Management Of Injuries Research Articles

Sports and Exercise Medicine: Present and Future

Sports and exercise medicine is a newly emerging medical speciality in association with sports and physical education. As the lifestyle of the average population has changed drastically with sedentary type and lack of physical exercise, thus, inviting various lifestyle-related diseases in society, this speciality has been gaining tremendous popularity in medical practices. This discipline is a combination of sports medicine and exercise medicine (therapy). Clinical and interventional physiology which is the resultant of these two components, plays an important role in injury management and for the promotion of health and wellbeing, devoid of any side effects. In the present editorial, with the objectives, an attempt has been made to discuss the present scenario of the discipline of sports and exercise medicine along with its future prospects, as in spite of its numerous benefits, not enough attention has been given to the holistic improvement of the healthcare system.

Dandelion-shaped strontium-gallium microparticles for the hierarchical stimulation and comprehensive regulation of wound healing

Abstract The management of full-thickness skin injuries continues to pose significant challenges. Currently, there is a dearth of comprehensive dressings capable of integrating all stages of wound healing to spatiotemporally regulate biological processes following full-thickness skin injuries. In this study, we report the synthesis of a dandelion-shaped mesoporous strontium-gallium microparticle (GE@SrTPP) achieved through dopamine-mediated strontium ion biomineralization and self-assembly, followed by functionalization with gallium metal polyphenol networks (MPNs). As CroCfunctional wound dressing, GE@SrTPP can release bioactive ions in a spatiotemporal manner akin to dandelion seeds. During the early stages of wound healing, GE@SrTPP demonstrates rapid and effective hemostatic performance while also exhibiting antibacterial properties. In the inflammatory phase, GE@SrTPP promotes M2 polarization of macrophages, suppresses the expression of pro-inflammatory factors, and decreases oxidative stress in wounds. Subsequently, during the stages of proliferation and tissue remodeling, GE@SrTPP facilitates angiogenesis through the activation of the HIF-1α/VEGF pathway. Analogous to the dispersion and rooting of dandelion seeds, the root-like new blood vessels supply essential nutrients for wound healing. Ultimately, in a rat chronic wound model, GE@SrTPP achieved successful full-thickness wounds repair. In summary, these dandelion-shaped GE@SrTPP microparticles demonstrate comprehensive regulatory effects in managing full-thickness wounds, making them highly promising materials for clinical applications.

Low-Velocity Ballistic Trauma–Related Upper Extremity Nerve Injury: A Systematic Review and Meta-Analysis

Purpose: Optimal management of upper extremity nerve palsy caused by low-velocity ballistic trauma (LBT) remains controversial. The aim of this systematic review was to summarize the available evidence on the management of nerve injuries caused by LBT to the upper extremity. Methods: A literature search was completed for the keywords “Upper extremity,” “Nerve Injury,” and “Ballistic.” 2 independent reviewers conducted a systematic screening of all articles and collected data from relevant publications. The data were summarized and pooled using a random-effect model. Results: 14 studies met inclusion criteria. Cohorts between 6 and 168 patients (n = 848) with upper extremity LBT were reported. Neurologic deficits were present in 45% (95% CI: 38 to 52%) of patients at the time of injury evaluation. Nerve exploration was done in 50% (95% CI: 27 to 73%) of these patients with neurologic deficits. Early nerve exploration was done in 19% (95% CI: 9 to 32%) of all patients. Surgical findings included nerve continuity (49%; 95% CI: 14 to 84%), nerve contusion (30%; 95% CI: 12 to 50%), and nerve transection (31%; 95% CI: 14 to 50%). Nerve transection rates found at the time of exploration ranged from 0 to 71% (mean 31%). Outcomes were good in 62% (95% CI: 41 to 81%); however, analyses were limited by subjective outcome reporting of the studies. Conclusions: Contrary to historical teaching that LBT causes neurapraxia, this review identified that 31% of resulting nerve injuries were neurotmesis (transections). These results advocate for systematic clinical follow-up and appropriately timed nerve intervention (within 3 to 6 months of injury) when neurologic deficits persist after ballistic injury. Level of evidence: Level III

The Inhibition of Reactive Oxygen Species Modulator 1 Attenuates Sevoflurane-Induced Neural Injury via Reducing Apoptosis and Oxidative Stress.

