Level Of Injury Research Articles

Behavior and damage potential of the newly emerged pest Myochrous armatus (Chrysomelidae: Eumolpinae) on soybean plants in Brazil

AbstractMyochrous armatus Baly, 1865 (Coleoptera: Chrysomelidae) has expanded its occurrence significantly into soybean‐growing areas of Brazilian Cerrado and became an important early‐season soil pest. Experiments were performed under field conditions from 2020 to 2023 to assess several aspects: (1) population behaviour over crop season and offseason; (2) day/night behaviour during the early stages of soybean plants and (3) injury to plants and potential damage to soybean yield to establish the Economic Injury Level (EIL). Adults of the M. armatus population presented a season‐long abundance during the specific period from late October to January, with major captures in November and December (end of Spring), either inside or on the edge of soybean fields. Weeds and volunteer plants of corn and cotton hosts adults and eggs. These findings suggest an univoltine life cycle. Behavioural assessments revealed that M. armatus does not exhibit a specific day, night or crepuscular behaviour, performing deeds at any time. The majority of insects (40% to 70%) were found in the soil throughout the day and night. Adults feed on soybean plants by scraping or cutting the stem, cotyledon, petiole and apical sprouting. Their preference is initially for the stem and cotyledon (up to 14 days after emergence), and later for the petiole (after 21 days of emergence). After 7 days of coexistence at V1‐V3 soybean stages, we observed a potential yield reduction of 35% for each insect per plant. Dynamic EIL estimations are between 0.4 and 1.9 adults per row metre, depending on the grower productivity expectation, control costs and soybean market value. Our results are fundamental for establishing Integrated Pest Management for M. armatus in soybean and other crop systems.

Safety improvement in open-pit mines with challenging mining conditions through upgrading avalanche prevention measures

One of the most common problems mining companies face in developing open-cut deposits in complicated geological and climatic conditions is avalanches during the spring-winter work period. This phenomenon is accompanied by a rapid displacement of snow masses, which can lead to catastrophic consequences. In this regard, the article aims to develop a modernized set of measures for avalanche protection. Prevention of avalanches of catastrophic scale, leading to blockages, road closures, and accidents, and the introduction of measures to reduce accidents and injuries in quarries and dumps, is a time-consuming task that requires serious approaches to its solution. The main research method is analyzing the applied anti-avalanche measures for active impact on snow cover and considering the possibility of using safer methods for active impact on avalanches at a particular mining enterprise. This approach allows for the evaluation of the advantages and disadvantages of the avalanche measures used and for choosing a set of measures to ensure more effective avalanche protection. The authors analyzed the existing shortcomings in the regulatory documents related to the provision of avalanche protection and anti-avalanche measures. It was found that they are not able to effectively ensure the development of internal local documents of enterprises in the field of anti-avalanche measures at the present stage. The resulting study showed that a comprehensive solution to the problem is needed through the introduction of several anti-avalanche devices to reduce the likelihood of avalanches of catastrophic scale. For the first time, the authors attempted to justify the possibility of using a modernized set of measures for the preliminary descent of snow avalanches to solve the problem of avalanche protection in the conditions of a real mountain object. The results obtained can be used to reduce the level of occupational injuries by reducing or eliminating accidents associated with unforeseen avalanches during the operation of an existing quarry.

Recommendations on the management and prevention of spinal cord injury in children following backbend dance

Spinal cord injury (SCI) is a kind of disease that indiscriminately affects all age groups, although the number of SCI cases in children is far lower than that in adults. In this paper, we discuss the appropriate diagnostic methods and prevention methods for SCI caused by repetitive hyperextension movement. Case study reports available in the published literature concerning SCI due to hyperextension movement, which were categorized using the American Spinal Injury Association (ASIA) grades, were gathered. Moreover, the age, gender, lesion length on magnetic resonance image (MRI), time of symptoms appearance, initial spinal cord atrophy region, neurological level of injury, and initial and final ASIA grades were analyzed. A total of 144 cases with SCI after backbend dance were included in our analysis, with some cases with an incubation period ranging between 15 min and 4 h showing no symptoms. Most of the collected cases were young girls of <11 years old. Early MRI showed that the pathological changes had extended toward cephalocaudal regions. In summation, the number of SCI cases, which are disabling for many children, is rapidly accumulating in China. Thus, SCI following repetitive hyperextension movements requires further research.

