Occurrence Of Injury Research Articles

Venous Congestion Assessed by Venous Excess Ultrasound (VExUS) and Acute Kidney Injury in Children with Right Ventricular Dysfunction.

Right ventricular dysfunction (RVD) is a complication following congenital cardiac surgery in children and can lead to systemic venous congestion, low cardiac output, and organ dysfunction. Venous congestion can be transmitted backwards and adversely affect encapsulated organs such as the kidneys. To investigate the association between systemic venous congestion, as estimated by Venous Excess Ultrasound (VExUS), and the occurrence of acute kidney injury (AKI) in children with RVD following congenital heart surgery. Secondary objectives included comparing changes in VExUS scores after initiating treatment for RVD and venous congestion. This was a prospective observational study in children with RVD. The VExUS study was performed on day 1, day 2, and day 3 and categorized as VExUS-1, VExUS-2, and VExUS-3. Among 43 patients with RVD and dilated inferior vena cava, 19/43 (44%), 10/43 (23%), and 12/43 (28%) were VExUS-2 and VExUS-3, respectively. There was an association between severe RVD and elevated pulmonary artery systolic pressures and a VExUS score >2. A significant association was observed between central venous pressure (CVP) measurements and VExUS. Among 31 patients with a high VExUS score >2, 18 (58%) had AKI. Additionally, improvement in CVP and fluid balance was associated with improving VExUS scores following targeted treatment for RVD. VExUS serves as a valuable bedside tool for diagnosing and grading venous congestion through ultrasound Doppler. An elevated VExUS score was associated with the occurrence of AKI, and among the components of VExUS, portal vein pulsatility may be useful as a predictor of AKI. Natraj R, Bhaskaran AK, Rola P, Haycock K, Siuba MTT, Ranjit S. Venous Congestion Assessed by Venous Excess Ultrasound (VExUS) and Acute Kidney Injury in Children with Right Ventricular Dysfunction. Indian J Crit Care Med 2024;28(5):447-452.

Acyclovir treatment of varicella-zoster virus meningeal infections and acute kidney injury: a multicentre case series study

Background Systematic treatment with intravenous acyclovir is usually given when varicella zoster virus (VZV) DNA is isolated in cerebrospinal fluid (CSF), indicating central nervous system (CNS) involvement. Our study aimed to describe therapeutic management and acute kidney injury (AKI) occurrence during acyclovir treatment of VZV infection with CNS involvement. Methods Multicentre, retrospective study including all patients from 2010 to 2022 with VZV DNA in CSF. Patient management and outcomes were compared according to clinical presentation and indications for intravenous acyclovir: i) definite (encephalitis, myelitis or stroke, peripheral nervous system (PNS) with ≥ 2 roots, herpes zoster ≥ 3 dermatomes, immunosuppression), ii) questionable (1 or 2 dermatomes) or iii) no indication (other situations). Results 154 patients were included (median age 66 (interquartile range 43–77), 87 (56%) males); 60 (39%) had encephalitis, myelitis or stroke, 35 (23%) had PNS involvement, 37 (24%) had isolated meningitis, 14 (9%) had isolated cutaneous presentation, and 8 (5%) had other presentations. Overall, 128 (83%) received intravenous acyclovir for more than 72 h. AKI occurred in 57 (37%) patients. Finally, 42 (27%) and 25 (16%) patients had respectively no or a questionable indication for intravenous acyclovir, while 29 (69%) and 23 (92%) of them received it for more than 72 h, with AKI in 13 (35%) and 13 (52%) patients, respectively. In-hospital mortality was 12% (n = 18), and no deaths were reported in isolated meningitis. Conclusions Intravenous acyclovir is widely prescribed when VZV DNA is isolated in CSF, regardless of the clinical presentation, with a high rate of AKI. Further studies are needed to better define the value of intravenous acyclovir in isolated VZV meningitis.

Donor Inhalation of Nebulized Dexmedetomidine Alleviates Ischemia-Reperfusion Injury in Rat Lung Transplantation

