Injury Classification Research Articles

RSNA 2023 Abdominal Trauma AI Challenge Review and Outcomes Analysis.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To evaluate the performance of the winning machine learning (ML) models from the 2023 RSNA Abdominal Trauma Detection Artificial Intelligence Challenge. Materials and Methods The competition was hosted on Kaggle and took place between July 26, 2023, to October 15, 2023. The multicenter competition dataset consisted of 4,274 abdominal trauma CT scans in which solid organs (liver, spleen and kidneys) were annotated as healthy, low-grade or high-grade injury. Studies were labeled as positive or negative for the presence of bowel/mesenteric injury and active extravasation. In this study, performances of the 8 award-winning models were retrospectively assessed and compared using various metrics, including the area under the receiver operating characteristic curve (AUC), for each injury category. The reported mean values of these metrics were calculated by averaging the performance across all models for each specified injury type. Results The models exhibited strong performance in detecting solid organ injuries, particularly high-grade injuries. For binary detection of injuries, the models demonstrated mean AUC values of 0.92 (range:0.91-0.94) for liver, 0.91 (range:0.87-0.93) for splenic, and 0.94 (range:0.93-0.95) for kidney injuries. The models achieved mean AUC values of 0.98 (range:0.96-0.98) for high-grade liver, 0.98 (range:0.97-0.99) for high-grade splenic, and 0.98 (range:0.97-0.98) for high-grade kidney injuries. For the detection of bowel/mesenteric injuries and active extravasation, the models demonstrated mean AUC values of 0.85 (range:0.74-0.73) and 0.85 (range:0.79-0.89) respectively. Conclusion The award-winning models from the AI challenge demonstrated strong performance in the detection of traumatic abdominal injuries on CT scans, particularly high-grade injuries. These models may serve as a performance baseline for future investigations and algorithms. ©RSNA, 2024.

The Major League Baseball Pitch Clock: one year position player injury analysis.

In 2023, Major League Baseball (MLB)implemented the pitch clock. The effects of the pitch clock on player injuryrates is largely unknown, and some, including the major league baseball playersassociation, have suggested that pitchers may be at an increased risk of injurywith its implementation. Position players have received little attention inthese discussions, even though they may be at the same theorized risk ofinjuries. The aim of this study is to determine if implementation of the 2023MLB pitch clock influenced the incidence of injuries in position players. It ishypothesized that implementation of the MLB pitch clock will lead to a rise ininjuries due to a reduction of time for the primary biological energy systemused by baseball to restore to normal levels. Injury data was collected from thefangraphs.com injury database, the most comprehensive MLB data and statisticaldatabase website, for the 2021, 2022, and 2023 MLB seasons. The incidence rateratio was calculated and used to compare the injury rate for the 2023 season tothe 2021 and 2022 seasons for both major anatomical categories and anatomicalsubcategories. A z-test for proportions was used to determine significance. Incidence rate ratio comparison of the2023 MLB pitch clock season versus the 2021 MLB season showed a decrease in thetotal incidence of injuries (p < .001), lower extremity injuries (p < .001),and hamstring injuries (p = .032). Incidence rate ratio comparison of the 2023MLB pitch clock season versus the 2022 MLB season showed a decrease in thetotal incidence of injuries (p = .010), undisclosed injuries (p < .001), andknee injuries (p = .035). Following the implementation of thepitch clock during the 2023 MLB season, the total number of injuries andseveral lower extremity injury categories decreased. Due to a decrease in theoverall time spent on the field in a single game and over a season, it could behypothesized that the pitch clock decreased the workload for position players,leading to this drop in injuries. Further longitudinal investigation must bedone to investigate if this influence of the MLB pitch clock persists overtime.

Pediatric Cervical Spine Trauma: A Narrative Review.

