1 [95% CI: −40.1 to −24.1] vs. −19.2 [95% CI: −27.1 to −11.3], p = 0.024), compared to the HA+PRP group, although these differences did not reach clinical significance. No significant between-group differences were observed in the WOMAC scores, EQ-5D-5L, or total WORMS scores at all time points (p > 0.05). At 12 months, MRI assessment revealed a significant decrease in bone marrow edema in the HA+PRP group (−0.7 [95% CI: −1.6 to 0.2]) compared to the HA group (0.7 [95% CI: −0.2 to 1.6], p = 0.030). Conclusions: Both HA+PRP and HA treatments were effective in reducing pain and improving function in patients with knee OA over 12 months. While HA demonstrated greater early pain relief, the addition of PRP was associated with a significant reduction in bone marrow edema at 12 months. These findings suggest potential structural benefits of HA+PRP, although clinical superiority over HA alone was not established. Full article

Lysophosphatidylinositols are degradation products of phosphatidylinositols within cell membranes and digestive metabolites of a high-fat diet in the gut. G-protein-coupled receptor 55 (GPR55) is a receptor that senses lysophosphatidylinositol and acts as an immune mediator, being primarily upregulated during immune cell activation. This study aimed to investigate the role of GPR55, using its antagonist, CID16020046, in a collagen-induced rheumatoid arthritis mouse model. It was observed that DBA-1J mice develop joint lesions characteristic of rheumatoid arthritis following immunization with bovine type II collagen. The administration of CID16020046 (1 mg/kg, intraperitoneally) alleviated rheumatoid arthritis symptoms and inflammatory responses. Histopathological analysis showed that CID16020046 reduced foot edema, proteoglycan loss, and bone erosion in the joints. CID16020046 also decreased rheumatoid-arthritis-induced serum IgG levels, as measured using enzyme-linked immunosorbent assays. The treatment reduced levels of pro-inflammatory cytokines (IL-1β and IL-6), Th1 cytokine (IFN-γ), and Th17 cytokine (IL-17A), along with matrix metalloproteinase-3 (MMP-3) and the receptor activator of nuclear factor-κB ligand (RANKL) in the feet. A significant reduction in splenomegaly was also observed, along with significant reductions in CD4⁺ T helper 1 (Th1) and Th17 cells in the spleen. Additionally, CID16020046 suppressed the differentiation of naïve T cells into CD4⁺IL-17⁺ Th17 cells. CID16020046 suppressed expression levels of inflammatory cytokine mRNAs in SW982 human synovial cells. In conclusion, blocking GPR55 alleviates collagen-induced rheumatoid arthritis symptoms by suppressing Th1 and Th17 cells in the spleen and pro-inflammatory cytokines in the joints, suggesting that GPR55 is a potential therapeutic target for autoimmune inflammatory diseases. Full article

Background: Axial involvement in psoriatic arthritis (axPsA) presents clinical and radiological differences from ankylosing spondylitis (AS), which may influence the therapeutic response. While Guselkumab has demonstrated efficacy in peripheral PsA, its role in axPsA is less well established, particularly in real-world settings. Objective: To evaluate the positive effects of Guselkumab therapy in patients with psoriatic arthritis (PsA), 58.6% of whom have axial involvement, in a 12-month, single-center, longitudinal, prospective observational cohort study conducted in a real-life setting. Methods: A cohort of 99 patients with PsA, including 58 with axial involvement (axPsA), was treated with Guselkumab for 12 months. Treatment efficacy was assessed by evaluating the reduction in mBASDAI, ASDAS, DAPSA, VAS Pain, LEI, and HAQ scores. The Friedman test was used to analyze whether the overall changes from baseline to 12 months were statistically significant. Patients with axial involvement were assessed by MRI, with scores measured at baseline (t₀), after 6 months (t₆), and after 12 months (t₁₂) of therapy. Statistical evaluation was conducted using the Friedman test, followed by pairwise comparisons of values obtained at different follow-up time points using the Wilcoxon signed-rank test. Additionally, the drug’s retention rate was examined using a Kaplan–Meier curve. Results: After 12 months of therapy, a statistically significant reduction was observed in all clinimetric parameters. Patients with axial involvement were also evaluated by MRI at baseline, after 6 months, and after 12 months of therapy. MRI images showed a reduction in bone marrow edema and a decrease in signal intensity, indicating a significant reduction in inflammation and confirming the drug’s efficacy. Retention rate values demonstrate that Guselkumab is well tolerated and effective in the long term for the majority of patients. Conclusions: This 12-month real-world study of 99 PsA patients confirms the efficacy of Guselkumab in reducing disease activity in both peripheral and axial forms. The findings align with previous RWE and clinical trials (DISCOVER-1 and -2), supporting its clinical utility in PsA and axPsA, with high treatment retention. Full article

