Additional Injury Research Articles

Poloxamer 188 Dose‐Dependently Protects Adult Mouse Coronary Artery Endothelial Cell Layers from Reoxygenation Injury

Poloxamer (P)188 is a tri-block copolymer shown to provide a cardioprotective effect when administered at the beginning of reoxygenation in adult mouse cardiomyocyte hypoxia/reoxygenation models. It is thought that it seals cells damaged by hypoxia via membrane stabilization, thus, protecting the cells from additional injury during reoxygenation. To further explore the effects of P188 on maintaining endothelial cell layer integrity, we treated confluent adult mouse coronary artery endothelial cell layers with varying concentrations of P188 upon initiation of a 2-hr reoxygenation period immediately following hypoxic periods of 3, 12, and 48 hrs. Using trans-endothelial electrical resistance (TEER), we found that P188 dose-dependently protected cells from further damage after hypoxia, with some doses returning TEER measurements even back to control/normoxia levels. However, we also observed that similar concentrations of P188 varied in effects as hypoxia times increased. Our results indicate that P188 protects the endothelial layer in a dose-dependent manner as long as it is administered after an optimal ischemia time to effectively preserve membrane integrity in tissue barriers. More research will need to be conducted to confirm our findings and determine the optimal combination of dosage and timing of P188 administration.

Trauma Tertiary Survey: Trauma Service Medical Officers and Trauma Nurses Detect Similar Rates of Missed Injuries.

Trauma tertiary surveys (TTSs) can improve patient outcomes by identifying missed injuries following initial trauma reception and resuscitation. Most TTSs are conducted by medical officers despite the multidisciplinary team approach of modern trauma care. The study aim was to assess the accuracy of detecting missed injuries when the TTS was performed by specialist trauma nursing staff, rather than trauma service medical officers (TSMOs). A prospective, convenience sample of adult trauma patients admitted to a tertiary trauma center and attended by the trauma service between October 2015 and August 2018 was obtained. For this sample, a TTS was completed by both the TSMO and the trauma nurse (TN). The number of radiological investigations ordered and missed injuries identified were compared between the two clinicians. Additional injuries were graded using the Clavien-Dindo system. The study sample consisted of 165 patients with a dual TTS, for which at least one team member requested 35 additional radiological investigations. There was fair agreement (κ = 0.36) between the TN and the TSMO in requesting additional radiological investigations. Ten missed injuries were identified by TN-initiated review (n = 24), and 4 missed injuries were identified by TSMO-initiated review (n = 21). Injuries identified following TTSs ranged in severity grading from 0 to 3. Performance of the TN on the TTS in the identification of missed injuries is similar to that of the TSMO. Trauma nurses use an appropriate and rationalized approach to ordering additional radiological investigations and contribute a valuable addition to trauma patient care.

Development of a model of electric impedance in the contact between the skin and a capacitive active electrode when measuring electrocardiogram in combustiology

Long-term ECG (electrocardiogram) measurement in patients with burns is a complicated problem since the overlapping of surface contact electrodes can lead to additional injuries. The possibility of ECG recording in patients with burns using capacitive electrodes was not proved, and there are no models of the electrode contact with a patient’s body while rehabilitation means are used. In this paper, the model of the contact between capacitive electrodes and the skin was modified and the circuit model of the contact: skin – bandages (saline solution) – film – active capacitive electrode, was described. The influence of the parameters of a capacitive electrode on the amplitude-frequency characteristics (AFC) of the contact of an electrode with skin was assessed. It was found that contact capacitance is crucial to obtain a high-quality ECG signal. The parameters of the impedance of bandages, saline solution, a dielectric film were calculated, and their effect on the AFC was studied. Based on the modified model, the AFC contact was modeled taking into consideration all the calculated parameters; it was found that the resulting AFC of the contact corresponds to the frequency range of the ECG signal. Analysis of the calculations proves the possibility of using capacitive electrodes when applying various rehabilitation means. It was found that at a change in the impedance of the saline solution from 0.1 gigaohms to 1 gigaohm, the changes in the AFC of the contact are not crucial for the final quality of the received signal. All calculations were carried out by modeling in the Qucs environment (ngspice SPICE). Simulation results can be used in the development of new types of capacitive electrocardiographic electrodes. The proposed model can be used to study other wound covers, as well as to model physiological processes when putting artificial skin and wound covers