Narrative review. To provide an updated overview of pediatric cervical spine trauma. Pediatric cervical spine trauma can cause debilitating morbidity and mortality and neurological impairment. The unique anatomic features of the developing cervical spine can predispose children to injuries. We reviewed the pediatric cervical spine trauma literature in PubMed and EMBASE. Pediatric cervical spine injury occurs in 1%-2% of pediatric trauma. The most frequent cause is motor vehicle collisions, with sports-related injuries being more common in older children. Larger head-to-body ratios and tissue elasticity can predispose young children to a greater risk of injury higher in the craniocervical junction and cervical spine. Standardized protocols and classification systems, such as the Pediatric Cervical Spine Clearance Working Group protocol and the AO Spine Injury and Subaxial Cervical Spine Injury Classifications, are valuable in triage as well as for assessing the need for operative versus nonoperative management. In general, operative approaches and principles are similar to those in adults, with modern instrumentation and fusion techniques achieving high rates of successful arthrodesis. Effective management and treatment of pediatric cervical spine injuries depends on early and accurate diagnosis, a thorough understanding of pediatric spinal anatomy, and a versatile surgical armamentarium.

Long-term prognosis after ST-elevation myocardial infarction according to the Canadian Cardiovascular Society classification of tissue injury severity in acute myocardial infarction

Abstract Background The recently proposed Canadian Cardiovascular Society (CCS) classification of acute myocardial infarction (MI) describes 4 stages of tissue injury identified by cardiac magnetic resonance imaging (CMR); 1) oedema without late gadolinium enhancement (LGE); 2) LGE without microvascular obstruction (MVO); 3) MVO; and 4) intramyocardial haemorrhage (IMH). Prior studies examining the relationship between these characteristics and outcomes are limited by variations in imaging and measurement techniques, in particular the distinction between MVO and IMH. The relationship between the proposed CCS classification of MI and outcomes has not been described. Purpose To explore the prognostic significance of the CCS classification of MI tissue injury in patients with ST-elevation MI (STEMI). Methods The British Heart Foundation MR-MI study was a prospective single-centre CMR cohort study in patients with STEMI (July 2011-November 2012). CMR was performed on a single Siemens MAGNETOM Avanto 1.5-Tesla scanner at 2 days post-STEMI. The imaging protocol included LGE and T2* mapping, allowing for the identification of infarct, MVO, and IMH. Follow-up for the occurance of major adverse cardiovascular events (MACE) (recurrent MI, ischaemic stroke and cardiovascular death) and a composite outcome of heart failure hospitalization/ICD implantation (HFH) or all-cause death was performed via electronic case note review. Results 246 patients had complete data for this analysis. Of these, 6 (2%) were CCS Stage 1, 105 (43%) were Stage 2, 33 (13%) were Stage 3, and 102 (41%) were Stage 4. Due to the low number in CCS stage 1, these patients were pooled with Stage 2 for the purposes of this analysis (CCS Stage 1/2). Average age was 58 (SD 11) years and 188 (76%) were male. With higher CCS stage, more patients were Killip class III/IV at presentation, had the LAD as culprit artery and had TIMI flow 0/1 pre-PCI. Patients with higher CCS stage had higher peak troponin-I and NT-proBNP, lower left ventricular function, higher left ventricular volumes and larger infarct size (Table). Median follow-up was 11.8 years. HFH or all-cause death occurred in 80 (33%) patients (22 HFH and 58 all-cause deaths), and MACE occurred in 63 (26%) patients (41 recurrent MI, 11 ischaemic stroke events, and 11 cardiovascular deaths). There were no significant differences in outcomes between CCS Stage 3 and CCS Stage 1/2 (Figure). Patients with CCS Stage 4 had a higher risk of HFH or all-cause death (HR 1.73, 95%CI 1.08-2.77; p=0.022) and MACE (HR 1.88, 95%CI 1.10-3.20; p=0.021) as compared with those in CCS Stage 1/2 (Figure). Conclusion The novel CCS classification of MI tissue injury identifies patients at the highest risk of adverse outcomes following STEMI. The relationship between the presence of IMH (CCS Stage 4) and adverse outcomes highlights the importance of T2* imaging in post-MI CMR protocols in order to identify this prognostically important biomarker.