Erythrocyte membrane biomimetic EGCG nanoparticles attenuate renal injury induced by diquat through the NF-κB/NLRP3 inflammasome pathway.

Diquat (DQ) poisoning can cause multiple organ damage, and the kidney is considered to be the main target organ. Increasing evidence shows that alleviating oxidative stress and inflammatory response has promising application prospects. Epigallocatechin gallate (EGCG) has potent antioxidant and anti-inflammatory effects. In this study, red blood cell membrane (RBCm)-camouflaged polylactic-co-glycolic acid (PLGA) nanoparticles (NPs) were synthesized to deliver EGCG (EGCG-RBCm/NPs) for renal injury induced by DQ. Human renal tubular epithelial cells (HK-2 cells) were stimulated with 600μM DQ for 12h and mice were intraperitoneally injected with 50mg/kg b.w. DQ, followed by 20mg/kg b.w./day EGCG or EGCG-RBCM/NPs for 3days. The assessment of cellular vitality was carried out using the CCK-8 assay, while the quantification of reactive oxygen species (ROS) was performed through ROS specific probes. Apoptosis analysis was conducted by both flow cytometry and TUNEL staining methods. Pathological changes in renal tissue were observed. The expressions of NLRP3, IL-1β, IL-18, NFκB and Caspase1 were detected by quantitative reverse transcription polymerase chain reaction (qRT-PCR), immunohistochemistry, immunofluorescence, and Western blot. The results showed that the DQ group had increased ROS expression, increased the level of oxidative stress, and increased apoptosis rate compared with the control group. Histopathological analysis of mice in the DQ group showed renal tubular injury and elevated levels of blood urea nitrogen (BUN), serum creatinine (SCr), kidney injury molecule-1 (KIM-1), and cystatin C (Cys C). Furthermore, the DQ group exhibited heightened expression of NLRP3, p-NFκB p65, Caspase1 p20, IL-1β, and IL-18. However, EGCG-RBCm/NPs treatment mitigated DQ-induced increases in ROS, apoptosis, and oxidative stress, as well as renal toxicity and decreases in renal biomarker levels. Meanwhile, the expression of the above proteins were significantly decreased, and the survival rate of mice was ultimately improved, with an effect better than that of the EGCG treatment group. In conclusion, EGCG-RBCm/NPs can improve oxidative stress, inflammation, and apoptosis induced by DQ. This effect is related to the NF-κB/NLRP3 inflammasome pathway. Overall, this study provides a new approach for treating renal injury induced by DQ.

Reduction of occupational injuries as a way to solve the problem of the shortage of personnel to reduce risks in the energy industry

Energy security is a priority area of economic development and an important component of the state's national security. Among the internal threats to energy security, experts point to market defects, equipment degradation and backwardness of technologies, imperfect management, personnel problems, and others. One of the reasons for the shortage of qualified personnel is industrial injuries. In the work, a comparative analysis of data for the period from 2015 to 2023 was carried out regarding the level of industrial injuries in various sectors of the economy and the causes of accidents. The fact of a sharp increase in the total number of insurance accidents in 2021–2022 was established only in two sectors - the sphere of health care and the sphere of electricity and gas supply. In other sectors of the economy, the number of industrial injuries decreased compared to 2015. The largest number of accidents with fatal consequences in the energy industry is caused by electrocution of personnel during maintenance and repair of electrical installations. As the conducted studies have shown, in recent years the number of accidents has increased significantly not only due to man-made reasons, which was explained by the corona virus pandemic, but also due to organizational reasons. Among the organizational reasons, violations of labor discipline are in the first places – non-fulfilment of the requirements of labor protection instructions, non-fulfilment of job duties and violation of the technological process. Therefore, the development of proposals for the improvement of the labor protection management system and labor relations in the energy industry is an urgent task. There are proposed measures to reduce the level of injuries due to organizational reasons in stressful conditions of mass absenteeism of personnel due to illness or during hostilities.