Introduction: The occurrence of lung ischemia-reperfusion injury (LIRI) after lung transplantation results in primary graft dysfunction (PGD) in more than 50% of cases, which seriously affects the prognosis of recipients. Currently, donor lung protection is the focus of research on improving graft survival in lung transplant recipients. Dexmedetomidine (Dex) is a widely used general anesthesia adjuvant in clinical practice to alleviate ischemia-reperfusion injury in the lungs, liver, heart, kidneys, and brain. However, intravenous infusion of Dex can cause negative effects on the cardiovascular system. Inhaling nebulized Dex can directly act on the alveolar tissue and alleviate its cardiovascular inhibitory effect by reducing drug intake. This study aimed to investigate the effect of donor nebulized Dex inhalation on LIRI after lung transplantation in rats. Methods: We randomly divided the male Sprague-Dawley rats into donor rats and recipient rats, and allowed the donor rats to inhale nebulized Dex or physiological saline 15 min before surgery. The donor lung was refrigerated for 8 h before each single-lung transplant. After 2 h of reperfusion of the transplanted lung, serum and transplanted lung tissue were collected. The wet-to-dry weight ratio of the lung tissue was measured, arterial blood gas was detected, and histopathology changes, oxidative stress, inflammatory reactions, and apoptosis were evaluated. Results: Pretransplant inhalation of Dex through the donor’s lung reduced the injury of the transplanted lung, increased the levels of malondialdehyde and myeloperoxidase, and decreased the levels of superoxide dismutase and glutathione in the lung tissue. Moreover, nebulized Dex inhalation of the donor lung inhibited LIRI-induced tumor necrosis factor-α, interleukin-6, and inducible nitric oxide synthase expression and also suppressed nuclear factor kappa B phosphorylation. Nebulized Dex inhalation reduced the rate of cell apoptosis in the transplanted lung tissue by inhibiting the upregulation of Bax, downregulation of Bcl-2, and increase in caspase-3 lysis caused by LIRI. Conclusion: Inhalation of atomized Dex is a potential donor lung protection strategy, which can be used to reduce LIRI after lung transplantation and may be helpful to improve the occurrence of PGD and prognosis of lung transplant recipients.

Avulsion and Soft Tissue Injuries of the Ulnar Collateral Ligament in Children and Adolescents

Background: Although pediatric medial epicondylar fractures and apophysitis are well studied, patterns of subapophyseal avulsion and ligamentous injuries of the medial elbow in this population merit investigation to inform optimal treatment strategies. Purpose: To describe the occurrence and demographic correlates of ulnar collateral ligament (UCL) avulsion and soft tissue injuries of the pediatric and adolescent elbow. Study Design: Cross-sectional study; Level of evidence, 3. Methods: An institutional review board–approved review was conducted to identify consecutive patients with medial elbow injuries treated in a tertiary pediatric sports medicine practice between 2016 and 2021. Radiographs were obtained during injury evaluation, and patients with nondisplaced medial epicondylar apophysitis and complete epicondylar fracture were excluded, resulting in 150 patients with soft tissue injuries occurring distal to the medial epicondyle apophysis (subapophyseal) for study. Radiographs were evaluated for bony avulsion of the UCL from either the medial epicondyle proximally or the ulnar sublime tubercle distally. Injuries without radiographic evidence of bony avulsion, but with clinical examination findings consistent with ligamentous injury, were classified as radiographically negative UCL injuries, and magnetic resonance imaging (MRI) was performed to further evaluate these injuries if moderate to severe medial swelling of the elbow or significant concern for medial structural injury was present on examination. These MRI scans were evaluated to classify the UCL injury and assess for periosteal or cartilaginous avulsions. Results: A total of 150 patients (mean age, 12.5 ± 3.4 years; 70 female), 55% (150/274) of the entire medial elbow injury population, had a subapophyseal injury. Of these patients, 62 had a bony avulsion detected on radiograph, and 88 had a radiographically negative injury. In addition to the 62 radiographic avulsions, the 61 MRI scans obtained on those radiographically negative injuries revealed 33 complete UCL disruptions, resulting in 63.3% (95/150) of patients sustaining a complete ligamentous disruption. With the MRI scans, 37 (61%) cases of cartilaginous or periosteal avulsion of the UCL were diagnosed. Overall, 66% of all 150 subapophyseal injuries had a bony, cartilaginous, or periosteal UCL avulsion. Patients with cartilaginous (mean age, 10.3 years) and bony (mean age, 10.6 years) avulsions were younger than those with central ligament injury (mean age, 14.2 years) or periosteal (mean age, 14.2 years) avulsions (P = .005). There was a significant association between the mechanism of injury and the location of UCL tear identified on MRI scans: traumatic falls were associated with distal tears, and throwing injuries were associated with proximal tears (P < .001). Conclusion: UCL central ligament and avulsion lesions may be frequently diagnosed after injury to the pediatric medial elbow, the majority of which are complete injuries, and may require MRI for diagnosis. The mechanism of injury may predict the location of ligamentous injury, and osteocartilaginous avulsions are more likely to present at younger ages than injuries to the soft tissue of the UCL or periosteum. The prevalence of these injuries merits further investigation into best protocols of nonoperative treatment or surgical repair techniques and outcomes.

Development and validation of a nomogram for oral mucosal membrane pressure injuries in ICU patients: A prospective cohort study.