Comprehensive classification and its value of capitellar cartilage injury concomitant with radial head fracture

BackgroundThere are defects in the existing classification of capitellar cartilage injury (CCI) concomitant with radial head fracture (RHF). This study aimed to introduce a comprehensive classification of CCI and to analyze its surgical guidance value.MethodsAccording to the affected site and severity, CCI was classified into four types: Type I - partial-thickness loss of articular cartilage, Type II - full-thickness loss of articular cartilage, Type III - full-thickness loss of articular cartilage with subchondral bone loss, Type IV - full-thickness loss of articular cartilage with thin cortex loss on the border of the capitellum; Different types suggest different surgical methods. Between January 2017 and January 2023, this comprehensive CCI classification was applied in 31 operated patients with CCI concomitant with RHF. The ranges of motion (ROM), Mayo Elbow Performance Index (MEPI) score, Hospital for Special Surgery (HSS) score and visual analog scale (VAS) for pain, were used to evaluate the functional recovery of the affected limb.ResultsMason Type I-IV RHF accounted for 6.45%, 38.71%, 48.39%, and 6.45%, respectively. Type I-IV CCI accounted for 12.90%, 35.48%, 45.16% and 6.45%, respectively. There was no relationship between the CCI and RHF types (p > 0.05). At the end of the follow-up period of 11–26 months with an average of 16 months, the elbow flexion and extension ROM recovered to (147.39 ± 9.84)°, forearm rotation ROM recovered to (168.74 ± 11.70)°, MEPI score recovered to (89.19 ± 4.17), HSS score recovered to (88.74 ± 4.62), VAS score recovered to (0.50 ± 0.57), indicating significant differences compared to preoperative measurements (p < 0.05). According to the MEPI and HSS scores, the excellent and good rate of functional recovery was 100%.ConclusionDifferent types of CCI differ not only in pathology but also in treatment methods. Surgical strategy according to the comprehensive CCI classification introduced in this paper may lead to a satisfactory outcome.

DBAII-Net with multiscale feature aggregation and cross-modal attention for enhancing infant brain injury classification in MRI.

MRI is pivotal in diagnosing brain injuries in infants. However, the dynamic development of the brain introduces variability in infant MRI characteristics, posing challenges for MRI-based classification in this population. Furthermore, manual data selection in large-scale studies is labor-intensive, and existing algorithms often underperform with thick-slice MRI data. To enhance research efficiency and classification accuracy in large datasets, we propose an advanced classification model. We introduce the Dual-Branch Attention Information Interactive Neural Network (DBAII-Net), a cutting-edge model inspired by radiologists' use of multiple MRI sequences. DBAII-Net features two innovative modules: (1) the Convolutional Enhancement Module (CEM), which leverages advanced convolutional techniques to aggregate multi-scale features, significantly enhancing information representation; and (2) the Cross-Modal Attention Module (CMAM), which employs state-of-the-art attention mechanisms to fuse data across branches, dramatically improving positional and channel feature extraction. Performances (accuracy, sensitivity, specificity, area under the curve, etc.) of DBAII-Net were compared with eight benchmark models for brain MRI classification in infants aged 6 months to 2 years. Utilizing a self-constructed dataset of 240 thick-slice brain MRI scans (122 with brain injuries, 118 without), DBAII-Net demonstrated superior performance. On a test set of approximately 50 cases, DBAII-Net achieved average performance metrics of 92.53% accuracy, 90.20% sensitivity, 94.93% specificity, and an area under the curve (AUC) of 0.9603. Ablation studies confirmed the effectiveness of CEM and CMAM, with CMAM significantly boosting classification metrics. DBAII-Net with CEM and CMAM outperforms existing benchmarks in enhancing the precision of brain MRI classification in infants, significantly reducing manual effort in infant brain research. Our code is available at https://github.com/jiazhen4585/DBAII-Net.

Intravenous Infusion of Autologous Mesenchymal Stem Cells Expanded in Auto Serum for Chronic Spinal Cord Injury Patients: A Case Series

Objective: The safety, feasibility, and potential functional improvement following the intravenous infusion of mesenchymal stem cells (MSCs) were investigated in patients with chronic severe spinal cord injury (SCI). Methods: The intravenous infusion of autologous MSCs cultured in auto-serum under Good Manufacturing Practices (GMP) was administered to seven patients with chronic SCI (ranging from 1.3 years to 27 years after the onset of SCI). In addition to evaluating feasibility and safety, neurological function was evaluated using the American Spinal Injury Association Impairment Scale (AIS), International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI-92), and Spinal Cord Independence Measure III (SCIM-III). Results: No serious adverse events occurred. Neither CNS tumors, abnormal cell growth, nor neurological deterioration occurred in any patients. While this initial case series was not blinded, significant functional improvements and increased quality of life (QOL) were observed at 90 and 180 days post-MSC infusion compared to pre-infusion status. One patient who had an AIS grade C improved to grade D within six months after MSC infusion. Conclusions: This case series suggests that the intravenous infusion of autologous MSCs is a safe and feasible therapeutic approach for chronic SCI patients. Furthermore, our data showed significant functional improvements and better QOL after MSC infusion in patients with chronic SCI. A blind large-scale study will be necessary to fully evaluate this possibility.