Sevoflurane causes neural injury by promoting apoptosis and oxidative stress. Reactive oxygen species modulator 1 (ROMO1) regulates apoptosis and oxidative stress, while its role in sevoflurane-induced neural injury remains unclear. This study intended to investigate the effect of ROMO1 knockdown on viability, apoptosis, and oxidative stress in sevoflurane-treated HT22 cells and its downstream pathway. HT22 cells were untreated (blank control), or treated with 1%, 2%, and 4% sevoflurane, respectively. Moreover, HT22 cells were transfected with siROMO1 small interfering RNA (siROMO1) or negative control siRNA (siNC) and then stimulated with 4% sevoflurane for further assays. Sevoflurane dose-dependently decreased cell viability and increased apoptosis rate versus blank control in HT22 cells. Sevoflurane elevated reactive oxygen species (ROS) fluorescence intensity, malondialdehyde (MDA), and lactate dehydrogenase (LDH) release, while reducing superoxide dismutase (SOD) activity in a dose-dependent manner versus blank control in HT22 cells. It also dose-dependently increased the relative mRNA and protein expressions of ROMO1 versus blank treatment in HT22 cells. Moreover, siROMO1 plus 4% sevoflurane increased cell viability, while decreasing apoptosis rate, ROS fluorescence intensity, MDA, and LDH release versus siNC plus 4% sevoflurane in HT22 cells. siROMO1 plus 4% sevoflurane elevated the phosphorylation of protein kinase B (AKT) versus siNC plus 4% sevoflurane in HT22 cells. ROMO1 inhibition reverses sevoflurane-induced neural injury by reducing apoptosis and oxidative stress in HT22 cells. The results indicate that ROMO1 may be a potential target for the management of sevoflurane-induced neural injury.

Disproportionality analysis of flutamide- or bicalutamide-induced liver injury with and without steroids by using the Japanese Adverse Drug Event Report database.

Although the mechanism underlying flutamide- or bicalutamide-induced liver injury may be immune related, the details remain unclear. If this mechanism is immune related, steroid use may be considered as a treatment option. Disproportionality analysis was conducted to evaluate the effect of concomitant steroid use on flutamide- and bicalutamide-induced liver injury. Male patients aged 20years or older who were receiving nonsteroidal anti-androgens from April 2004 to October 2023 were screened from the Japanese Adverse Drug Event Report database. Data on liver injury, age, weight, height, steroid use, obesity, hepatic stenosis, alcohol-related hepatic disorders, hepatitis B and C, and common drugs known to cause drug-induced liver injury were analyzed. Liver injury was defined by the Standardized Medical Dictionary for Regulatory Activities query index (code 20000006, version 27.0). Among 142,430 patients, 2,316 were administered nonsteroidal anti-androgens. Reports of liver injury were disproportionate depending on the agents used (reporting odds ratio [ROR], 1.29; 95% confidence intervals [CI], 1.13-1.46), especially among flutamide or bicalutamide users (flutamide: ROR, 6.09; 95% CI, 4.51-8.23; bicalutamide: ROR, 1.24; 95% CI, 1.05-1.48). Multivariable logistic regression analysis correlated steroid use with a lower risk of flutamide- or bicalutamide-induced liver injury (flutamide: odds ratio, 0.07; 95% CI, 0.01-0.52; bicalutamide: odds ratio, 0.45; 95% CI, 0.21-0.96). Our findings suggest that flutamide and bicalutamide may increase the risk of liver injury compared to enzalutamide, apalutamide, and darolutamide. Furthermore, our study indicated that steroid use could aid in the management of liver injury.

Laboratory medicine and sports: where are we now?

Laboratory medicine in sport and exercise has significantly developed during the last decades with the awareness that physical activity contributes to improved health status, and is present in monitoring both professional and recreational athletes. Training and competitions can modify concentrations of a variety of laboratory parameters, so the accurate laboratory data interpretation includes controlled and known preanalytical and analytical variables to prevent misleading interpretations. The paper represents a comprehensive summary of the lectures presented during the 35th Annual Symposium of the Croatian Society of Medical Biochemistry and Laboratory Medicine. It describes management of frequent sport injuries and sums up current knowledge of selected areas in laboratory medicine and sports including biological variation, changes in biochemical parameters and glycemic status. Additionally, the paper polemicizes sex hormone disorders in sports, encourages and comments research in recreational sports and laboratory medicine. In order to give the wider view, the connection of legal training protocols as well as monitoring prohibited substances in training is also considered through the eyes of laboratory medicine.