Background/Objectives: This study evaluated the effects of vascular photobiomodulation (VPBM) on pain intensity, edema, and facial temperature variation in patients undergoing alveolar bone grafting (ABG) surgery. Methods: A total of 42 patients with cleft lip and palate (aged 9–25 years) scheduled for ABG using iliac crest bone were randomly assigned in equal numbers (14 per group) to one of three groups: control (ABG only), test (ABG + VPBM), and placebo (ABG + simulated VPBM). Iliac and facial pain and edema were clinically evaluated 24 h post-surgery, along with thermographic facial analysis. Follow-up was conducted via phone calls for one week. Results: No statistically significant differences were observed among the groups regarding facial pain and edema at 24 h post-surgery. However, iliac pain significantly differed between the placebo and control groups (p = 0.045). A significant time-related effect on both facial and iliac pain outcomes was noted during follow-up, irrespective of the group. The need for rescue medication and self-perception of reduced edema did not differ significantly. Thermographic analysis reveals a significantly lower temperature variation in the test group (2.36 °C) compared to the other groups (p = 0.007). Conclusions: Overall, VPBM therapy influenced postoperative pain in the early recovery phase and temperature in the immediate postoperative period but did not significantly affect edema. Full article

Background: Deep learning (DL) reconstruction techniques have shown promise in reducing MRI acquisition times while maintaining image quality. However, the impact of different acceleration factors on diagnostic accuracy in shoulder MRI remains unexplored in clinical practice. Purpose: The purpose of this study was to evaluate the diagnostic accuracy of 2-fold and 4-fold DL-accelerated shoulder MRI protocols compared to standard protocols in clinical practice. Materials and Methods: In this prospective single-center study, 88 consecutive patients (49 males, 39 females; mean age, 51 years) underwent shoulder MRI examinations using standard, 2-fold (DL2), and 4-fold (DL4) accelerated protocols between June 2023 and January 2024. Four independent radiologists (experience range: 4–25 years) evaluated the presence of bone marrow edema (BME), rotator cuff tears, and labral lesions. The sensitivity, specificity, and interobserver agreement were calculated. Diagnostic confidence was assessed using a 4-point scale. The impact of reader experience was analyzed by stratifying the radiologists into ≤10 and >10 years of experience. Results: Both accelerated protocols demonstrated high diagnostic accuracy. For BME detection, DL2 and DL4 achieved 100% sensitivity and specificity. In rotator cuff evaluation, DL2 showed a sensitivity of 98–100% and specificity of 99–100%, while DL4 maintained a sensitivity of 95–98% and specificity of 99–100%. Labral tear detection showed perfect sensitivity (100%) with DL2 and slightly lower sensitivity (89–100%) with DL4. Interobserver agreement was excellent across the protocols (Kendall’s W = 0.92–0.98). Reader experience did not significantly impact diagnostic performance. The area under the ROC curve was 0.94 for DL2 and 0.90 for DL4 (p = 0.32). Clinical Implications: The implementation of DL-accelerated protocols, particularly DL2, could improve workflow efficiency by reducing acquisition times by 50% while maintaining diagnostic reliability. This could increase patient throughput and accessibility to MRI examinations without compromising diagnostic quality. Conclusions: DL-accelerated shoulder MRI protocols demonstrate high diagnostic accuracy, with DL2 showing performance nearly identical to that of the standard protocol. While DL4 maintains acceptable diagnostic accuracy, it shows a slight sensitivity reduction for subtle pathologies, particularly among less experienced readers. The DL2 protocol represents an optimal balance between acquisition time reduction and diagnostic confidence. Full article