An Updated Evaluation of the Management of Nerve Gaps: Autografts, Allografts, and Nerve Transfers.

Within the past decade, there have been multiple innovations in the field of nerve surgery. In this review, we highlight critical changes and innovations that have helped advance the field and present opportunities for further study. This includes the modification and clarification of the classification schema for nerve injuries which informs prognosis and treatment, and a refined understanding and application of electrodiagnostic studies to guide patient selection. We provide indications for operative intervention based on this nerve injury classification and propose strategies best contoured for varying injury presentations at differing time points. Lastly, we discuss new developments in surgical techniques and approaches based on these advancements.

Traumatic injuries in ankylosing spinal diseases

Ankylosing spinal diseases, such as ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH), are highly important in spinal traumatology and are therefore specifically considered in the AO Spine Classification of spinal injuries. These diseases make the spine extremely susceptible to injury and also complicate the diagnosis and treatment, leading to an increased mortality. Concomitant neurological injuries are frequent. The treatment of such injuries requires great attention and careful preparation. Early and precise diagnostics using computed tomography (CT) and magnetic resonance imaging (MRI) as well as a surgical intervention are crucial for the survival and the quality of life of patients. The treatment is carried out surgically as conservative treatment often leads to high complication rates. In postoperative care special attention must be paid to cardiopulmonary complications.

Comparison of the AO/OTA 1996/2007 and 2018 pelvic ring fracture classifications.

Pelvic ring fractures may present with relevant mechanical and haemodynamic instability. Classifications of the bony or ligamentous injuries of the pelvic ring are well established. The most common classifications used analyse the injury mechanisms and the resulting instability of the pelvic ring structure. Fracture classifications should be simple and easy to use, comprehensive, andradiographically and anatomically based, resulting in a hierarchical alphanumeric order of types and subtypes and thereby allow adequate treatment decisions based on a high degree of inter- and intraobserver reliability. In 2018 a new AO/OTA pelvic ring fracture and dislocationclassification was published that combined the most commonly used "historical" classification schemes, e.g. the Tile/AO classification and the classification according to Young and Burgess. Compared with these older classifications, several relevant changes were integrated in the 2018 edition. The changes between the AO/OTA 1996/2007 and 2018 classifications were analysed in detail. Overall, several problems were identified regarding the type-B pelvic ring injury classification. These changes may result in difficulties in classifying pelvic ring injuries and thereby prevent relevant comparisons between former and future clinical studies on pelvic injuries.Level of Evidence: V.

The correlation of neurosurgery motor examinations with ISNCSCI motor examinations in patients with spinal cord injury: a multicenter TRACK-SCI study.

The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) assessment is the gold standard for evaluation of neurological function after spinal cord injury (SCI). Although it is an invaluable tool for diagnostic and research purposes, it is time consuming and can be impractical in acute injury settings. Clinical neurosurgery motor examinations (NMEs) could serve as an expeditious surrogate for SCI research when ISNCSCI motor examinations are not feasible. The aim of this study was to evaluate the agreement between motor examinations performed by the neurosurgery clinical team and ISNCSCI examiners. The multicenter prospective Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) registry was queried to identify patients with recorded neurosurgery and research motor examinations within 24 hours of each other. Pearson correlations and modified Bland-Altman analyses were performed using data from matching upper-extremity, lower-extremity, and combined examinations. Kappa analysis was used to test interrater reliability with respect to determination of American Spinal Injury Association Impairment Scale (AIS) grade. There were 72 pairs of matching clinical and research examinations in 63 patients. NME scores were strongly correlated with ISNCSCI motor scores (R = 0.962, p < 0.001). Both upper- and lower-extremity NME scores were strongly correlated with upper- and lower-extremity ISNCSCI motor scores, respectively (R = 0.939, p < 0.001; and R = 0.959, p < 0.001, respectively). In modified Bland-Altman analyses, total, upper-extremity, and lower-extremity NME scores and ISNCSCI motor scores showed low systematic bias and high agreeability (total: bias = 0.3, limit of agreement [LoA] = 36.6; upper extremity: bias = -0.5, LoA = 17.6; lower extremity: bias = 0.8, LoA = 24.0). There were 66 pairs of examinations that had thorough sensory and rectal examinations for AIS grade calculation. Using kappa analysis to test the interrater reliability of AIS grade calculation using NME versus ISNCSCI motor scores, the authors found a weighted kappa of 0.883 (SE 0.061, 95% CI 0.736-0.976), indicating strong agreement. Overall, this study suggests that ISNCSCI motor scores and NME scores are strongly correlated and highly agreeable. When conducting SCI research, a thorough clinical motor examination may be a useful surrogate when ISNCSCI examinations are missing.