Histomorphological effects of ß,Ɛ-Carotene-3,3’-diol on the liver following indomethacin-induced hepatotoxicity in adult male Wistar rats

Medicinal plants are globally used as food and in the management of different ailments based on their peculiar phytochemical contents. This study aimed to evaluate the histomorphological effects of ß,Ɛ-Carotene-3,3’-diol on the liver following indomethacin-induced hepatotoxicity in adult male Wistar rats. This is to determine the ameliorative effect of graded doses of ß,Ɛ-Carotene-3,3’-diol. A total of twenty-five adult Wistar rats were randomly divided into five groups (n=5). Liver injury was induced by oral administration of 20 mg/kg b.w of indomethacin after 24 hours fast to animals in groups B-E. Twenty four hours after the induction, animals in groups C-E were given different doses of ß,Ɛ-Carotene-3,3’-diol. At the end of the experimentation, the animals were sacrificed and the livers were collected and fixed for histopathological and histomorphological analyses. The results showed that indomethacin increased the activities of AST, ALT and ALP and also induced histopathological changes. Treatment with ß,Ɛ-Carotene-3,3’-diol was able to attenuate liver injury caused by indomethacin in a dose dependent manner as evidenced in the histoarchitectural changes. This was also corroborated by the histomorphometric analyses. In conclusion, the results suggested the positive influence of ß,Ɛ-Carotene-3,3’-diol in ameliorating liver injury caused by indomethacin and by extension, may be adopted in the management of liver related injury.

A global snapshot on health systems capacity for detection, monitoring, and management of acute kidney injury: A multinational study from the ISN-GKHA.

Acute kidney injury (AKI) is a significant cause of morbidity and mortality, especially in low and lower-middle income countries. Data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) were used to evaluate the organization of structures and services for the provision of AKI care in world countries and ISN regions. An international survey of key stakeholders (clinicians, policymakers, and patient advocates) from countries affiliated with the ISN was conducted from July to September 2022 to assess structures and services for AKI care across countries. Main findings of the study show that overall, 167 countries or jurisdictions participated in the survey, representing 97.4% of the world's population. Only 4% of countries had an AKI detection program based on national policy or guideline, and 50% of these countries used a reactive approach for AKI identification (i.e., cases managed as identified through clinical practice). Only 19% of national governments recognized AKI as a healthcare priority. Almost all countries (98% of the countries surveyed) reported capacity to provide acute hemodialysis (HD) for AKI, but in 31% of countries, peritoneal dialysis (PD) was unavailable for AKI. About half of all countries (44% of countries surveyed) provided acute dialysis (HD or PD) via public funding, but funding availability varied across ISN regions, including less than a quarter of countries in Oceania and South East Asia (17%) and Africa (24%) and highest availability in Western Europe (91%). Availability increased with the increasing country income level. Initiatives have been developed to propose and promote optimal care for AKI (including the ISN 0-by-25 initiative), but capacity for optimal AKI care remains low, particularly in low- and lower-middle-income countries. Concerted efforts by the global community are required to close these gaps, to improve AKI outcomes across the world.