Establishing a nomogram to estimate the probability of oral mucosal membrane pressure injury of endotracheal tube-intubated hospitalized patients in intensive care unit. Multicentre prospective cohort study. Using Lasso regression and COX regression, variable selection was performed on demographic, clinical and laboratory data of 1037 ICU endotracheal tube-intubated hospitalized patients from West China Hospital, to construct a nomogram. External validation was conducted on 484 ICU endotracheal tube-intubated patients from People's Hospital of Zhongjiang County. Among 38 potential predictors, five variables emerged as independent predictors, integrated into the nomogram: administration of antibiotics, nutritional therapy duration, agitation, hypotension and albumin levels. We established a nomogram based on the hospital characteristics of ICU endotracheal tube-intubated patients, aiding in the prediction of the occurrence of oral mucosal membrane pressure injury. The study followed TRIPOD guidelines. The nomogram we developed can assist clinical worker in better identifying at-risk patients and risk factors. It enables the implementation of evidence-based nursing interventions in care to prevent the development of oral mucosal membrane pressure injury. The study has been registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn) under registration number ChiCTR2200056615.

A Comparison of the Specific Facial Trauma Cases at the Department of Maxillofacial Surgery, Gdansk, Poland, from March 2019 to August 2023.

Background: Accidents involving the maxillofacial area are sudden and unforeseen, such as traffic accidents and physical altercations. The COVID-19 pandemic was a critical threat to the public in aspects not only involving physical health but also those affecting psychological health due to isolation, leading to a higher incidence of stress and depression among the general population and specifically in patients with OMF trauma. This study assessed the relationship between the impact of the COVID-19 pandemic and the quantity and severity of maxillofacial injuries. Methods: Data were retrieved from the Department of Maxillofacial Surgery of the University Clinical Centre in Gdansk from March 2019 to August 2023. Results: There was an increased risk of injury occurrence to the condylar process of the mandible, especially the left side, Le Fort type II/III fractures, injuries of the maxillary alveolar process, and displacement of the upper facial mass. Simultaneously, a decreased occurrence of certain injuries i.e., Le Fort type III fractures and Le Fort type I/II fractures, was recorded. Conclusions: The COVID-19 pandemic led to an increased occurrence of high-energy injuries, including displacement of the upper facial mass (p = 0.010).

Does abdominal protrusion in pregnant women affect abdominal injury severity in motor vehicle collisions? A nationwide database study.

Some pregnant women avoid vehicle driving owing to the risk of contact between their protruding abdomen and steering wheel. This study was performed to determine whether abdominal protrusion in late-term pregnant car users affects the occurrence and severity of abdominal injuries in motor vehicle collisions using a national crash database. The National Automotive Sampling System/Crashworthiness Data System was used to analyse maternal background, collision characteristics, outcome and Abbreviated Injury Scale (AIS) scores for the body regions of all persons involved in the collision. Comparison of pregnant and non-pregnant women in the driver's seat showed no significant differences in the rate of AIS scores of ≥2 (2+) for abdominal injuries and female outcomes. Comparison of use of the driver's seat and front passenger's seat by pregnant women showed no significant difference in rate of AIS 2+ injuries or in maternal and fetal outcomes. Comparison of pregnant women with a gestational age of ≤27 and >27 weeks in the driver's seat showed no significant differences in rate of AIS 2+ injuries or in maternal and fetal outcomes. Based on the data from relatively low-speed frontal collisions, obstetrician/gynaecologists should advise pregnant women that they do not need to change their preferred car seat from the driver's seat to another seat because of fear of contact between their protruding abdomen and the vehicle interior.

#1091 Quantifying the potential contribution of drugs to the occurrence of acute kidney injury in patients with chronic kidney disease

Abstract Background and Aims Patients with CKD have high risk of AKI. Quantifying the contribution of drugs to the occurrence of AKI in this population and assessing its risk factors is important to design preventive interventions. We sought to comprehensively describe drug-related components associated with AKI in patients with CKD. We documented the incidence of drug-related AKI, the proportion of preventable AKI, identified the various drugs potentially associated with it, explored the risk factors, and assessed the one-year incidences of the recurrence of drug-related AKI, kidney failure, and death. Method The CKD-REIN study is a national prospective cohort of 3,033 nephrology outpatients with a confirmed diagnosis of CKD (eGFR &amp;lt;60 mL/min/1.73 m²) in France. AKIs and adverse drug reactions (ADRs) were prospectively identified from hospital charts, medical records, and patient interviews. Nephrologists used the Kidney Disease: Improving Global Outcomes criteria to adjudicate all stages of AKI, and expert pharmacologists used validated tools to adjudicate ADRs (including drug-related AKIs). A drug-related AKI was considered serious when the outcome is death, a life-threatening situation, hospital admission, disability, permanent damage, or another important medical event. We used cause-specific Cox proportional hazard models to investigate the patients’ baseline clinical characteristics associated with the risk of drug-related AKI. Results Over a median [interquartile range] period of 4.9 [3.4-5.1] years, 832 cases of AKI were reported in 639 (21%) of the 3,033 study participants. Over a quarter of the AKI events were drug-related (n = 236, 28%); from those, 47% were hospital- and 53% community-acquired AKI. From the 168 serious drug-related AKI events, 28% were considered preventable or potentially preventable. The three most frequently implicated drug classes were diuretics, renin-angiotensin system inhibitors, and contrast agents. At least two concomitant medications were implicated in more than half of the AKIs with a drug-related component, RASis and diuretics, two diuretics, and diuretics and antibiotics were the 3 most frequent associations (Figure). A history of cardiovascular events, and the presence of diabetes, lower levels of hemoglobin and eGFR, poor medication adherence, and ≥5 drugs being taken daily were associated with a greater risk of drug-related AKI. The one-year cumulative incidences of recurrent drug-related AKI, kidney replacement therapy, and death were 7%, 15%, and 11%, respectively, after the first drug-related AKI. Conclusion Drug-related AKI is prevalent among patients with CKD. Further training in drug management for both CKD patients and healthcare professionals involved in their care might mitigate the incidence of drug-related AKI.