AO Spine-DGOU Osteoporotic Fracture Classification System: Internal Validation by the AO Spine Knowledge Forum Trauma.

Cross-sectional survey. Injury classifications are important tools to identify fracture patterns, guide treatment-decisions and aid to identify optimal treatment plans. The AO Spine-DGOU Osteoporotic Fracture (OF) classification system was developed, and the aim of this study was to assess the reliability of this new classification system. 23 Members of the AO Spine Knowledge Forum Trauma participated in the validation process. Participants were asked to rate 33 cases according to the OF classification at 2 time points, 4weeks apart (assessment 1 and 2). The kappa statistic (κ) was calculated to assess inter-observer reliability and intra-rater reproducibility. The gold master key for each case was determined by approval of at least 5 out of 7 members of the DGOU. A total of 1386 ratings (21 raters) were performed. The overall inter-rater agreement was moderate with a combined kappa statistic for the OF classification of 0.496 in assessment 1 and 0.482 in assessment 2. The combined percentage of correct ratings (compared to gold-standard) in assessment 1 was 71.4% and 67.4% in assessment 2. The average intra-rater reproducibility was substantial (κ = 0.74, median 0.76, range 0.55 to 1.00, SD 0.13) for the assessed fracture types. The assessed overall inter-rater reliability was moderate and substantial in some instances. The average intra-rater reproducibility is substantial. It seems that appropriate training of the classification system can enhance inter- and intra-rater reliability.

Military-Civilian Partnership to Improve Combat Casualty Care Readiness Among Non-physician Providers.

Military-civilian partnerships (MCP) provide a bidirectional exchange of information and trauma best practices. In 2021, Penn Presbyterian Medical Center and the U.S. Navy signed a 3-year memorandum of understanding to embed active duty trauma providers into the Trauma Division to facilitate the training and sustainment of combat casualty care (CCC) skills. To date, there is little evidence to demonstrate the efficacy of military-civilian partnerships in maintaining combat casualty readiness in non-physician trauma providers. We evaluated the impact of combat casualty readiness for non-physician providers by mapping clinical experiences in an urban Level I trauma center against the Defense Health Agency's Joint Trauma Systems (JTS) Clinical Practice Guidelines (CPG). The JTS CPGs provide best practices for CCCand highlight the critical skills providers need to know before deploying to an austere environment. Patient acuity data and specific JTS CPG skills performed by a non-physician providers were collected in their respective specialties for each patient seen between January 2023 to January 2024. Analyses were performed using descriptive statistics via Redcap. A sample of 6 Navy personnel in different specialties: 1 Physician Assistant, 3 Registered Nurses (emergency medicine, perioperative, critical care), and 2 corpsmen (scrub tech and search & rescue/prehospital medic) completed 1299 records on patients treated. In all, 685 (52.7%) were trauma patients and 614 (47.3%) were non-trauma patients. Categories of injuries seen, listed from the most frequent to the least, were as follows: Other (764), Falls (250), Motor Vehicle Crashes (164), Gunshot Wound (126), Stab-related injuries (41). Category 1 skills, defined as "essential to know," were performed in 921 (36.1%) of the patients treated. In Category 2, skills described as "important to know" were performed in 889 (34.8%) of the patients treated. Category 3 skills, identified as "less urgent" as they are rare among trauma patients, were performed in 486 (19.0%) of the patients treated, and 252 (9.8%) required none of the JTS CPG skills. These categories were further broken down based on the frequency of the skills performed. Analysis revealed strengths and identified opportunities to direct clinical experience for underperforming skills. Military-civilian partnerships support CCC readiness. The data presented and the continuation of mapping personnel's clinical experience to military CPGs can gauge readiness in non-physician trauma providers. Notably, several skills in each category were identified as opportunities to modify the clinical exposure of the military provider. These findings indicate that modifications in clinical assignments could enhance active duty combat casualty readiness in these critical skills.