Cerebral venous thrombosis and Covid 19: Literature review

Introduction: Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) was first detected in December 2019 in the city of Wuhan, China, and has since taken on worldwide proportions. It is known that individuals with Coronavirus disease-19 (COVID-19) have systemic clinical manifestations. Among the multisystemic effects, cerebral venous thrombosis (CVT) is responsible for high mortality rates. In this sense, understanding the association between CVT and SARS-CoV-2 infection directly impacts the disease's morbidity and mortality. Methodology: Literature review in the PubMed and Embase databases, with the following search terms: “COVID-19”, “SARS-CoV-2”, “Venous thromboembolism”, “Thrombosis”, “Cerebral Venous Thrombosis”, “Intracranial Sinus Thrombosis” and “Cranial Sinus Thrombosis”. The selected articles were written in English, which addressed the various aspects of COVID-19. Results and discussion: CVT are a rare complication of COVID-19, with an incidence between 0.02 to 1% of hospitalized patients. However, it can reach about 75% of mortality in affected individuals. Pathophysiology seems to be associated with the state of hypercoagulability and the systemic inflammatory process resulting from viral infection. Thus, recent studies show a consensus on the early anticoagulation of patients affected by the virus, to reduce mortality in these cases. However, the differences between the types of anticoagulation, Low Molecular Weight Heparin (LMWH), Unfractionated Heparin (UFH), Dabigatran have not yet been well established, although there is a predilection for the use of LMWH. Also, thrombectomy is a therapeutic intervention option that should be evaluated, due to the risk of additional endothelial injury from the use of stent retrievers. Conclusion: Although it has a relatively low incidence, CVT aggravates the condition and increases the risk of death for patients with COVID-19. Because of this, early diagnosis and evaluation of therapeutic options for CVT are essential for the development of clinical management.

Superoxide Dismutase-Loaded Nanoparticles Attenuate Myocardial Ischemia-Reperfusion Injury and Protect Against Chronic Adverse Ventricular Remodeling.

Early revascularization is critical to reduce morbidity after myocardial infarction, although reperfusion incites additional oxidative injury. Superoxide dismutase (SOD) is an antioxidant that scavenges reactive oxygen species (ROS) but has low endogenous expression and rapid myocardial washout when administered exogenously. This study utilizes a novel nanoparticle carrier to improve exogeneous SOD retention while preserving enzyme function. Its role is assessed in preserving cardiac function after myocardial ischemia-reperfusion (I/R) injury. Here, nanoparticle-encapsulated SOD (NP-SOD) exhibits similar enzyme activity as free SOD, measured by ferricytochrome-c assay. In an in vitro I/R model, free and NP-SOD reduce active ROS, preserve mitochondrial integrity and improve cell viability compared to controls. In a rat in vivo I/R injury model, NP-encapsulation of fluorescent-tagged SOD improves intramyocardial retention after direct injection. Intramyocardial NP-SOD administration in vivo improves left ventricular contractility at 3-hours post-reperfusion by echocardiography and 4-weeks by echocardiography and invasive pressure-volume catheter analysis. These findings suggest that NP-SOD mitigates ROS damage in cardiac I/R injury in vitro and maximizes retention in vivo. NP-SOD further attenuates acute injury and protects against myocyte loss and chronic adverse ventricular remodeling, demonstrating potential for translating NP-SOD as a therapy to mitigate myocardial I/R injury.