Expect the unexpected: fulminant myocardial cytotoxic Injury from Trabectedin

BackgroundTrabectedin (Tbt) is an alkylating agent prescribed for soft tissue sarcomas after treatment failure of first line agents. While cardiomyopathy can occur with Tbt treatment after anthracycline exposure, Tbt-induced fulminant myocardial cytotoxic injury in the setting of other systemic cytotoxicity associated with Tbt has not been reported.Case presentation51-year-old female with hypertension, hyperlipidemia, metastatic leiomyosarcoma with progression of disease despite several lines of chemotherapy including doxorubicin-based therapy was started on Trabectedin (Tbt) 5 days prior to presentation with symptoms of fever, myalgias, arthralgias, and palpitations. She was admitted for management of rhabdomyolysis, acute kidney and liver injuries which were reportedly known to be associated with Tbt treatment. A baseline electrocardiogram (ECG) revealed sinus tachycardia with non-specific T-wave changes, and a transthoracic echocardiogram (TTE) was unremarkable. However, on day 3 of hospitalization, an episode of asymptomatic sustained monomorphic ventricular tachycardia with a heart rate of 150 beats per minute was captured on telemetry. A 12-lead ECG revealed new septal T-wave inversions. Labs revealed rising hs-TnI levels (peak at 37,933ng/L) and serum markers suggested multi-organ failure. Steroids were initiated given its role in treating multi-organ Tbt-induced toxicity. A cardiac MRI to rule out myocarditis and left heart catheterization to rule out obstructive coronary artery disease were forgone due to acute renal failure. A right heart catheterization with an endomyocardial biopsy was performed revealing normal cardiac filling pressures and indices. Pathology showed cytoplasmic vacuoles indicating drug-induced myocardial cytotoxicity. Serial echocardiograms revealed preserved biventricular function. The patient’s clinical condition deteriorated with multi-organ failure despite maximal supportive care in the intensive care unit. She ultimately passed away, and an autopsy was declined.ConclusionThis is the first reported case of fulminant myocardial injury after initiation of Tbt with histologic evidence of drug-induced myocardial cytotoxicity. While it is unclear if anthracyclines potentiate Tbt cytotoxic injury as in this case, it is plausible; and that Tbt-induced cardiotoxicity ranges from subclinical to fulminant. Given increasing use of Tbt in refractory high-grade sarcomas, raising awareness of its toxicity profile will improve early detection and outcomes.

High-energy blunt pelvic ring injuries and pre-hospital pelvic binder applications – A retrospective assessment based on a prospective registry

IntroductionApplication of a pelvic binder in the pre-hospital settings is a crucial step of high-energy blunt pelvic ring injury (PRI) management protocols. The aim of this retrospective cohort study was to evaluate the percentage of pre-hospital pelvic binder's applications in high-energy blunt type B or C PRI patients managed at a single level I trauma center, and to assess its impact on the medical resource requirements and patients' outcomes. MethodsThe institutional Severely Injured Patients’ Registry was screened for patients meeting the following inclusion criteria: (1) high-energy blunt PRI; (2) admission between 2014.01.01 and 2022.12.31; (3) age ≥16 years; and (4) available computed tomography of the pelvis. Exclusion criteria were: (1) death before admission; (2) low-energy injury; (3) penetrating, blast and electrical injuries; and (4) secondary transfers. Study variables, including pre-hospital application of a pelvic binder and demographic, clinical, management and outcome data were extracted from the registry. Additionally, AO/OTA classifications were determined. ResultsA consecutive series of 262 patients was included into the final analysis. Of these, 58.8 % received a pre-hospital pelvic binder (PPB), increasing from type A (45.1 %) to type B (57.8 %) and type C (73.7 %). Pre-hospital hemodynamic instability was a major factor triggering the use of PPB in high-energy blunt type B PRI patients with PPB in 76.9 % of the cases with hemodynamic instability vs. 51.3 % of the cases without hemodynamic instability (p = 0.009). This difference was not statistically significant for high-energy blunt type C PRI patients (82.8 % vs. 64.3 %, p = 0.200). The presence of a physician on the trauma site contributed to the increased percentage of PRI managed with PPB from 43.5 % to 67.3 % in type B PRI (p = 0.011), and from 50 % to 77.1 % in type C PRI (p = 0.257).This study showed an increased need for packed red blood cells (PRBC) transfusions in subgroups treated with PPB and no statistically significant differences in term of intensive care unit (ICU) and total hospital length of stay and complications between high-energy blunt type B or C PRI patients with or without PPB.Comparison of mortality rates in patients with and without PPB showed a trend towards lower mortality rates with PPB in patients with AIS extremity participating in at least 50 % of the total ISS. ConclusionIn the ideal pre-hospital scenario, every high-energy blunt type B or C PRI patient should be managed with a PPB. Continuous pre-hospital team training and information is crucial to achieve this goal. The preparation of Emergency Department and ICU who admit a patient with PPB should include a sufficient number of PRBC ready for transfusion. Mortality rates did not seem to be affected by PPB, except for a trend towards lower mortality rates in patients in whom their PRI was the major component of the global severity of their injury. This might point out the critical and positive effect of PPB in high-energy blunt PRI patients.

