Injury Patterns Research Articles

Patterns of anatomical injury and anaesthesia procedures in wounded Ukrainian soldiers from Anti-Terrorist Operation/Operation Joint Forces: 2014–2021

IntroductionThe study aims to analyse the causes and anatomical patterns of explosive and gunshot wounds in Ukrainian soldiers acquired during the Anti-Terrorist Operation/Operation Joint Forces. We also investigated how general...

Fish behavior at the horizontal screen of a novel shaft hydropower plant

AbstractPreventing fish entrainment during their downstream passage at hydropower plants remains a major challenge in reducing the ecological impacts of hydropower production. We investigated fish behavior at the world's first innovative shaft hydropower plant with its novel screen concept, aiming at reducing fish entrainment due to the fully horizontal arrangement of the screen and low vertical suction effects toward the turbine. Based on ARIS sonar recordings, we assessed whether fish could move unhindered across the turbine intake area toward the bypass corridors at the sluice gate for safe downstream passage. For a range of species (Anguilla anguilla, Barbus barbus, Thymallus thymallus, Salmo trutta, and Hucho hucho) and operation modes (high/low turbine load), we assessed behavioral patterns such as screen avoidance, dwelling behavior, and search behavior at the screen. Contrary to the engineers' expectations, the innovative screen arrangement neither guided the fish away from the turbine intake to the bypass corridors nor prevented them from swimming vertically into the turbine shaft. Rather, fish freely moved near the screen and avoidance behavior was only rarely observed. Both the dwelling and active search behavior, which was particularly evident in eel, are directly linked to an increased risk of screen passage and subsequent turbine‐related death or injuries. Our findings illustrate that consideration of fish behavior at turbine inlet structures is a crucial component which needs to be integrated with other variables such as fish mortality and injury patterns for a comprehensive evaluation and improvement of fish passage at hydropower plants.

A Holocene history of climate, fire, landscape evolution, and human activity in northeastern Iceland

Abstract. Paleoclimate reconstructions across Iceland provide a template for past changes in climate across the northern North Atlantic, a crucial region due to its position relative to the global northward heat transport system and its vulnerability to climate change. The roles of orbitally driven summer cooling, volcanism, and human impact as triggers of local environmental changes in the Holocene of Iceland remain debated. While there are indications that human impact may have reduced environmental resilience during late Holocene summer cooling, it is still difficult to resolve to what extent human and natural factors affected Iceland's late Holocene landscape instability. Here, we present a continuous Holocene fire record of northeastern Iceland from proxies archived in Stóra Viðarvatn sediment. We use pyrogenic polycyclic aromatic hydrocarbons (pyroPAHs) to trace shifts in fire regimes, paired with continuous biomarker and bulk geochemical records of soil erosion, lake productivity, and human presence. The molecular composition of pyroPAHs and a wind pattern reconstruction indicate a naturally driven fire signal that is mostly regional. Generally low fire frequency during most of the Holocene significantly increased at 3 ka and again after 1.5 ka BP before known human settlement in Iceland. We propose that shifts in vegetation type caused by cooling summers over the past 3 kyr, in addition to changes in atmospheric circulation, such as shifts in North Atlantic Oscillation (NAO) regime, led to increased aridity and biomass flammability. Our results show no evidence of faecal biomarkers associated with human activity during or after human colonisation in the 9th century CE. Instead, faecal biomarkers follow the pattern described by erosional proxies, pointing toward a negligible human presence and/or a diluted signal in the lake's catchment. However, low post-colonisation levels of pyroPAHs, in contrast to an increasing flux of erosional bulk proxies, suggest that farming and animal husbandry may have suppressed fire frequency by reducing the spread and flammability of fire-prone vegetation (e.g. heathlands). Overall, our results describe a fire frequency heavily influenced by long-term changes in climate through the Holocene. They also suggest that human colonisation had contrasting effects on the local environment by lowering its resilience to soil erosion while increasing its resilience to fire.

Golf cart injuries have similar severity to all-terrain vehicle injuries in children: a multicenter comparison over a 5-year period

BackgroundGolf carts (GCs) and all-terrain vehicles (ATVs) are popular forms of personal transport. Although ATVs are considered adventurous and dangerous, GCs are perceived to be safer. Anecdotal experience suggests increasing...