High-dimensional proteomic analysis for pathophysiological classification of traumatic brain injury.

Pathophysiology and outcomes after Traumatic Brain Injury (TBI) are complex and heterogenous. Current classifications are uninformative about pathophysiology. Proteomic approaches with fluid-based biomarkers are ideal for exploring complex disease mechanisms, as they enable sensitive assessment of an expansive range of processes potentially relevant to TBI pathophysiology. We used novel high-dimensional, multiplex proteomic assays to assess altered plasma protein expression in acute TBI. We analysed samples from 88 participants from the BIO-AX-TBI cohort (n=38 moderate-severe TBI [Mayo Criteria], n=22 non-TBI trauma, n=28 non-injured controls) on two platforms: Alamar NULISA™ CNS Diseases and OLINK® Target 96 Inflammation. Patient participants were enrolled after hospital admission, and samples taken at a single timepoint up to 10 days post-injury. Participants also had neurofilament light, GFAP, total tau, UCH-L1 (all Simoa®) and S100B (Millipore) data. The Alamar panel assesses 120 proteins, most of which were previously unexplored in TBI, plus proteins with known TBI-specificity, such as GFAP. A subset (n=29 TBI, n=24 non-injured controls) also had subacute (10 days to 6 weeks post-injury) 3T MRI measures of lesion volume and white matter injury (fractional anisotropy). Differential Expression analysis identified 16 proteins with TBI-specific significantly different plasma expression. These were neuronal markers (calbindin2, UCH-L1, visinin-like protein1), astroglial markers (S100B, GFAP), neurodegenerative disease proteins (total tau, pTau231, PSEN1, amyloid-beta-42, 14-3-3γ), inflammatory cytokines (IL16, CCL2, ficolin2), cell signalling (SFRP1), cell metabolism (MDH1) and autophagy related (sequestome1) proteins. Acute plasma levels of UCH-L1, PSEN1, total tau and pTau231 correlated with subacute lesion volume. Sequestome1 was positively correlated, whilst CLL2 was inversely correlated, with white matter fractional anisotropy. Neuronal, astroglial, tau and neurodegenerative proteins correlated with each other, IL16, MDH1 and sequestome1. Exploratory clustering (k means) by acute protein expression identified 3 TBI subgroups that differed in injury patterns, but not age or outcome. One TBI cluster had significantly lower white matter fractional anisotropy than control-predominant clusters, but had significantly lower lesion subacute lesions volumes than another TBI cluster. Proteins that overlapped on two platforms had excellent (r>0.8) correlations between values. We identified TBI-specific changes in acute plasma levels of proteins involved in neurodegenerative disease, inflammatory and cellular processes. These changes were related to patterns of injury, thus demonstrating that processes previously only studied in animal models are also relevant in human TBI pathophysiology. Our study highlights how proteomic approaches might improve classification and understanding of TBI pathophysiology, with implications for prognostication and treatment development.

Struggling to Understand the NEC Spectrum-Could the Integration of Metabolomics, Clinical-Laboratory Data, and Other Emerging Technologies Help Diagnosis?

Necrotizing enterocolitis (NEC) is the most prevalent and potentially fatal intestinal injury mainly affecting premature infants, with significant long-term consequences for those who survive. This review explores the scale of the problem, highlighting advancements in epidemiology, the understanding of pathophysiology, and improvements in the prediction and diagnosis of this complex, multifactorial, and multifaced disease. Additionally, we focus on the potential role of metabolomics in distinguishing NEC from other conditions, which could allow for an earlier and more accurate classification of intestinal injuries in infants. By integrating metabolomic data with other diagnostic approaches, it is hoped to enhance our ability to predict outcomes and tailor treatments, ultimately improving care for affected infants.

Sagittal Fragment Rotation and Ogden Type-I Classification Are Hallmarks of Combined Tibial Tubercle Fracture and Patellar Tendon Injury.