Muscle Injuries in Elite Youth Football Academy: A Six-Year Longitudinal Study on the U15 Football Team

To develop specific preventive strategies, it is necessary to investigate in detail the occurrence of injuries in young football players. This study aimed to provide details about the type, location, severity, and contact nature of muscle injuries in elite U15 Croatian football players. A total number of 130 muscle injuries occurred during the six competitive seasons, of which 88 were DOMS injuries and 42 were rupture injuries. Specifically, 87% of all muscle injuries belonged to the four major groups, with only 15 injuries to the other muscle groups: hamstrings (43), quadriceps (41), adductors (25), calves (6). The muscle injury incidence was stable during the observed period as the injury incidence rate ratio (IRR) was 1.01 (95%CI: 0.99–1.03), with 3.13 (95%CI: 3.09–3.17) muscle injuries per 1000 h of exposure in the first season and 3.06 (95%CI: 3.02–3.1) in the sixth season. A significantly higher risk for muscle injuries was discovered in the competition as the incidence for the whole observed period was 7.38 (95%CI: 7.29–7.47) compared to 2.25 (95%CI: 2.24–2.26) in the training period. Despite the relatively stable number of sustained muscle injuries, the relative proportion of muscular injuries increased over the years due to a severe decrease in the total number of injuries. Regarding the proportion of players who had sustained a muscle injury, our results suggest that approximately two out of five players can expect a muscular injury over the one-season period. Relatively high injury expectancy rates, as well as reinjury rates, require specific preventive interventions that will reduce the number and severity of new and recurred injuries. Future studies should include a wide set of predictor variables in order to establish the most important injury risk factors.

Clinical predictive value of the CRP-albumin-lymphocyte index for prognosis of critically ill patients with sepsis in intensive care unit: a retrospective single-center observational study.

Sepsis is a complex syndrome characterized by physiological, pathological, and biochemical abnormalities caused by infection. Its development is influenced by factors such as inflammation, nutrition, and immune status. Therefore, we combined C-reactive protein (CRP), albumin, and lymphocyte, which could reflect above status, to be the CRP-albumin-lymphocyte (CALLY) index, and investigated its association with clinical prognosis of critically ill patients with sepsis. This retrospective observational study enrolled critically ill patients with sepsis who had an initial CRP, albumin, and lymphocyte data on the first day of ICU admission. All data were obtained from the Affiliated Hospital of Jiangsu University. The patients were divided into quartiles (Q1-Q4) based on their CALLY index. The outcomes included 30-/60-day mortality and acute kidney injury (AKI) occurrence. The association between the CALLY index and these clinical outcomes in critically ill patients with sepsis was evaluated using Cox proportional hazards and logistic regression analysis. A total of 1,123 patients (63.0% male) were included in the study. The 30-day and 60-day mortality rates were found to be 28.1 and 33.4%, respectively, while the incidence of AKI was 45.6%. Kaplan-Meier analysis revealed a significant association between higher CALLY index and lower risk of 30-day and 60-day mortality (log-rank p < 0.001). Multivariate Cox proportional hazards analysis indicated that the CALLY index was independently associated with 30-day mortality [HR (95%CI): 0.965 (0.935-0.997); p = 0.030] and 60-day mortality [HR (95%CI): 0.969 (0.941-0.997); p = 0.032]. Additionally, the multivariate logistic regression model showed that the CALLY index served as an independent risk predictor for AKI occurrence [OR (95%CI): 0.982 (0.962-0.998); p = 0.033]. The findings of this study indicated a significant association between the CALLY index and both 30-day and 60-day mortality, as well as the occurrence of AKI, in critically ill patients with sepsis. These findings suggested that the CALLY index may be a valuable tool in identifying sepsis patients who were at high risk for unfavorable outcomes.