Background/Objectives: Mild traumatic brain injury (mTBI) is a leading cause of pediatric emergency department visits, particularly among children under three years old. Although computed tomography (CT) is the gold standard for diagnosing intracranial injuries, its use in young children poses radiation risks. Identifying reliable clinical indicators that justify CT imaging is essential for optimizing both patient safety and resource utilization. Objective: This study aimed to evaluate CT findings in children under three years of age with mTBI and no focal neurological deficits, as well as to identify clinical predictors associated with skull fractures and intracranial injuries. Methods: A retrospective analysis was conducted on 224 children under 36 months who presented with mTBI to a tertiary pediatric hospital from July 2019 to July 2024. Demographic data, injury mechanisms, clinical presentation and CT findings were evaluated. Univariate and multivariate regression analyses were performed to identify risk factors associated with skull fractures and intracranial injuries. Results: Falls accounted for 96.4% of injuries, with the majority occurring from heights of 0.5–1 m. The parietal region was the most frequently affected site (38%). Skull fractures were present in 46% of cases and were primarily linear (92.8%). Intracranial hematomas were identified in 13.8% of cases, while brain edema was observed in 7.6%. Significant predictors of skull fractures included age under 12 months (p < 0.001), falls from 0.5–1 m (p = 0.005), somnolence (p = 0.030), scalp swelling (p = 0.001) and indentation of the scalp (p = 0.016). Parietal bone involvement was the strongest predictor of both skull fractures (OR = 7.116, p < 0.001) and intracranial hematomas (OR = 4.993, p < 0.001). Conversely, frontal bone involvement was associated with a lower likelihood of fractures and hematomas. Conclusions: The findings highlight key clinical indicators that can guide decision-making for CT imaging in children with mTBI. Infants under 12 months, falls from moderate heights and parietal bone involvement significantly increase the risk of fractures and intracranial injuries. A more refined diagnostic approach could help reduce unnecessary CT scans while ensuring the timely identification of clinically significant injuries. Full article

Background: Sacroiliitis in children is usually connected with one of the subtypes of juvenile idiopathic arthritis (JIA), such as enthesitis-related arthritis, psoriatic arthritis, or undifferentiated arthritis. The main diagnostic method is magnetic resonance imaging (MRI) of the sacroiliac joints, which can reveal bone marrow edema (BME) as a sign of an active inflammation process. This research aimed to retrospectively investigate the associations between the clinical presentation, laboratory test results, and MRI results of the sacroiliac joints of children. Methods: A total of 152 paediatric patients who underwent MRI of the sacroiliac joints were included in this single-centre study. The mean age of patients was 13.91 ± 2.97, while the female-to-male ratio was 1.36:1. JIA diagnosis was confirmed in 91 (59.87%) patients. Results: The main symptom reported by 128 (83.21%) patients was chronic pain, while in another 40 (31.25%) patients, it was chronic back pain. Patients with arthritis and BME in the sacroiliac joints were more likely to report chronic back pain, while patients with JIA but without BME in the sacroiliac joints were often positive for anti-nuclear antibodies (ANA). The widening of any joint contour was observed in 43 (28.29%) patients, and reduced joint mobility was observed in 61 (40.13%). Elevation of inflammatory blood parameters occurred in 31 (20.39%) patients, but this was not statistically related to BME presence in the sacroiliac joints. Radiological findings included BME (n = 36; 23.68% of examinations), joint space narrowing (n = 10; 27.78% of examinations), erosions (n = 7; 19.44% of examinations), and joint fluid (n = 7; 19.44% of examinations). There was a statistically significant relationship between the presence of BME in the sacroiliac joints and all of the above radiological findings. Conclusions: The radiological findings of MRI of the sacroiliac joints are significantly statistically related to chronic back pain in patients, while there is no relationship between any inflammatory blood parameter and the presence of BME. Full article

Extremity trauma, including ischemia (e.g., prolonged tourniquet application or crush), is common among battlefield injuries. Injured muscle releases toxins leading to rhabdomyolysis and, potentially, acute kidney injury (AKI). The goal of this study was to characterize sequelae of ischemic extremity injury over 72 h, focusing on time courses of rhabdomyolysis and AKI. Male Sprague Dawley rats were placed into two groups. Ischemic injury was produced in anesthetized rats using bilateral tourniquets (TK; n = 10) for 5 h; control (CON; n = 9) rats were treated identically without TK application. Indicators of rhabdomyolysis and renal function were measured in conscious rats 1 day preinjury (baseline, BL) and then at 1.5, 24, 48, and 72 h post-TK release. Prolonged TK application produced necrosis in both muscle and bone marrow but not in kidney. The wet/dry weights indicated edema in injured limbs at 72 h (4.1 (0.5) (TK) vs. 2.9 (0.1) (CON); p < 0.001). TK rats exhibited a 100-fold increase in creatine kinase activity compared to CON at 1.5 h (20,040 (7265) U/L vs. 195 (86) U/L (mean (SD); p < 0.0001). TK decreased the mean glomerular filtration rate (GFR; p < 0.001) at 1.5 h, but these values recovered by 24 h in concert with elevated urinary flow and alkalinization. Prolonged ischemic extremity injury therefore produced severe rhabdomyolysis without irreversible renal damage. Full article