Competition between brown stink bug (Hemiptera: Pentatomidae) and corn earworm (Lepidoptera: Noctuidae) in field corn.

Interspecific competition is an important ecological concept which can play a major role in insect population dynamics. In the southeastern United States, a complex of stink bugs (Hemiptera: Pentatomidae), primarily the brown stink bug, Euschistus servus (Say), and corn earworm, Helicoverpa zea (Boddie) (Lepidoptera: Noctuidae), are the 2 most common pests of field corn, Zea mays L. (Poales: Poaceae). Stink bugs have the greatest potential for economic injury during the late stages of vegetative corn development when feeding can result in deformed or "banana-shaped" ears and reduced grain yield. Corn earworm moths lay eggs on corn silks during the first stages of reproductive development. A 2-year field study was conducted to determine the impact of feeding by the brown stink bug during late-vegetative stages on subsequent corn earworm oviposition, larval infestations, and grain yield. Brown stink bug feeding prior to tasseling caused deformed ears and reduced overall grain yield by up to 92%. Across all trials, varying levels of brown stink bug density and injury reduced the number of corn earworm larvae by 29-100% and larval feeding by 46-85%. Averaged across brown stink bug densities, later planted corn experienced a 9-fold increase in number of corn earworm larvae. This is the first study demonstrating a competitive interaction between these major pests in a field corn setting, and these results have potential implications for insect resistance management.

Determining Factors and Economic Injury Levels for Sphenophorus levis for Chemical and Biological Control in Irrigated and Non-irrigated Sugarcane Crops.

Globally, people use sugarcane (Saccharum officinarum) to produce sugar and ethanol. Rainfed or irrigated sugarcane agricultural systems are available. Among the pests affecting this crop, the weevil Sphenophorus levis, Vaurie 1978 (Coleoptera: Curculionidae), is increasingly becoming a significant threat in southern South America. Sphenophorus levis populations are controlled using chemical or biological measures. Control decisions hinge upon the economic injury level (EIL). The EIL delineates the pest density that results in financial losses for producers. This study aims to determine the EIL for S. levis, considering the factors favoring this insect pest and chemical and biological control methods in rainfed and irrigated systems. The intensity of S. levis attacks was monitored in commercial sugarcane plantations over four years in João Pinheiro, Minas Gerais, Brazil. Sampling occurred in a 50 × 50 × 30-cm-deep trench dug in the soil surrounding the sugarcane clump. The total number of stumps in the clump, including those attacked by S. levis, was tallied. The EILs for this pest were 5.93% and 4.85% of targeted stumps for chemical control in rainfed and irrigated crops, respectively. Biological control in sugarcane plots resulted in an EIL of 4.15% and 3.40% for stumps attacked in rainfed and irrigated crops, respectively. Pest attacks were more severe during rainy years and in older sugarcane crops. The EIL values determined in this study could inform integrated pest management programs for sugarcane crops.

Heavy metals and elderly kidney health: A multidimensional study through Enviro-target Mendelian Randomization