The Performance of Extracorporeal Membrane Oxygenation in Various Viral Pneumonia Pandemics: A Meta-Analysis and Systematic Review

Objective: To compare the effects of extracorporeal membrane oxygenation (ECMO) and routine mechanical ventilation on mortality and the risk of associated adverse events in patients with severe viral pneumonia. Methods: PubMed, the Cochrane Library, Embase, Web of Science, and other databases were searched to collect case-control or cohort studies on prognoses associated with ECMO treatment for viral pneumonia. Search terms included extracorporeal membrane oxygenation, ECMO, viral pneumonia, COVID-19, influenza, MERS, and others. According to the PICOS principle, two evaluators independently screened the literature, extracted the data, cross-checked the data, and extracted the data again. Two researchers evaluated the risk of bias in the included studies according to the Newcastle-Ottawa Scale (NOS) and cross-checked the results. Meta-analysis was performed using RevMan 5.3 software. Results: Nine studies were included for analysis, encompassing a total of 4,330 patients, which were categorized into ECMO and CMV groups. There were no significant differences between the two groups in most baseline data; however, the ECMO group had a lower oxygenation index, and some studies reported higher SOFA scores in the ECMO group compared to the CMV group. There was no significant difference in in-hospital mortality between the two groups. The length of ICU stay, total hospital stay, and total mechanical ventilation time were longer in the ECMO group than in the CMV group. In terms of adverse events, there was no significant difference in the occurrence of kidney injury between the two groups. Bleeding events were reported in two studies, with more bleeding events occurring in the ECMO group. According to the subgroup analysis of different virus types, there were no statistical differences in the above aspects among patients with swine flu, novel coronavirus, and MERS. Conclusion: ECMO has a certain degree of positive significance in the treatment of severe viral pneumonia, but there is no significant difference in the treatment outcome of ECMO across different epidemic periods. The timing of ECMO treatment, patient management, and withdrawal evaluation still need further research.

Safety of Empagliflozin: An Individual Participant-Level Data Meta-Analysis from Four Large Trials.

Empagliflozin is a sodium-glucose co-transporter-2 inhibitor used to treat type 2 diabetes (T2D) to improve glycemic control, reduce risk of cardiovascular death in patients with T2D, and treat patients with symptomatic chronic heart failure (HF) and chronic kidney disease (CKD). The safety profile of empagliflozin is well documented, although adverse events (AEs) remain of interest to clinicians. This study provides an up-to-date safety evaluation of empagliflozin. Data were pooled from four long-term trials which included: patients with T2D and established cardiovascular disease (EMPA-REG OUTCOME), patients with HF, with/without diabetes (EMPEROR-Reduced and EMPEROR-Preserved), and patients with CKD, with/without diabetes (EMPA-KIDNEY). Since three of the four trials evaluated empagliflozin 10mg, the meta-analysis was restricted to this dose. Total trial medication exposure was 19,727 patient-years for patients who received empagliflozin (n = 10,472) and 19,447 patient-years for placebo (n = 10,461). The percentages of patients with serious AEs, fatal AEs, and AEs leading to discontinuation were similar for both groups. The incidences of serious urinary tract infection and serious pyelonephritis or urosepsis were similar for both groups but higher for women taking empagliflozin versus placebo. Serious genital infections were not increased with empagliflozin versus placebo. There was a slight increase in ketoacidosis and serious volume depletion in patients who received empagliflozin versus placebo. The occurrence of serious acute kidney injury was lower with empagliflozin versus placebo. Empagliflozin was not associated with an increased incidence of severe hypoglycemia, bone fractures, or lower limb amputations. Empagliflozin is therefore considered safe in people without diabetes, the elderly, patients with very low estimated glomerular filtration rate, low body mass index, and HF. Safety is unaltered by blood pressure, concomitant medication for hypertension, HF, and immunosuppression. This meta-analysis of long-term safety data extends current knowledge and confirms the safety and tolerability of empagliflozin.

Adrenal insufficiency in pediatric kidney transplantation recipients.

Immunosuppression of pediatric kidney transplant (PKT) recipients often includes corticosteroids. Prolonged corticosteroid exposure has been associated with secondary adrenal insufficiency (AI); however, little is known about its impact on PKT recipients. This was a retrospective cohort review of PKT recipients to evaluate AI prevalence, risk factors, and adverse effects. AI risk was assessed using morning cortisol (MC) and diagnosis confirmed by an ACTH stimulation test. Potential risk factors and adverse effects were tested for associations with MC levels and AI diagnosis. Fifty-one patients (60.8% male, age 7.4 (IQR 3.8, 13.1) years; 1 patient counted twice for repeat transplant) were included. Patients at risk for AI (MC < 240 nmol/L) underwent definitive ACTH stimulation testing, confirming AI in 13/51 (25.5%) patients. Identified risk factors for AI included current prednisone dosage (p = .001), 6-month prednisone exposure (p = .02), daily prednisone administration (p = .002), and rejection episodes since transplant (p = .001). MC level (2.5 years (IQR 1.1, 5.1) post-transplant) was associated with current prednisone dosage (p < .001), 6-month prednisone exposure (p = .001), daily prednisone administration (p = .006), rejection episodes since transplant (p = .003), greater number of medications (β = -16.3, p < .001), 6-month hospitalization days (β = -3.3, p = .013), creatinine variability (β = -2.4, p = .025), and occurrence of acute kidney injury (β = -70.6, p = .01). Greater corticosteroid exposure was associated with a lower MC level and confirmatory diagnosis of AI noted with an ACTH stimulation test. Adverse clinical findings with AI included greater medical complexity and kidney function lability. These data support systematic clinical surveillance for AI in PKT recipients treated with corticosteroids.