Needle stick injury

ABSTRACT: Veterinary related needles stick injuries have the potential to cause significant, life changing injuries. Despite this they are still reported frequently to the Veterinary Medicines Directorate (VMD). There are also many anecdotal stories surrounding the culture and practice of using needles in veterinary medicine that suggest a high level of additional needle stick injuries may go unreported. The aim of this article is to highlight the dangers of veterinary related needle stick injuries and equip members of the veterinary team to feel empowered to seek appropriate treatment should they sustain such an injury.

Trends in Blunt Splenic Injury Management: The Rise of Splenic Artery Embolization

IntroductionSplenic injury is common in blunt trauma. We sought to evaluate the injury characteristics and outcomes of BSI admitted over a 10-y period to an academic trauma center. MethodsA retrospective review of adult blunt splenic injury patients admitted between January 2009 and September 2018. ResultsThe 423 patients meeting inclusion criteria were divided by management: Observational (OBS, n = 261), splenic surgery (n = 114 including 4 splenorrhaphy patients), SAE (n = 43), and multiple treatment modalities (3 had SAE followed by surgery and 2 OBS patients underwent splenic surgery at readmission). The most common mechanism of injury was motor vehicle collision (47.8%). The median ISS (OBS 17, SAE 22, Surgery 34) and spleen AIS (OBS 2, SAE 3, Surgery 4) were significantly different. Complication rates (OBS 21.8%, SAE 9.3%, Surgery 45.6%) rates were significantly different, but mortality (OBS 7.3%, SAE 2.3%, Surgery 13.2%), discharge to home and readmission rates were not. Additional abdominal injuries were identified in 26.3% of the surgery group and 2.7% of OBS group. SAE rate increased from 3.0% to 28%; median spleen AIS remained 2-3. Thirty-five patients expired; 28 had severe head, chest, and/or extremity injuries (AIS ≥4). ConclusionSAE rates increased over time. Splenorrhaphy rates were low. SAE was associated with relatively low rates of mortality and complications in appropriately selected patients.

CARBON TECHNOLOGY ACTIVE COCONUT SHELL ON AIR FILTER MEDIA FOR DOMESTIC WASTE AIR WASTE

Clean availability air used when coming from wells (air land) for the needs of everyday residents, air conditions are very murky, yellow, sour and post-idanan from the pollution of domestic waste air from waste air laundry, bathroom, toilet waste and the rest of the rice field irrigation system, although currently Kp. Sendal Kopo, Panenjoan Village has a unit of clean air water is the top thing to treat the surrounding residents Community-Based Sanitation (Sanimas) from the central government is limited only dipoman air waste household results to irrigate rice fields, not for air needs One way in processing ground air by designing air filters from PVC pipes using activated carbon media from coconut shells and additional media foam filter, injury, zeolite stone, activated carbon and sand silica for air to make the air good air. Simple air filter everywhere in Kp.Sendal Kopo, Panenjoan Village, Carenang District, Serang District, Banten Province. Any activity there provides favours throughout the community Kp. Sendal Kopo, Village Panenjoan RT / RW: 004/01 involved in the workshop of making simple air filters and counselling will maintain and manage clean air so that with the village Of Panenjoan will be murky and political air into air that has standard air through clean air design intalasi air

Injury epidemiology in professional ballet: a five-season prospective study of 1596 medical attention injuries and 543 time-loss injuries

ObjectivesTo describe the incidence rate, severity, burden and aetiology of medical attention and time-loss injuries across five consecutive seasons at a professional ballet company.MethodsMedical attention injuries, time-loss injuries and dance...