The burden of periprosthetic femoral fractures in England and Wales: Insights from the first two years of data collection in the National Hip Fracture Database and regional variation in care

IntroductionPeriprosthetic femoral fractures (PPFFs) represent an important healthcare problem, with a rising incidence noted due to an increase in the number of arthroplasty surgeries being performed. There is a current lack of national consensus as to how these complex, often frail patients are managed. AimsOur primary aim was to present the epidemiology of PPFFs in England and Wales over the first two years of data collection by the National Hip Fracture Database (NHFD). Secondary aims included how well the NHFD Key Performance Indicators (KPIs) are met for PPFF patients, whether centres reporting a higher burden of PPFF patients are more likely to meet KPIs compared to lower volume centres, and to also identify if regional variation in care for these patients exist. MethodsPatients aged 60 years or over, admitted to any acute hospital in England or Wales with a PPFF within the period 1st January 2020 to 31st December 2021 were included. Fractures were classified using the Vancouver system. The primary outcome of interest was the incidence of PPFF in England and Wales. Secondary outcomes included i) geographical distribution, ii) pattern of injury, iii) treatment received, iv) KPI performance nationally, v) KPI performance by top 5 highest volume hospitals vs the rest, vi) KPI performance by region and vii) KPI performance compared with native hip fracture patients. ResultsA total of 5,566 PPFFs were reported during our study period. A 31 % increase in cases was seen between 2020 and 2021 (2,405 to 3,161). The South-West of England reported the highest burden of PPFFs (14 % of all cases reported in 2021). Vancouver B subtypes were most common around hip replacements (62 %) and C subtype around knee replacements (55 %). A total of 4,598 patients (82.6 %) underwent operative management. There was regional variation in KPI attainment. When compared to KPI attainment for native hip fractures PPFF care under performed in most regions and domains. High volume PPFF centres were not associated with improved attainment of KPIs. ConclusionWe have described the incidence, nature, and management of PPFF at national and regional levels using routinely collected NHFD data. Both numerically and due to case complexity, PPFF are a considerable challenge to patients and health services alike. This epidemiology is not captured by other existing datasets and increased case contribution to the NHFD is encouraged to improve understanding and enable prioritisation and delivery of further care and research.

Follow-up biopsies in gastrointestinal immune checkpoint inhibitor toxicity may show markedly different inflammatory patterns than initial injury

Colitis is a common manifestation of immune checkpoint inhibitor (ICI) toxicity and can present with varied histologic patterns of inflammation, some of which have been shown to be associated with specific ICI drug types. Although the histologic features of ICI colitis seen at the time of diagnosis have been described, there have been few reports following these patients over time. We evaluated initial and follow-up biopsies in 30 patients with ICI colitis and found that 37% of patients developed a different pattern of injury on follow-up biopsy compared to the initial biopsy. Patients with a different inflammatory pattern were more likely to have restarted ICI therapy before their follow-up biopsy (64%) compared to those without a change in inflammatory pattern (11%; P < 0.01). The majority of these patients had changed ICI drug types (86%). Additionally, many cases changed to an inflammatory bowel disease (IBD)-like pattern (36%), raising a question of de novo IBD. However, all of our patients with an IBD-like pattern experienced sustained resolution of symptoms without steroids or other immunosuppressive medications following discontinuation of ICI therapy, consistent with a diagnosis of ICI toxicity. Our findings suggest that follow-up biopsies in patients with ICI colitis may show a different histology and that this does not necessarily warrant a change in the histologic diagnosis to another disease.

Obesity and Penetrating Trauma: Outcomes from a Level 1 Trauma Center in New York City.