Biomechanical mechanisms of anterior cruciate ligament injury in the jerk dip phase of clean and jerk: A case study of an injury event captured on-site

BackgroundWeightlifting exposes athletes to significant loads, potentially placing the knee joint in an abnormal mechanical environment and leading to anterior cruciate ligament (ACL) injuries. Once an ACL injury occurs, it can affect athletes’ competitive ability to varying degrees and even prematurely end their career. Understanding the biomechanical mechanisms of ACL injuries in weightlifters helps in comprehensively understanding the stress patterns and degrees on ACL during human movement, and identifying potential injury-causing factors, thereby enabling the implementation of appropriate preventive measures to reduce the occurrence of injuries. This study aimed to explore the biomechanical mechanisms of ACL injuries during the jerk dip phase of clean and jerk in weightlifters, providing a theoretical basis for the prevention of ACL injuries in weightlifting sports. MethodsThis study utilized the German SIMI Motion 10.2 movement analysis system and the AnyBody simulation system to analyze the kinematic and dynamic parameters of a 109 kg + class weightlifter (height: 191 cm, age: 22 years, weight: 148 kg, athletic level: elite) performing a 205 kg clean and jerk (non-injured) and a 210 kg clean and jerk (ACL injury occurred). The differences in kinematic and dynamic indicators of lower limb joints under injured and non-injured jerk dip conditions were investigated. ResultsKnee joint torque during non-injured clean and jerk was consistently positive (i.e., external rotation) but turned from positive to negative (i.e., from external rotation to internal rotation) during injured clean and jerk and reached a maximum internal rotation torque of 21.34 Nm at the moment of injury. At every moment, the muscle activation and simulated muscle force of the quadriceps and gastrocnemius during the injured clean and jerk were higher than those during the non-injured clean and jerk. By contrast, the muscle activation and simulated muscle force of the semitendinosus, semimembranosus, biceps femoris, and soleus during non-injured clean and jerk were higher than those during injured clean and jerk. The knee joint internal rotation angle during injured clean and jerk first increased and then declined, reaching a peak at 46.93° at the moment of injury, whereas it gradually increased during non-injured clean and jerk. The proximal tibia on the left side during the injured clean and jerk moved forward faster by 0.76 m/s compared with that during the non-injured clean and jerk. ConclusionsThe small muscle activation and simulated muscle force of the hamstring and soleus could not resist timely and effectively the large muscle activation and simulated muscle force of the quadriceps (especially the medial quad) and gastrocnemius. As such, the force applied to the ACL could exceed its ultimate load-bearing capacity. Kinematic indicators in the athlete's injured lift demonstrated certain disparities from those in their non-injured lift. Knee internal rotation and tibial anterior translation during the jerk dip phase of weightlifting might be the kinematic characteristics of ACL injuries.