Scrub Sponge as A Wound Debridement Device

Introduction: Wound debridement is necessary before skin grafting or wound closure. Inappropriate wound bed preparation will led to graft rejection and sometimes catastrophic results, especially in large wounds,. Usage of popular debridement and excision devices such as dermatomes has some difficulties and disadvantages. In this study we will introduce metallic scrub sponge as a safe and effective debridement device.Methods: The surgeon usually uses a sterile metallic scrub sponge over the wound with transverse or rotational repeated movement. Wound preparing with metallic sponge should be stopped when pinpoint bleeding occurs. We used sterile metallic sponge for more than 2500 burn patients.Results: The results are excellent for deep second degree burn (and deeper burns at least 5-10 days after burn when some eschar loosening occurs). Work with scrub sponge was effective, fast and safe.Discussion: Metallic scrub sponge is a useful device for wound preparation due to its some special characteristics. Debridement of the burn wound with metallic sponge can preserve the spontaneous epithelialization potential of skin in second degree burns and reduce additional injury to the viable tissue that is inevitable by surgical debridement. Cost effectiveness, easy accessibility, safety, softness, inertness and some others are among the other advantages of metallic sponge usage for wound preparation.Conclusion: Due to metallic sponge’s simplicity and capability to remove necrotic loose tissues and easy accessibility everywhere and minimal adverse effects, it is a good first line tool for wound preparation and debridement.

Characteristics of burn casualties treated at role 2 in Afghanistan.

Role 2 medical treatment facilities (MTFs) are frequently located in austere settings and have limited resources. A dedicated assessment of burn casualties treated at this level of care has not been performed. Therefore, the objective of this study was to characterize burn casualties presenting to role 2 MTFs in Afghanistan, along with the procedures they required, complications, and mortality to begin understanding the resources consumed by their care. We identified burn casualties from the Department of Defense Trauma Registry (DODTR). The inclusion criteria were (1) experienced burn injuries in Afghanistan between October 2005 and April 2018 and (2) had documentation of treatment at role 2 in the DODTR. We excluded casualties with only first-degree burns, not otherwise specified burns, or only corneal burns. Casualty demographics, injury characteristics, procedures, and outcomes were reported. We identified 453 burn casualties with a median (interquartile range) Injury Severity Score of 10 (4-22) and percent total body surface area burned of 11 (5-30). There were 123 casualties (27.2%) with inhalation injury, and the casualties experienced 3,343 additional traumatic injuries and needed 2,530 procedures. Casualties with documentation of resuscitation information received a median (interquartile range) of 1.9 (0.7-3.7) L of crystalloid fluids. Complications were documented in 53 casualties (11.7%). Final mortality was reported in 36 casualties (8.0%), and mortality at role 2 MTFs was reported in 7 casualties (1.5%). Burn casualties had many injuries and needed many procedures, including those related to airway management, resuscitation, and wound care. Given the urgency of these procedures, ensuring that there is enough equipment and supplies will be important in the future. Although infrequent, some casualties experienced complications. Factors that may influence resuscitation include injury severity, concomitant traumatic injuries, and available supplies. Obtaining more contextual information on the patient care environment will be useful going forward. Epidemiological, level III.

Improving trauma tertiary survey performance and missed injury identification using an education-based quality improvement initiative.

Performance of a trauma tertiary survey (TTS) reduces rates of missed injuries, but performance has been inconsistent at trauma centers. The objectives of this study were to assess whether quality improvement (QI) efforts would increase the frequency of TTS documentation and determine if TTS documentation would increase identification of traumatic injuries. Our hypothesis was that QI efforts would improve documentation of the TTS. Before-and-after analysis of QI interventions at a level 1 trauma center was performed. The interventions included an electronic template for TTS documentation, customized educational sessions, and emphasis from trauma leadership on TTS performance. The primary outcome was documentation of the TTS. Detection of additional injuries based on tertiary evaluation was a secondary outcome. Associations between outcomes and categorical patient and encounter characteristics were assessed using χ2 tests. Overall, 592 trauma encounters were reviewed (296 preimplementation and 296 postimplementation). Trauma tertiary survey documentation was significantly higher after implementation of the interventions (30.1% preimplementation vs. 85.1% postimplementation, p < 0.001). Preimplementation documentation of the TTS was less likely earlier in the academic year (14.3% first academic quarter vs. 46.5% last academic quarter, p < 0.001), but this temporal pattern was no longer evident postimplementation (88.5% first academic quarter vs. 77.9% last academic quarter, p = 0.126). Patients were more likely to have a missed traumatic injury diagnosed on TTS postimplementation (1.7% in preimplementation vs. 5.7% postimplementation, p = 0.009). Documentation of the TTS and missed injury detection rates were significantly increased following implementation of a bundle of QI interventions. The association between time of year and documentation of the TTS was also attenuated, likely through reduction of the resident learning curve. Targeted efforts to improve TTS performance may improve outcomes for trauma patients at teaching hospitals. Care management, Level IV.