Community Nurses' Experiences Assessing Early-Stage Pressure Injuries in People With Dark Skin Tones: A Qualitative Descriptive Analysis.

To examine community nurses' experiences of caring for people with dark skin tones at high risk of developing a pressure injury. Qualitative descriptive design. Focus groups and individual semi-structured interviews were conducted among registered nurses working in the community between November 2023 and March 2024. Thematic analysis was used. The findings reveal the lack of nurse education on diverse skin tones, how community nurses gain knowledge on skin tone diversity in the context of pressure injuries and the topics community nurses believe are crucial to improve the management of pressure injuries in patients with dark skin tones. The study highlights the gap in nurse education regarding diverse skin tones, revealing how community nurses acquire knowledge related to pressure injuries in patients with dark skin tones. This research could inform the development of targeted educational programmes and training initiatives, ultimately preventing patient harm and enhancing the quality of care and health outcomes for patients with dark skin tones. It provides valuable insights into key topics that community nurses consider essential for improving the early recognition and management of pressure injuries in people with darker skin tones. The research adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. A project steering group contributed to the concept of the study and checked the interview questions were relevant and suitable.

Single-centre retrospective analysis: 16 cases of percutaneous nephrolithotripsy complicating hepatic puncture injury in a 7-year experience.

The aim of this retrospective analytical study was to investigate the diagnosis and management of liver puncture injuries caused by percutaneous nephrolithotripsy (PCNL). The clinical data of 1069 patients who underwent PCNL between Oct. 2017 and Apr. 2024 were analyzed. The diagnosis of liver puncture injury was confirmed by postoperative examination of three-dimensional reconstruction computed tomography (3D-CT) findings, and the data from these patients were statistically and retrospectively analyzed. A total of 16 cases were collected, including 9 males and 7 females, with an average age of 58.31 ± 14.30years, a mean body mass index (BMI) of 23.54 ± 3.88kg/m2. Liver puncture injury was identified and classified as tangential or penetrating according to the anatomy of the nephrostomy tube and liver. The average decrease in hemoglobin level after operation was 14.25 ± 11.97g/L. One patients received blood transfusions for preoperative anemia and postoperative blood loss, and all patients were cured and discharged after delaying the removal of nephrostomy tube under conservative treatment, the time of nephrostomy tube removal after a single PCNL procedure was 6.44 ± 1.26days. This article proposes a grading system for PCNL-complicated liver puncture injuries that will help physicians to better understand their characteristics and guide the development of management. In the absence of obvious signs of peritonitis and hemodynamic stability, conservative treatment of the liver puncture injury caused by PCNL is safe and effective.

Sirt4 Overexpression Modulates the JAK2/STAT3 and PI3K/AKT/mTOR Axes to Alleviate Sepsis-Induced Acute Lung Injury.

Sepsis-induced acute lung injury (ALI) is a severe organ dysfunction characterized by lung inflammation and apoptosis. The mechanisms underlying sepsis-induced ALI remain poorly understood. Here, we determined the effects of sirtuin 4 (SIRT4) on sepsis-induced ALI. Lipopolysaccharide (LPS)-induced injury cell and cecal ligation and puncture (CLP) animal models were established. Overexpression vectors and lentiviral transfections were used to upregulate SIRT4 expression. Lung cell apoptosis, inflammation, and the levels of associated factors were evaluated. Changes in the PI3K/AKT/mTOR and JAK2/STAT3 pathways were measured, and their potential involvement was examined using LY294002 (PI3K inhibitor), 740 Y-P (PI3K agonist), AG490 (JAK2 inhibitor), and coumermycin A1 (JAK2 agonist). Lower SIRT4 expression was observed in LPS-exposed A549 cells and CLP rats. In LPS-induced A549 cells, Sirt4 overexpression enhanced cell viability, resisted apoptosis, restored the expression of apoptosis-associated proteins (HMB1, cleaved CASP3, BAX, and BCL), and reduced the secretion of pro-inflammatory cytokines (IL-6, IL-1β, and TNF-α). In CLP rats, Sirt4 overexpression prolonged survival time, alleviated lung histopathological damage, reduced pulmonary edema, mitigated lung infection, decreased lung apoptosis, and lowered serum levels of inflammatory cytokines. Furthermore, Sirt4 overexpression blocked JAK2/STAT3/AKT/mTOR phosphorylation. 740 Y-P and coumermycin A1 reversed the protective effects of Sirt4 overexpression in LPS-treated A549 cells, resulting in decreased cell viability and increased apoptosis. LY294002 and AG490 enhanced the protective effects of Sirt4 overexpression in LPS-treated A549 cells. SIRT4 alleviates sepsis-induced ALI by inhibiting JAK2/STAT3/PI3K/AKT/mTOR signaling. Upregulating SIRT4 expression may serve as an innovative therapeutic approach for lung injury management in sepsis.