Long-Term Outcomes Associated With β-Lactam Allergies

β-lactam (BL) allergies are the most common drug allergy worldwide, but most are reported in error. BL allergies are also well-established risk factors for adverse drug events and antibiotic-resistant infections during inpatient health care encounters, but the understanding of the long-term outcomes of patients with BL allergies remains limited. To evaluate the long-term clinical outcomes of patients with BL allergies. This longitudinal retrospective cohort study was conducted at a single regional health care system in western Pennsylvania. Electronic health records were analyzed for patients who had an index encounter with a diagnosis of sepsis, pneumonia, or urinary tract infection between 2007 and 2008. Patients were followed-up until death or the end of 2018. Data analysis was performed from January 2022 to January 2024. The presence of any BL class antibiotic in the allergy section of a patient's electronic health record, evaluated at the earliest occurring observed health care encounter. The primary outcome was all-cause mortality, derived from the Social Security Death Index. Secondary outcomes were defined using laboratory and microbiology results and included infection with methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, or vancomycin-resistant Enterococcus (VRE) and severity and occurrence of acute kidney injury (AKI). Generalized estimating equations with a patient-level panel variable and time exposure offset were used to evaluate the odds of occurrence of each outcome between allergy groups. A total of 20 092 patients (mean [SD] age, 62.9 [19.7] years; 12 231 female [60.9%]), of whom 4211 (21.0%) had BL documented allergy and 15 881 (79.0%) did not, met the inclusion criteria. A total of 3513 patients (17.5%) were Black, 15 358 (76.4%) were White, and 1221 (6.0%) were another race. Using generalized estimating equations, documented BL allergies were not significantly associated with the odds of mortality (odds ratio [OR], 1.02; 95% CI, 0.96-1.09). BL allergies were associated with increased odds of MRSA infection (OR, 1.44; 95% CI, 1.36-1.53), VRE infection (OR, 1.18; 95% CI, 1.05-1.32), and the pooled rate of the 3 evaluated antibiotic-resistant infections (OR, 1.33; 95% CI, 1.30-1.36) but were not associated with C difficile infection (OR, 1.04; 95% CI, 0.94-1.16), stage 2 and 3 AKI (OR, 1.02; 95% CI, 0.96-1.10), or stage 3 AKI (OR, 1.06; 95% CI, 0.98-1.14). Documented BL allergies were not associated with the long-term odds of mortality but were associated with antibiotic-resistant infections. Health systems should emphasize accurate allergy documentation and reduce unnecessary BL avoidance.

Prospective comparative study of unilateral biportal endoscopic transforaminal lumbar interbody fusion and endoscopic transforaminal lumbar interbody fusion for treatment of single-segment degenerative lumbar spinal stenosis with lumbar spondylolisthesis

To compare the effectiveness of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis with lumbar spondylolisthesis. Between November 2019 and May 2023, a total of 81 patients with single-segment degenerative lumbar spinal stenosis with lumbar spondylolisthesis who met the selection criteria were enrolled. They were randomly divided into UBE-TLIF group (39 cases) and Endo-TLIF group (42 cases). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, body mass index, surgical segment, and preoperative visual analogue scale (VAS) scores for low back and leg pain, Oswestry Disability Index (ODI), and serum markers including creatine kinase (CK) and C reactive protein (CRP). Total blood loss (TBL), intraoperative blood loss, hidden blood loss (HBL), postoperative drainage volume, and operation time were recorded and compared between the two groups. Serum markers (CK, CRP) levels were compared between the two groups at 1 day before operation and 1, 3, and 5 days after operation. Furthermore, the VAS scores for low back and leg pain, and ODI at 1 day before operation and 1 day, 3 months, 6 months, and 12 months after operation, and intervertebral fusion rate at 12 months after operation were compared between the two groups. All surgeries were completed successfully without occurrence of incision infection, vascular or nerve injury, epidural hematoma, dural tear, or postoperative paraplegia. The operation time in UBE-TLIF group was significantly shorter than that in Endo-TLIF group, but the intraoperative blood loss, TBL, and HBL in UBE-TLIF group were significantly more than those in Endo-TLIF group ( P<0.05). There was no significant difference in postoperative drainage volume between the two groups ( P>0.05). The levels of CK at 1 day and 3 days after operation and CRP at 1, 3, and 5 days after operation in UBE-TLIF group were slightly higher than those in the Endo-TLIF group ( P<0.05), while there was no significant difference in the levels of CK and CPR between the two groups at other time points ( P>0.05). All patients were followed up 12 months. VAS score of low back and leg pain and ODI at each time point after operation significantly improved when compared with those before operation in the two groups ( P<0.05); there was no significant difference in VAS score of low back and leg pain and ODI between the two groups at each time point after operation ( P>0.05). There was no significant difference in the intervertebral fusion rate between the two groups at 12 months after operation ( P>0.05). UBE-TLIF and Endo-TLIF are both effective methods for treating degenerative lumbar spinal stenosis with lumbar spondylolisthesis. However, compared to Endo-TLIF, UBE-TLIF requires further improvement in minimally invasive techniques to reduce tissue trauma and blood loss.

CHRONICLES OF HEALING: UNVEILING THE SECRETS OF ABRASION AND LACERATION DATING IN FORENSIC PATHOLOGY

Objective: In the field of forensic pathology, understanding the timeline of injury occurrence is of paramount importance. This study, titled "Chronicles of Healing: Unveiling the Secrets of Abrasion and Laceration Dating in Forensic Pathology," conducted a postmortem investigation to assess wound dating by gross and histopathological examination of blunt injuries. Methods: A total of 195 case samples from 119 cases were scrutinized to establish the timing of various gross changes and microscopic alterations that transpire following blunt trauma. The study encompassed abrasions, contusions, and lacerations occurring within a time frame ranging from 0 h to a maximum of 45 d. Results: The findings revealed that the gross changes in abrasions closely correlated with the corresponding microscopic changes, while contusions exhibited a similar correlation, except for a variation in the appearance of bluish color. In lacerations, the correlation was primarily evident during the early stages of injury. Conclusion: Importantly, the study emphasized the substantial impact of comorbid conditions on the healing process, highlighting the need for cautious evaluation in such cases. The study concludes that naked eye examination alone is insufficient for precise injury dating, underscoring the importance of histopathological examination to ensure accurate conclusions regarding injury age.