A geospatial examination of specialist care accessibility and impact on health outcomes for patients with acute traumatic spinal cord injury in New South Wales, Australia: a population record linkage study

BackgroundTimely treatment is essential for achieving optimal outcomes after traumatic spinal cord injury (TSCI), and expeditious transfer to a specialist spinal cord injury unit (SCIU) is recommended within 24 h from injury. Previous research in New South Wales (NSW) found only 57% of TSCI patients were admitted to SCIU for acute post-injury care; 73% transferred within 24 h from injury. We evaluated pre-hospital and inter-hospital transfer practices to better understand the post-injury care pathways impact on patient outcomes and highlight areas in the health service pathway that may benefit from improvement.MethodsThis record linkage study included administrative pre-hospital (Ambulance), admissions (Admitted Patients) and costs data obtained from the Centre for Health Record Linkage, NSW. All patients aged ≥16 years with incident TSCI in NSW (2013–2016) were included. We investigated impacts of geographical disparities on pre-hospital and inter-hospital transport decisions from injury location using geospatial methods. Outcomes assessed included time to SCIU, surgery and the impact of these variables on the experience of inpatient complications.ResultsInclusion criteria identified 316 patients, geospatial analysis showed that over half (53%, n = 168) of all patients were injured within 60 min road travel of a SCIU, yet only 28.6% (n = 48) were directly transferred to a SCIU. Patients were more likely to experience direct transfer to a SCIU without comorbid trauma (p < 0.01) but higher ICISS (p < 0.001), cervical injury (p < 0.01), and transferred by air-ambulance (p < 0.01). Indirect transfer to SCIU was more likely with two or more additional traumatic injuries (p < 0.01) or incomplete injury (p < 0.01). Patients not admitted to SCIU at all were older (p = 0.05) with lower levels of injury (p < 0.01). Direct transfers received earlier operative intervention (median (IQR) 12.9(7.9) hours), compared with patients transferred indirectly to SCIU (median (IQR) 19.5(18.9) hours), and had lower risk of complications (OR 3.2 v 1.4, p < 0.001). Complications included pressure injury, deep vein thrombosis, urinary infection, among others.ConclusionsGetting patients with acute TSCI patients to the right place at the right time is dependent on numerous factors; some are still being triaged directly to non-trauma services which delays specialist and surgical care and increases complication risks. The higher rates of complication following delayed transfer to a SCIU should motivate health service policy makers to investigate reasons for this practice and consent to improvement strategies. More stringent adherence to recommended guidelines would prioritise direct SCIU transfer for patients injured within 60 min radius, enabling the benefits of specialised care.

Scrub Sponge as A Wound Debridement Device.