Obesity is associated with increased morbidity and mortality in trauma scenarios; however, there has been conflicting evidence on outcomes of obesity and penetrating injuries, specifically gunshot wounds and stab wounds. We hypothesized that obesity may be protective due to a "cushioning effect" attributed to increased adiposity. This was a retrospective cohort study of patients presenting to a Level 1 Trauma Center with a penetrating trauma (gunshot/stab) injury during 2008-2021. Patients with a BMI ≥ 30 were compared to those with a BMI < 30. The primary outcome was Injury Severity Score (ISS). Secondary outcomes included intensive care unit (ICU) length of stay, days on ventilation, length of hospital stay, service of admission (trauma surgery, general surgery, discharged home, general medical floor), the body region of injury(s), Abbreviated Injury Scale (AIS), OR requirement, type of surgery, and discharge status. Statistical analysis was performed using χ2-test or Fisher's exact tests for categorical data, and Student's t-test or Mann-Whitney U-test for continuous variables with p < 0.05 as statistically significant. Subgroup analysis was performed based on the mechanism of injury. There were 721 patients that met inclusion criteria, of which 540 were classified in the non-obese group and 181 (25.1%) in the obese group. The primary outcome, mean ISS score, in obese patients (9.0, SD = 13.0) and non-obese patients (9.4, SD = 13.8) was similar between groups respectively. Secondary outcomes, which included rates of severe abdominal injury (AIS ≥ 3), rates of intra-abdominal organ injury, and rates of gastro-intestinal resection, were also similar between non-obese and obese patients. This study did not demonstrate the existence of a "cushioning effect" in the setting of penetrating traumatic injury. Patients with increased BMI had similar a ISS score and patterns of injury as their non-obese counterparts.

Epidemiological Data of Patients Consulted to Physical Therapy Clinic in the 2023 Kahramanmaraş Earthquake

On February 6, 2023, 7.8-magnitude earthquake occurred in Kahramanmaraş, Türkiye. This earthquake was one of the most devastating disasters to hit Türkiye, resulting in an official death count of over 45,000. In this study, we aimed to determine the injury patterns of the patients who were consulted to the physical therapy and rehabilitation clinic after the Kahramanmaraş earthquake, and to ensure that their physicians were better prepared for possible earthquakes. Our study was completed between February and June 2023. All patients, male and female, who had earthquake-related injuries and were consulted to the physical therapy unit were included. Discharged patients were screened retrospectively. Inpatients were investigated prospectively. A total of 220 patients were included in the study. The patients were examined in terms of age, gender, date of application, pain score, time under the dent, complaint at admission, additional disease, type of injury, and treatment applied. Statistical analyzes were performed using SPSS version 22.0 software. The most frequently affected age group was 15-30 years old. The most common complaints were pain, limitation of movement and difficulty in walking. The most common surgical procedures are fasciotomy, internal fixation, and amputation. The most commonly injured limbs are the lower extremities. The most common level of amputation was transtibial amputation. After the earthquake, patients need physical therapy and rehabilitation. The knowledge and experience of the physicians of the relevant branches about the frequently observed injury patterns should be increased. This study is generally in line with most other studies reporting the epidemiology of injury after earthquakes. However, there is no standardization among the studies. Therefore, standardization in reporting earthquake injuries is necessary for evidence-based response policy planning after natural disasters.

Mining Injuries 2012-2019: Using Workers' Compensation Claims Data From 35 States to Identify Rates and Costs Associated by Nature of Injury, Event/Exposure, and Body Part Affected.

This study summarized the frequency and cost of mining-related injuries. Mining-related workers' compensation (WC) claims data from 35 states were summarized to report counts, claim rates, and costs for 2012-2019. These data were compared with Mine Safety and Health Administration injury and employment data for the same period. Despite system differences, both WC and Mine Safety and Health Administration counts and rates declined over time and injury patterns were similar. Total WC costs were approximately $2.325B. Medical-only claims represented 59.4% of the claims by count, but only 3.3% of costs. Lost-time nonfatal claims represented 40.2% of the claims by count, but 90.2% of costs. Claims frequency and costs varied greatly by injury event/exposure, part of body, and nature. Injury frequency has declined but costs remain high. The most costly and disabling cases were identified.