Internal Drainage: An Interim Alternative to External Biliary Fistula in the Management of Postcholecystectomy Bile Duct Injury

Internal Drainage: An Interim Alternative to External Biliary Fistula in the Management of Postcholecystectomy Bile Duct Injury

In situ photocrosslinkable hydrogel treats radiation-induced skin injury by ROS elimination and inflammation regulation

The clinical management of radiation-induced skin injury (RSI) poses a significant challenge, primarily due to the acute damage caused by an overabundance of reactive oxygen species (ROS) and the ongoing inflammatory microenvironment. Here, we designed a dual-network hydrogel composed of 5 % (w/v) Pluronic F127 diacrylate and 2 % (w/v) hyaluronic acid methacryloyl, termed the FH hydrogel. To confer antioxidant and anti-inflammation properties to the hydrogel, we incorporated PVP-modified Prussian blue nanoparticles (PPBs) and resveratrol (Res) to form PHF@Res hydrogels. PHF@Res hydrogels not only exhibited multiple free radical scavenging activities (DPPH, ABTS), but also displayed multiple enzyme-like activities (POD-, catalase). Meanwhile, PHF@Res-2 hydrogels significantly suppressed intracellular ROS and promoted the migration of fibroblasts in a high-oxidative stress environment. Moreover, in the RSI mouse model, the PHF@Res-2 hydrogel regulated inflammatory factors and collagen deposition, significantly reduced epithelial hyperplasia, promoted limb regeneration and neovascularization, and accelerated wound healing, outperforming the commercial antiradiation formulation, Kangfuxin. The PHF@Res-2 hydrogel dressing shows great potential in accelerating wound healing in RSI, offering tremendous promise for clinical wound management and regeneration.

Exosomes for the Management of Rotator Cuff Injuries: A Systematic Review

Exosomes for the Management of Rotator Cuff Injuries: A Systematic Review

Management of Multiligament Knee Injuries Using Anatomic Autograft Reconstructions: A Case Series.

While proven effective management of multiligament knee injury (MLKI) using allograft is often reported, it has shown an increased risk for graft failure compared with autograft and raises availability and cost issues. Osseous stock preservation and tunnel convergence avoidance led us to develop a compromise innovative surgical procedure using only ipsilateral autograft for anatomic reconstruction of Schenck III-L or higher MLKI. We report the description and early outcomes of our initial experience. Our strategy consisted of an anatomic single-bundle posterior cruciate ligament reconstruction with quadriceps tendon autograft and a "Versailles" reconstruction for the posterolateral corner, which we modified to reconstruct the anterolateral ligament in case of anteromedial rotatory instability, called "full lateral." A second-stage surgery was planned for anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft. Outcomes were Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores for functional status, Short Form 12 (SF-12) for quality of life, and visual analog scale (VAS) for pain. Complications, full weight-bearing, return to work, and sport were also computed. Between March 2019 and August 2020, 10 patients were included. At follow-up, light pain was found in nine patients with a mean VAS of 1.2 ± 2.16 during the day. The mean Lysholm, Tegner, and subjective IKDC scores were good, with 61.2 ± 20.6, 2.8 ± 2.1, and 52.6 ± 20.4, respectively. However, quality of life was altered with poor SF-12 scores. In our first 10 patients with Schenck III-L or higher MLKI, our procedure using only ipsilateral autograft enabled correct daily knee functional activities while preserving osseous stock.