Introduction:Wound debridement is necessary before skin grafting or wound closure. Inappropriate wound bed preparation will led to graft rejection and sometimes catastrophic results, especially in large wounds,. Usage of popular debridement and excision devices such as dermatomes has some difficulties and disadvantages. In this study we will introduce metallic scrub sponge as a safe and effective debridement device.Methods:The surgeon usually uses a sterile metallic scrub sponge over the wound with transverse or rotational repeated movement. Wound preparing with metallic sponge should be stopped when pinpoint bleeding occurs. We used sterile metallic sponge for more than 2500 burn patients.Results:The results are excellent for deep second degree burn (and deeper burns at least 5-10 days after burn when some eschar loosening occurs). Work with scrub sponge was effective, fast and safe.Discussion:Metallic scrub sponge is a useful device for wound preparation due to its some special characteristics. Debridement of the burn wound with metallic sponge can preserve the spontaneous epithelialization potential of skin in second degree burns and reduce additional injury to the viable tissue that is inevitable by surgical debridement. Cost effectiveness, easy accessibility, safety, softness, inertness and some others are among the other advantages of metallic sponge usage for wound preparation.Conclusion:Due to metallic sponge’s simplicity and capability to remove necrotic loose tissues and easy accessibility everywhere and minimal adverse effects, it is a good first line tool for wound preparation and debridement.

Factors affecting discharge of patients with sternal fractures

Aim: Sternal fractures, especially those due to motor vehicle accidents, are encountered in emergency department. There are no clear recommendations on discharge of patients with isolated sternal fractures from the emergency department. In this study, we aimed to examine the relationship between fracture type and severity of injury as well as factors affecting the decision of early discharge in case of sternal fractures detected in the emergency department. Materials and Methods: Patients who presented to the emergency department with trauma between 2014 and 2019 were retrospectively analyzed. Demographic characteristics, trauma mechanisms, additional injuries, injury severity scores, location of sternal fracture and displacement status, echocardiography findings, troponin I values, electrocardiography findings, duration of emergency department and hospital stay, and 30- day mortality of trauma patients aged above over 18 years with sternal fractures on thorax computed tomography included in the study were evaluated. Results: The mean age of 184 patients who were diagnosed with sternal fractures during the 5-year period was 49.9 ± 16.6 years, and 75.5% (n=139) of them were males. On examining the mechanisms of trauma, we found that the most common cause (63.5%; n=117) was motor vehicle accidents. The most common concomitant injuries were rib fractures (56.5%; n=104) and spinal fractures (44%; n=81). It was found that 73.9% (n=136) of sternal fractures were localized in the corpus and 63% (n=116) were non-displaced. It was determined that 33% (n = 61) of the patients were discharged from the emergency department, the mean duration of emergency department stay was 28.3 ± 24.3 hours, and the mean total hospitalization time was 9.8 ± 20.1 days. There was a significant relationship between the time to discharge with injury severity scores (ISS) and troponin I values of the patients. Conclusion: It should be noted that additional life-threatening injuries may be encountered more often in patients presenting with a high injury severity score (&amp;gt;15) and with a manubrium sterni fracture. In sternal fractures, early discharge from the emergency department can be considered in patients with a low injury severity scores (≤15) in whom no abnormal findings are detected in a follow-up performed with echocardiography, troponin I, electrocardiography, and constant monitoring.

Magnetic resonance imaging of medial collateral ligament avulsion fractures of the knee in children: a potentially underestimated injury.

Literature regarding medial collateral ligament (MCL) injuries is focused on adults with superficial MCL disruptions. However, children follow different injury patterns, with avulsion fractures at ligament attachment sites occurring commonly. Such avulsions have not been characterized for pediatric MCL injuries. To elucidate imaging findings, and review management and outcomes of pediatric MCL avulsion fractures. We conducted a 10-year retrospective review of knee magnetic resonance (MR) imaging reports for patients younger than 16years old diagnosed with acute MCL avulsion fracture. MR imaging was reviewed to confirm and characterize the components of the avulsion (perichondrium without or with cartilage, and/or bone) and to identify additional knee injuries. Radiographs, if available, from the time of injury were reviewed. Clinical management and patient outcomes were recorded. Eighteen patients (13 boys, 5 girls) incurred an acute MCL avulsion fracture. All avulsions involved the deep MCL attachment: 17 meniscofemoral and 1 meniscotibial component. Two avulsions also included the superficial MCL attachment. Nine boys had non-osseous avulsions, all radiographically occult. All girls had radiographically apparent avulsions. Three girls and three boys sustained associated knee derangements, most commonly anterior cruciate ligament (ACL) injury (n=4). All MCL avulsions were initially treated conservatively; one child required subsequent surgery for ongoing pain. Pediatric MCL avulsion fractures in this study uniformly involve the attachment of the deep MCL and can be entirely non-osseous, particularly in boys who lag in skeletal maturity, making these injuries radiographically occult. MR imaging may be required to recognize these avulsions, which can impact the duration of rest and knee bracing.