Interaction with the Extratropics as a New Hypothesis for the Spectral Peak of the Madden–Julian Oscillation

Abstract The Madden–Julian oscillation (MJO) propagates eastward as a disturbance of mostly zonal wind and precipitation along the equator. The initial diagnosis of the MJO spectral peak at 40–50-day periods suggests a reduction in amplitude associated with slower MJO events that occur at lower frequencies. If events on the low-frequency side of the spectral peak continued to grow in amplitude with reduced phase speed, the spectrum would just be red. Wavelet regression analysis of slow and fast eastward-propagating MJO signals during northern winter assesses how associated moisture and wind patterns could explain why slow MJO events achieve lower amplitude in tracers of moist convection. Results suggest that slow MJO events favor a ridge anomaly over Europe, which drives cool dry air equatorward over Africa and Arabia as the active convection develops over the Indian Ocean. We hypothesize that dry air tracing back to this source, together with a longer duration of the events, leads to associated convection diminishing along the equator and instead concentrating in the Rossby gyres off the equator. Significance Statement The Madden–Julian oscillation (MJO) dominates the subseasonal variability of the tropical atmosphere. This work suggests that it favors maximum convective activity in the 40–50-day period range because lower-frequency MJO signals tend to import more cool dry air from the extratropics and along the equator, thereby weakening the slower events.

Pathogenic Mechanisms of Diabetic Neuropathy

Diabetes stands as the predominant cause of peripheral neuropathy, and diabetic neuropathy (DN) is an early-onset and most frequent complication of diabetes. Distal symmetric polyneuropathy is the major form of DN; however, various patterns of nerve injury can manifest. Growing evidence suggests that hyperglycemia-related metabolic disorders in neurons, Schwann cells, and vascular endothelial cells play a major role in the development and progression of DN; however, its pathogenesis and development of disease-modifying therapies warrant further investigation. Herein, recent studies regarding the possible pathogenic factors of DN (polyol and other collateral glycolysis pathways, glycation, oxidative stress, Rho/Rho kinase signaling pathways, etc.) and therapeutic strategies targeting these factors are introduced.

Cerebellar Mutism Syndrome and Dentato-Thalamo-Cortical Tract Disruption in Diffusion Tractography Following Surgery for Medulloblastoma.

Background Cerebellar mutism syndrome (CMS), a complication following medulloblastoma surgery, has been linked to dentato-thalamo-cortical tract (DTCT) injury; the association of the degree of DTCT injury with severity of CMS-related symptoms has not been investigated. Purpose To investigate the association between severity of CMS-related symptoms and degree and patterns of DTCT injury with use of diffusion tensor imaging (DTI), and if laterality of injury influences neurologic symptoms. Materials and Methods This retrospective case-control study used prospectively collected clinical and DTI data on patients with medulloblastoma enrolled in a clinical trial (between July 2016 and February 2020) and healthy controls (between April and November 2017), matched with the age range of the participants with medulloblastoma. CMS was divided into types 1 (CMS1) and 2 (CMS2). Multivariable logistic regression was used to investigate the relationship between CMS likelihood and DTCT injury. Results Overall, 82 participants with medulloblastoma (mean age, 11.0 years ± 5.2 [SD]; 53 male) and 35 healthy controls (mean age, 18.0 years ± 3.06; 18 female) were included. In participants with medulloblastoma, DTCT was absent bilaterally (AB), absent on the right side (AR), absent on the left side (AL), or present bilaterally (PB), while it was PB in all healthy controls. Odds of having CMS were associated with higher degree of DTCT damage (AB, odds ratio = 272.7 [95% CI: 269.68, 275.75; P < .001]; AR, odds ratio = 14.40 [95% CI: 2.84, 101.48; P < .001]; and AL, odds ratio = 8.55 [95% CI: 1.15, 74.14; P < .001). Left (coefficient = -0.07, χ2 = 12.4, P < .001) and right (coefficient = -0.15, χ2 = 33.82, P < .001) DTCT volumes were negatively associated with the odds of CMS. More participants with medulloblastoma with AB showed CMS1; unilateral DTCT absence prevailed in CMS2. Lower DTCT volumes correlated with more severe ataxia. Unilateral DTCT injury caused ipsilateral dysmetria; AB caused symmetric dysmetria. PB indicated better neurologic outcome. Conclusion The severity of CMS-associated mutism, ataxia, and dysmetria was associated with DTCT damage severity. DTCT damage patterns differed between CMS1 and CMS2. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Dorigatti Soldatelli and Ertl-Wagner in this issue.

Management of Pediatric Supination-inversion Ankle Injuries Involving Distal Tibia and Intraepiphyseal Distal Fibula Fractures.