Invasive devices to monitor the intraspinal perfusion pressure in the hemodynamic management of acute spinal cord injury: A systematic scoping review.

Various methods for measuring intrathecal pressure (ITP) after spinal cord injury (SCI) to guide hemodynamic management have been investigated. To synthesize the current literature, this current study conducted a scoping review of the use of intrathecal devices to monitor ITP during acute management of SCI with the aim of understanding the association between ITP monitoring with physiological and clinical outcomes. A systematic review of literature following the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. All eligible studies were screened for inclusion and exclusion criteria. Data extracted included number of patients included, severity of injury, characteristics of the intervention-intrathecal device used to record the ITP, outcomes -hemodynamic parameters observed, changes in the American Spinal Injury Association (ASIA) Impairment Scale (AIS), total motor scores, association of ITP with other physiological variables. The search yielded a total of 1,698 articles, of which 30 observational studies and 2 randomized clinical trials were deemed eligible based on their use of an intrathecal invasive device to monitor spinal cord perfusion pressure (SCPP) in patients with SCI. Of these, 9 studies used a lumbar drain, 23 a Codman pressure probe and 1 study that used both. These studies underscore the crucial interplay between ITP, the SCPP and physiological variables, with neurological outcome. It is still unclear whether monitoring from a lumbar drain is accurate enough to highlight what is occurring at the site of SCI, which is the main advantage of Codman Probe, however, the latter requires specialized personnel that may not be available in most settings. Minor adverse effects were associated with lumbar drain catheters, while cerebrospinal fluid leak requiring repair (~ 7%) is the main concern with Codman Probes. Future investigation of SCPP protocols via lumbar drains and Codman probes ought to involve multi-centered randomized controlled trials and continued translational investigation with animal models.

Detecting Patient Position Using Bed-Reaction Forces for Pressure Injury Prevention and Management

A key best practice to prevent and treat pressure injuries (PIs) is to ensure at-risk individuals are repositioned regularly. Our team designed a non-contact position detection system that predicts an individual’s position in bed using data from load cells under the bed legs. The system was originally designed to predict the individual’s position as left-side lying, right-side lying, or supine. Our previous work suggested that a higher precision for detecting position (classifying more than three positions) may be needed to determine whether key bony prominences on the pelvis at high risk of PIs have been off-loaded. The objective of this study was to determine the impact of categorizing participant position with higher precision using the system prediction F1 score. Data from 18 participants was collected from four load cells placed under the bed legs and a pelvis-mounted inertial measurement unit while the participants assumed 21 positions. The data was used to train classifiers to predict the participants’ transverse pelvic angle using three different position bin sizes (45°, ~30°, and 15°). A leave-one-participant-out cross validation approach was used to evaluate classifier performance for each bin size. Results indicated that our prediction F1 score dropped as the position category precision was increased.

Single Institution Experience with Lumbar Drainage and Subarachnoid Hemorrhage

In our paper, we evaluate the effect of lumbar drainage on delayed cerebral ischemia and requirements for permanent cerebrospinal fluid diversion in patients with aneurysmal subarachnoid hemorrhage. We performed a retrospective cohort study from 2014-2023 at the University of Arkansas for Medical Sciences (UAMS) examining factors associated with patients (n=150) who had aneurysmal subarachnoid hemorrhage and a lumbar drain placed. Main outcomes examined were incidence of delayed cerebral ischemia, need for permanent cerebrospinal fluid diversion, and neurologic outcomes at discharge that were compared to currently published standards. We failed to appreciate a reduced occurrence of delayed cerebral ischemia (37.3% with the current literature supporting rates of 20-30%); however, we did find a low rate of requiring permanent cerebrospinal fluid diversion (12% compared to 10-20% in the current literature) with overall good neurologic outcomes at discharge (~69% of patients had a Glasgow Outcome Scale (GOS) of 4-5 at discharge). Patients with GOS≥4 at discharge were noted to be more likely to have more days or lumbar drainage and less likely to be older than 65, have had an external ventricular drain placed, and have experienced delayed cerebral ischemia. Lumbar drainage is a potentially useful adjunct in the management of secondary neurologic injury in subarachnoid hemorrhage.