Tibial tubercle fractures (TTFs) are uncommon injuries, comprising <3% of all proximal tibial fractures. These fractures occasionally occur in conjunction with a patellar tendon injury (PTI). We aimed to identify risk factors associated with combined TTF and PTI. A retrospective review was performed of patients presenting to a single, tertiary children's hospital with TTF between 2012 and 2023. Demographic data, operative details, radiographs, and injury patterns were analyzed. Radiographs were assessed for the epiphyseal union stage (EUS), Ogden classification, and fracture patterns. Multiple logistic regression models were used to assess the impact of body mass index, comminution, fracture fragment rotation, EUS, bilateral injury, and Ogden classification on injury type. We identified 262 fractures in 252 patients (mean age, 13.9 ± 1.31 years). Of the patients, 6% were female and 48% were Black. Of the 262 fractures, 228 (87%) were isolated TTFs and 34 (13%) were TTFs with PTI. Multivariable analysis demonstrated fragment rotation on lateral radiographs (p < 0.0001) and Ogden Type-I classification (p < 0.0001) to be the most predictive risk factors for a combined injury. Rotation was associated with a substantial increase in the odds of a combined injury, with an odds ratio of 22.1 (95% confidence interval [CI], 6.1 to 80.1). Ogden Type-I fracture was another significant risk factor, with an odds ratio of 10.2 (95% CI, 3.4 to 30.4). The Ogden classification and fragment rotation are the most useful features for distinguishing between isolated TTF and combined TTF with PTI. This is the first study to identify risk factors for TTF combined with PTI. Surgeons may use this information to aid in preoperative planning. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Time to use the right classification to predict the severity of checkpoint inhibitor-induced liver injury, as assessed for causality using the updated RUCAM.

While immune checkpoint inhibitors (ICIs) are revolutionising cancer therapy, checkpoint inhibitor-induced liver injury is a significant immune-related side effect of this immunotherapy. This study focuses on the severity classifications and characteristics of patients with checkpoint inhibitor-induced hepatitis. A retrospective analysis of patients with severe Checkpoint Inhibitor-induced hepatitis grade 3 and 4 according to the recommended Common Terminology Criteria for Adverse Events (CTCAE) classification was conducted. Data on clinicobiological characteristics, treatment and outcomes were collected from 3 university hospitals, and causality was assessed by using the updated Roussel Uclaf Causality Assessment Method. The severity of hepatitis was assessed using the Model for End-stage Liver Disease score, the Drug-Induced Liver Injury Network, and the Drug-Induced Liver Injury International Expert Working Group classifications. We retrospectively included 100 patients presenting various hepatitis patterns with a median time to onset of 20 days after checkpoint inhibitors. Severity grading varied significantly among the classifications used. A lower incidence of severe cases was observed when using the Drug-Induced Liver Injury classifications instead of the recommended CCTCAE classification, and this was correlated with outcomes. This retrospective study challenges the efficacy of the CTCAE classification in defining the severity of Checkpoint Inhibitor-induced hepatitis and suggests that the traditional hepatology-focused scores may be more relevant. The CTCAE classification is inconsistent and gives equal weight to jaundice and elevated transaminases, which leads to steroid overtreatment and limits the rechallenge of ICIs.

Review of the treatment options and results of earthquake-related pelvic injuries after the Türkiye earthquake on 6th February.

The aim of this study was to review the characteristics and classifications of pelvic injuries due to earthquake trauma, to determine the treatment options and outcomes, and to present the experiences of our single trauma center. Sixty patients (23 male, 37 female) who underwent surgical treatment for pelvic ring injuries after the earthquake were analyzed in this study. Demographic data, such as age and gender, operations, and fracture details were recorded. Laboratory results and the amount of blood used were included in the analysis. Fractures were classified according to the Young-Burgess classification. Surgical treatment methods, side of injury, accompanying injuries, and treatment results were analyzed using SPSS software. Left-sided trauma was the most common mechanism of injury, with 36 patients (60%) sustaining left-sided pelvic fractures. Pelvic ring fractures were detected in 78.3% of patients, and combined acetabulum and pelvic ring fractures were identified in 21.7% of patients. Thoracic trauma and extra-pelvic fractures were seen in 12 (20%) and 18 (30%) patients, respectively. Twenty percent of patients underwent emergency abdominal surgery prior to pelvic surgery. Complications were observed in 7 patients (11.6%) in the early period. The average amount of blood used for patients was 2.91 U (min: 0, max: 13 U, SD: 2.66). This study has shown us that lateral compression injuries are more common, and that low hemoglobin levels, high inflammation parameters, previous abdominal surgery, accompanying fractures, and lung injury are the main characteristics of patients with earthquake-related pelvic injuries. It also demonstrates that for the optimal use of materials and implants, experience in different techniques is required, and shows the significant need for blood transfusions in the treatment of these injuries. Level IV, Therapeutic study.