Pediatric ankle fractures are prevalent injuries that make up a notable portion of all periphyseal injuries. The Salter-Harris classification is the most popular classification about physeal and periepiphyseal injuries. Ogden expanded on this and described type 7 fractures which are completely intraepiphyseal and include propagation of the fracture from the articular surface through the epiphyseal cartilage and do not involve the physis. These injuries are common about the distal fibula in pediatric patients with supination-inversion type injuries. There are no specific guidelines or recommendations on treatment of these injuries in the literature. We present three cases of this injury pattern and describe our chosen management that leads each patient to full, painless ankle range of motion and return to all prior activities and sports without complication. Supination-inversion type pediatric ankle fractures are common injuries that all orthopaedic surgeons will encounter at some point throughout their practice or training. Recognizing fracture variants and understanding treatment options of pediatric ankle fractures are important for the orthopaedic community as a whole.

Risk factors related to significant hepatic inflammation in patients with acute drug-induced liver injury

Background and aimsCurrently, research on biopsy-proven acute drug-induced liver injury (DILI) remains limited. This study aimed to identify clinical characteristics and risk factors for significant hepatic inflammation in patients with acute DILI. MethodsAn ambispective cohort study was conducted on biopsy-proven acute DILI patients admitted to our hospital from 2012 to 2018. Using the Scheuer scoring system, patients were categorized into G0-2 or G3-4 groups and followed up for 12 months after first admission. Clinical characteristics and outcomes were retrieved from medical records. ResultsThe median age of the 157 enrolled patients (65.6% female) was 40.4 (interquartile range (IQR), 31.9–49.1) years. The median latency and length of hospitalization were 30.0 (IQR, 5.0–60.0) and 18.0 (IQR, 12.0–26.0) days. The proportions of patients in the G0-2 and G3-4 groups were 54.8% and 45.2%, respectively. Logistic regression analysis revealed that females (odds ratio (OR): 2.623, 95% confidence interval (CI): 1.169–5.887, p = 0.019), higher body mass index (OR: 1.168, 95% CI: 1.029–1.325, p = 0.016), higher total bilirubin (OR: 1.004, 95% CI: 1.000–1.007, p = 0.047), and lower prothrombin activity (OR: 0.976, 95% CI: 0,957–0.995, p = 0.013) were associated with significant hepatic inflammation. The predominance of the hepatocellular injury pattern (60.5%) at admission transformed into a predominance of the cholestatic pattern (60.5%) at discharge. During follow-up, 23 patients (14.6%) developed chronic DILI, with nine patients (5.7%) progressing to cirrhosis. Moreover, 15 female patients (9.6%) developed autoimmunity (3cases in the G0-2 group vs 12 cases in the G3-4 group, p < 0.05). ConclusionAcute DILI patients with high-risk factors were more likely to develop significant hepatic inflammation, and females with significant inflammation were at a higher risk of developing autoimmunity during follow-up.

Current US prevalence of myocardial injury patterns and clinical outcomes among hospitalised patients with familial hypercholesterolaemia: insight from the National Inpatient Sample—a retrospective cohort study

BackgroundFamilial hypercholesterolaemia (FH) increases propensity for premature atherosclerotic disease. Knowledge of inpatient outcomes among patients with FH admitted with acute myocardial injury (AMI) is limited.ObjectivesOur study aimed to identify myocardial...

Investigating the effectiveness of a mobile wind turbine generating electricity from vehicle air movement

This study presents an evaluation of the effectiveness of a portable wind generator designed to harness wind flow generated by moving vehicles for electricity production. With a growing emphasis on renewable energy sources and the need for sustainable power solutions, innovative approaches such as utilizing vehicle-induced wind currents have gained attention. The portable wind generator under examination is engineered to capture airflow from passing vehicles and convert it into electrical energy. Through a combination of field experiments and theoretical analysis, the performance and efficiency of the device were assessed under various environmental and traffic conditions. Factors such as wind speed, direction, and vehicle velocity were considered in the evaluation process. The results indicate promising potential for the portable wind generator as a supplementary power source, particularly in environments with high vehicular traffic. However, challenges such as variability in wind patterns and optimal positioning of the generator remain areas for further investigation and refinement. Overall, this study contributes to the understanding of utilizing unconventional wind resources and provides insights into the practical implementation of mobile wind energy technology for sustainable electricity generation.