β-Caryophyllene promotes the survival of random skin flaps by upregulating the PI3K/AKT signaling pathway

BackgroundFlap transplantation is a widely used plastic repair technique in surgical procedures, aimed at addressing skin defects resulting from diverse wounds and diseases. However, due to the insufficient blood supply after flap surgery, the occurrence of ischemia-reperfusion injury, and an excessive sterile inflammatory response, flaps frequently develop complications (e.g., partial or complete ischemic necrosis). These complications have adverse effects on wound healing and repair. β-Caryophyllene (BCP) is a bicyclic sesquiterpene that is widely present in plants. It mitigates oxidative stress and inflammatory responses, demonstrates neuroprotective and analgesic properties, and serves a protective function in organs or tissues subjected to ischemia-reperfusion injury. However, no study has confirmed whether BCP can be used in the field of flap transplantation to improve the flap survival rate. MethodsTo assess the impact of BCP on random flap survival, we constructed a modified McFarlane random flap model on the rat. After 7 consecutive days of gavage with different doses of BCP, we measured the survival area ratio, angiogenesis, blood perfusion, tissue inflammation level, apoptosis-related protein levels, and the PI3K/AKT signaling pathway expression of the random flap. ResultsBCP treatment increased the survival area of the flap in a dose-dependent manner after random flap transplantation in rats. BCP mainly promoted the formation of tissue blood vessels, improved flap blood perfusion, limited the local inflammatory response, and reduced apoptosis. In addition, we demonstrated that BCP works primarily by promoting the PI3K/AKT signaling expression while enhancing the phosphorylation of AKT. Administration of wortmannin, a selective inhibitor of PI3K, eliminated the effects of BCP. ConclusionBCP can promote the survival of random flaps by upregulating the PI3K/AKT signaling pathway, increasing tissue blood perfusion, and limiting the inflammatory response and apoptosis.

Geriatric nutritional risk index is associated with the occurrence of acute kidney injury in critically ill patients with acute heart failure

Background: During the acute heart failure (AHF), acute kidney injury (AKI) is highly prevalent in critically ill patients. The occurrence of the latter condition increases the risk of mortality in patients with acute heart failure. The current research on the relationship between nutritional risk and the occurrence of acute kidney injury in patients with acute heart failure is very limited. Methods: This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV, version 2.1) database. We included adult patients with AHF who were admitted to the intensive care unit in the study. Results: A total of 1310 critically ill patients with acute heart failure were included. The AUC of geriatric nutritional risk index (GNRI) (0.694) is slightly superior to that of controlling nutritional status (CONUT) (0.656) and prognostic nutritional index (PNI) (0.669). The Log-rank test revealed a higher risk of acute kidney injury in patients with high nutritional risk (p < 0.001). Multivariate COX regression analysis indicated that a high GNRI (adjusted HR 0.62, p < 0.001) was associated with a reduced risk of AKI during hospitalization in AHF patients. The final subgroup analysis demonstrated no significant interaction of GNRI in all subgroups except for diabetes subgroup and ventilation subgroup (P for interaction: 0.057-0.785). Conclusion: Our study findings suggest a correlation between GNRI and the occurrence of acute kidney injury in patients hospitalized with acute heart failure.

Did safety-engineered device implementation contribute to reducing the risk of needlestick and sharps injuries? Retrospective investigation of 20 years of observation in a specialist tertiary referral hospital.

In Poland, there are numerous cases of injuries caused by sharp instruments annually, still significantly more than in other European Union countries. The aim of this study was to analyze work-related injuries among healthcare workers in a selected hospital before and after the implementation of safety-engineered devices (SED). Retrospective analysis of medical documentation regarding occupational needlestick and sharps injuries (NSSI) in a tertiary referral surgical hospital in 1998-2018. The study group consisted of nurses and doctors who had been injured and reported the incident. The frequency of injury reports, injury rate, and characterization of circumstances surrounding NSSI are presented. Over the period of 20 years, a total of 257 NSSI incidents were reported. The average injury rate was statistically significant for nurses (p = 0.004) and was higher before the introduction of SED. Moreover, the number of injuries among nurses showed a downward trend during the study period. However, for doctors, there was no statistically significant difference in the median puncture rate (p = 0.099), and the number of injuries showed an increasing trend. In this study, the authors' have demonstrated not only the occurrence of injuries and punctures in the daily work of medical personnel but also the potential for their reduction through the use of safety equipment at every workstation where healthcare services are provided using sharp medical instruments. Int J Occup Med Environ Health. 2024;37(2):234-43.