Facial Injuries Due to Cycling are Prevalent: Improved Helmet Design Offering Facial Protection is Recommended

<h3>Purpose</h3> Safety equipment for recreational cycling is commonly designed to protect the calvarium, but not the face, in the event of a crash. The purpose of this study is to identify the prevalence of facial injuries and their most common subcategories due to cycling injuries and to serve as an anatomical guide of what facial structures most need protection. <h3>Methods</h3> We report a cross-sectional study of consecutive patients reported to the National Electronic Injury Surveillance System from January 1, 2010 to December 31, 2019. Patients were included in our study if they were evaluated in the emergency department (ED) for an injury due to cycling trauma. Primary outcome was injury to the face. Other variables of interest include age, sex, race, ED disposition, type of facial injury, location of facial injury, and presence of additional injuries. Descriptive and univariate statistics of the primary outcome were computed with these variables. <h3>Results</h3> There were 138,078 total patients injured due to cycling trauma reported by National Electronic Injury Surveillance System -participating EDs during the study period and, of those, 14,326 patients experienced injury to the face, revealing a 10.4% prevalence of facial injury due to cycling trauma (14,326/138,078). Thirteen percent (1,987/14,326) of facial injuries were fractures, and the most involved structures were the nose (786/1987; 40%), orbit (459/1987; 23%), and mandible (405/1987; 20%). Compared to children, adults demonstrate a greater risk of facial fracture (23.5% versus 6.5%, <i>P</i> < .0001) and hospital admission after facial injury (8.9 vs 2.8%, <i>P</i> < .0001). <h3>Conclusions</h3> The prevalence of facial injury in the setting of cycling trauma is over 10%, and 13% of these injuries were facial fractures. With this high prevalence, there is a need for cycling helmets that include facial protection or faceguards, and we outline the commonly fractured anatomical areas that need the most protection.

Localization of Brachial Plexopathies Using a Novel Diagnostic Program.

Background: Assessing the extent and specific location of brachial plexus injuries can be difficult given the variety of mechanisms of injury and anatomic complexity of the plexus. We developed a program to accurately assess the location of a patient's neurologic injury based on electromyographic data. Purpose: We sought to test our hypothesis that the location of traumatic brachial plexopathies could be accurately assessed with a novel program that processed electromyogram (EMG) and mechanism of injury data. Methods: This retrospective diagnostic cohort study was carried out with a novel diagnostic algorithm developed with the Python programming language. The program accepts user input of muscles demonstrating decreased motor unit recruitment, positive sharp waves, or fibrillation potentials. The testing data set was derived from a registry of brachial plexus injuries treated at our center. The primary outcome was the percent concordance of the algorithm's diagnosis with the surgical diagnosis. Results: Ninety-five cases met the inclusion criteria. Median time from injury onset to EMG examination was 4 months; median time from EMG examination to surgery was 1.2 months. The program diagnosis matched the surgical diagnosis in 92 out of 95 (97%) of cases, including cases with multilevel injuries and additional peripheral nerve injuries. Conclusion: This program accurately localized brachial plexopathies in nearly all cases, including those involving polytrauma or complex patterns of injury. This algorithm may be valuable as an aid to complete electrodiagnostic examinations, a diagnostic adjunct when planning treatment of severe plexus palsies, or an educational tool.