Validation of optimised intracranial spectroscopic probe for instantaneous in-situ monitoring and classification of traumatic brain injury

The development of an optical interface to directly distinguish the brain tissue's biochemistry is the next step in understanding traumatic brain injury (TBI) pathophysiology and the best and most appropriate treatment in cases where in-hospital intracranial access is required. Despite TBI being a globally leading cause of morbidity and mortality in patients under 40, there is still a lack of objective diagnostical tools. Further, given its pathophysiological complexity the majority of treatments provided are purely symptomatic without standardized therapeutic targets. Our tailor-engineered prototype of the intracranial Raman spectroscopy probe (Intra-RSP) is designed to bridge the gap and provide real-time spectroscopic insights to monitor TBI and its evolution as well as identify patient-specific molecular targets for timely intervention. Raman spectroscopy being rapid, label-free and non-destructive, renders it an ideal portable diagnostics tool. In combination with our in-house developed software, using machine learning algorithms for multivariate analysis, the Intra-RSP is shown to accurately differentiate simulated TBI conditions in rat brains from the healthy controls, directly from the brain surface as well as through the rat's skull. Using clinically pre-established methods of cranial entry, the Intra-RSP can be inserted into a 2-piece optimised cranial bolt with integrated focussing and correctly identify a sample in real-life conditions with an accuracy >80 %. To further validate the Intra-RSP's efficiency as a TBI monitoring device, rat brains mildly damaged from inflicted spinal cord injury were found to be correctly classified with 94.5 % accuracy. Through optimization and rigorous in-vivo validation, the Intra-RSP prototype is envisioned to seamlessly integrate into existing standards of neurological care, serving as a minimally invasive, in-situ neuromonitoring tool. This transformative approach has the potential to revolutionize the landscape of neurological care by providing clinicians with unprecedented insights into the nature of brain injuries and fostering targeted, timely and effective therapeutic interventions.

The Thoracolumbar Injury Classification and Severity Score Appropriately Predicts Treatment in Children Aged 10 and Under.

Retrospective cohort study. This study aims to assess the validity of the Thoracolumbar Injury Classification and Severity Score (TLICS) in patients ≤10 years-old. TLICS is a validated measure developed to help facilitate clinical decision-making regarding thoracolumbar spinal trauma in adults. Studies examining the utility of TLICS in children skew towards older pediatric patients, where the spine's biomechanical properties are more similar to adults. Due to differences in a pre-adolescent spine compared to a more mature, adolescent spine, it is unclear if TLICS can be applied to younger patients. A single center spine trauma registry was queried for patients ≤10 with an acute, traumatic thoracolumbar fracture treated at a level-1 pediatric trauma center between 2006 and 2020. Test characteristics and Receiver-Operator Curve were used to evaluate TLICS based on TLICS <4=nonsurgical treatment and TLICS >4=surgery recommendation. We identified 94 patients with traumatic thoracolumbar fractures (surgical=20; non-surgical=74). Despite TLICS-suggested operative management in 28 patients with TLICS>4, 9 (32.1%) were initially treated non-operatively. All patients who deviated from TLICS-suggested treatment had flexion-distraction injuries (FDI). Sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 89.2%, 70.4%, and 100%, respectively. The receiver operating characteristic curve demonstrated strong diagnostic ability of TLICS in predicting need for surgery (area under the curve: 0.97, F1-score: 0.86). TLICS score <4 showed strong validity and is highly specific in predicting non-operative management for patients ≤10 years-old with thoracolumbar fractures. However, TLICS >4 has more limited specificity in indicating the necessity for surgical intervention, as many FDIs were successfully treated without surgery. Additional factors other than TLICS score may need to be considered for these more severe injuries to optimize management in this age group.