An Uncommon Cause of Elevated Liver Transaminases: Immune Reconstitution Inflammatory Syndrome from Unmasking of Occult Mycobacterium Avium Complex Infection in an HIV Infected Patient

Abnormal liver chemistry from the development of immune reconstitution inflammatory syndrome (IRIS) may reflect an unmasking of subclinical disease. We present the case of a 37-year-old female with a mixed pattern of liver injury from disseminated mycobacterium avium complex infection after starting antiretroviral therapy (ART). Presenting symptoms were fever, confusion, dysphagia, and abdominal discomfort for one week. Exam revealed a fever of 103.2°F, hypotension, encephalopathy, and abdominal tenderness. Lab work was significant for acute normocytic anemia, leukopenia, absolute CD4 count 28 cells/cmm, HIV viral load 276 viral copies/ml (vc/ml), ALT 267 U/L, AST 484 U/L, alkaline phosphatase 342 U/L, and normal total bilirubin. Imaging revealed hepatomegaly with steatosis and mesenteric and retroperitoneal lymphadenopathy. Percutaneous liver biopsy demonstrated noncaseating granulomas with AFB-positive organisms, with AFB blood cultures growing Mycobacterium avium complex (MAC), consistent with disseminated MAC infection. Clinicians must have a high index of suspicion for IRIS when determining the etiology of elevated liver transaminases in patients with HIV.

Four distinct patterns of anterior cruciate ligament injury in women’s professional football (soccer): a systematic video analysis of 37 match injuries

BackgroundTo identify mechanisms and patterns of anterior cruciate ligament (ACL) injury in adult women’s professional football by means of video match analysis.MethodsACL match injuries sustained in Germany’s first women’s league...

Tibial tuberosity fracture in adult as an unusual pattern of injury

Tibial tuberosity avulsion is an uncommon fracture in adults, such lesions typically seen in adolescent male with well-developed quadriceps, ligaments when they are stronger than growth plate. We described a case of 51-year-old gentlemen had direct trauma to left knee, no risk factors were identified, not able to walk, difficulty in straight leg raise test, radiograph of left knee showed tibial tuberosity avulsion fracture. The fracture was treated with open reduction and internal fixation, f/u with successful rehabilitation which results in good range of motion and excellent function at knee joint. The aim of study is present unusual and rare case of tibial tuberosity Avulsion fracture in adult, early diagnosis, surgical mode of treatment, post-surgery rehabilitation and possible complications.

Post-lockdown burden of road injury involving hospitalisation in Victoria, Australia: A statewide, population-based time series analysis.

Ever since COVID-19, short-term changes in transport injury patterns have been observed. The aim is to examine both the initial and the enduring impact of government lockdown and the pandemic on road injuries requiring hospitalisation and road fatalities. Time series analysis of Transport Accident Commission (TAC) claims involving hospitalisation and fatalities in Victoria, Australia, from July 2016 to May 2023, including lockdown (March 2020 to October 2020) and post-lockdown (November 2020 onwards). A total of 46 450 TAC claims were included. Average claims during the pre-pandemic period were 652/month. Lockdown restrictions were associated with a statistically significant fall in monthly claims (-255, 95% confidence interval [CI] = -315 to -194, P < 0.01). This was consistent across road users, days of the week, hours of the day, injury severity, sex and central versus rural locations. The post-lockdown period had a statistically significant reduction in monthly claims to 76% (95% CI = 67-84) of pre-pandemic levels (-158, 95% CI = -213 to -102, P <0.01). This was consistent across all subgroups except bicyclist injuries, which remained constant (-8, 95% CI = -16 to 0, P = 0.05). There was a significant upward trend in the fatality-to-claim ratio post-lockdown (0.001, 95% CI = 0-0.001, P <0.01). Road injury requiring hospitalisation decreased significantly during governmental lockdown and has returned to three-quarters of pre-pandemic levels (except bicyclist injuries that have remained constant), but there is an increasingly disproportionate number of fatalities. This represents a new baseline of injury burden for EDs and hospitals that manage trauma patients.