Neurosurgical analysis of logging accidents: An observational study

ObjectiveForestry is one of the most dangerous occupations with record high rates of accidents and mortality relative to other occupations. In the past, related studies have been conducted within the scope of occupational safety, occupational health, and public health. Clinical studies on this subject are extremely rare and not within the scope of neurosurgery. We intended to facilitate the management of logging accidents for physicians by conducting a clinical study on logging accidents. This first-of-its-kind study also aimed to comprehend the injury mechanisms in order to contribute to the efforts made to prevent injuries and to facilitate the management of these cases. MethodsThe hospital records of patients who presented at the Karabük University EAH Emergency Department owing to logging accidents between 1/1/2019 and 5/1/2020 in the Karabük province were retrospectively analyzed. The information about patient profile, demographic information, mechanism of the logging injury, and the patterns of spinal and cranial injuries as well as other body area injuries (if any) were retrieved from the hospital records. The spinal and cranial injury patterns were analyzed from the imaging records (MRI or CT). ResultsA total of 19 subjects were included in this analysis, of which 5 had cranial injury (26.3%), 2 had spinal injury (10.5%), 1 (5.2%) had both cranial and spinal injuries (this subject died in the intensive care unit at follow-up). A total of 9 (47%) subjects died. Three subjects were followed up for observation (15.7%), while 5 (26.3%) were referred to the department of orthopedics. The cranial and spinal injuries were accompanied by additional injuries such as rib fracture, hemothorax, fibula fracture, and pneumothorax. These injuries occurred in pathological conditions such as cardiac arrhythmia, facial paralysis, and epilepsy. One subject developed spinal cord damage (5.2%) that progressed to neurological shock and crash syndrome. Overall, 19 injuries occurred mainly due to 5 different mechanisms. ConclusionsThe patterns of resultant spinal and cranial injuries and the related demographic information would facilitate efficient patient management. Understanding the injury mechanisms would facilitate both the management and diagnosis of such cases and the prevention of logging accidents through combined efforts of occupational safety and public health specialists.

Approach to Traumatic Diaphragm Injuries: Single Center Experience.

Traumatic diaphragm injuries are rare. After blunt trauma, injuries occur with a 1-7% rate. This rate increases up to 15% in penetrating injuries. Diagnosis may be diffi cult and imaging tests may be misleading. The misdiagnosis may lead to herniated abdominal organs towards the intrathoracic cavity, with a mortality rate between 30% and 60%. This study was designed to investigate the data of patients operated for diaphragmatic injury in our clinic. The files of trauma patients admitted to our hospital between 2014-2019 were reviewed retrospectively. The files of cases with diaphragmatic injury were examined. Patients were evaluated in terms of age, sex, type of injury, localization, additional organ injuries, grade, surgical method, and mortality. Values were statistically analyzed. A total of 20 patients were included in the study. Of the patients, 7 were female and 13 were male. The mean age was 32.7 (17-52) years. Of the cases, 10 were with stab wounds while 4 were incar traffi c accidents and 6 were gunshot wounds. Although all patients had thoracoabdominal injuries, 4 patients had additional pelvic injuries. Of the cases, 14 were accompanied with lung injury while 5 with intestinal, 4 with the spleen, 3 with liver, and 2 with cardiovascular injury. Patients with intestinal resection performed had a longer hospitalization period than others. When the severity of the injury was evaluated, grade 3 injuries were detected most commonly, whereas 3 patients had grade 1, 2, and 4 injuries. Grade 5 injury was detected in 1 patient. Primary repair was performed in 18 patients and mesh repair was performed in 2 patients. In three cases, the repair was performed with a thoracic way. One patient died on the postoperative fi rst day. Diaphragmatic injuries that may be missed during imaging may be damaged with many organs. Diaphragmatic injuries should be kept in mind in the upper abdominal and thoracic injuries.