Chronic Kidney Disease (CKD), closely linked to environmental factors, poses a significant public health challenge. This study, based on 529 triple-repeated measures from key national environmental pollution area and multiple gene-related public databases, employs various epidemiological and bioinformatics models to assess the impact of combined heavy metal exposure (Chromium [Cr], Cadmium [Cd], and Lead [Pb]) on early renal injury and CKD in the elderly. Introducing the novel Enviro-Target Mendelian Randomization method, our research explores the causal relationship between metals and CKD. The findings indicate a positive correlation between increased levels of metal and renal injury, with combined exposure caused renal damage more significantly than individual exposure. The study reveals that metals primarily influence CKD development through oxidative stress and metal ion resistance pathways, focusing on three related genes (SOD2, MPO, NQO1) and a transcription factor (NFE2L2). Metals were found to regulate oxidative stress levels in the body by increasing the expression of SOD2, MPO, NQO1, and decreasing NFE2L2, leading to CKD onset. Our research establishes a new causal inference framework linking environmental pollutants-pathways-genes-CKD, assessing the impact and mechanisms of metal exposure on CKD. Future studies with more extensive in vitro evidence and larger population are needed to validate.

Evaluating the yield of surviving plants from early‐season hail damage in corn: A field survey

AbstractEconomic losses due to hailstorms across US corn fields occur every year. Hailstorms result in leaf defoliation, decreasing photosynthetic area and impairing carbon assimilation and crop yield for all corn (Zea mays L.) development stages. However, more attention is often given to stand reductions rather than damage to stems or leaf defoliation. During the 2014 growing season, a natural hail event affected many areas of eastern Nebraska. Twelve affected corn fields were surveyed and included in this study. An injury score scale (1–5) was developed based on various injury and severity levels before the V6 (6‐leaf corn growth stage) (six‐collared leaves). Scores were assigned to affected fields approximately 10–15 days after the hailstorm. At the end of the growing season, ears were harvested, and grain yield per plant was determined. The highest grain yield (p < 0.05) was recorded with plants that were affected but retained a main stem in good condition, albeit defoliation was present (score 1, lowest damage category). In contrast, when the main stem was cut and the plant had poor regrowth (score 3), yields were reduced by approximately 53% compared to plants with an injury score of 1. A significant negative linear relationship (R2 = 0.63, p < 0.01) between injury score and yield was observed (higher injury score from hail events resulted in lower yields). Based on these results, corn yield reduction due to plant injury from hail events before V6 should not be only attributed to stand reductions. Our findings indicate an opportunity to adjust the US evaluation standards for early‐season hail damage events in corn fields.

Racial differences in serological markers across the first year of injury in spinal cord injury: a retrospective analysis of a multi-center interventional study

Study designSecondary analysis of a randomized, multi-center, placebo-controlled study(Sygen®).ObjectivesTo evaluate racial differences in serological markers in individuals with spinal cord injury(SCI) across the first year of injury.SettingHospitals in North America.MethodsSerological markers (e.g.,cell count, liver, kidney, and pancreatic function, metabolism, and muscle damage) were assessed among 316 participants (247 White, 69 Black) at admission, weeks 1, 2, 4, 8, and 52 post-injury. Linear mixed models were employed to explore the main effects of time, race (Black vs. White), and their interaction, with adjustment of covariates such as study center, polytrauma, injury (level, completeness), treatment group, and sex.ResultsA main effect of race was observed where White individuals had higher alanine transaminase, blood urea nitrogen(BUN), BUN/Creatinine ratio, sodium, and chloride, while Black individuals had higher calcium, total serum protein, and platelets. For markers with interaction effects, post-hoc comparisons showed that at week 52, White individuals had higher mature neutrophils, hematocrit, hemoglobin, mean corpuscular hemoglobin, albumin, and triglycerides, and Black individuals had higher amylase. Eosinophils, monocytes, red blood cells, aspartate aminotransferase, bilirubin, cholesterol, partial thromboplastin time, urine specific gravity, urine pH, CO2, and inorganic phosphorus did not differ between races.ConclusionsOur results revealed racial differences in serological markers and underscores the importance of considering race as a determinant of physiological responses. Future studies are warranted to explore the causes and implications of these racial disparities to facilitate tailored clinical management and social policy changes that can improve health equity.

Poster 391: Injury Risk Cut-offs for Bone Density and Body Composition in Professional Female Ballet Dancers

Objectives: Female professional ballet performers are a unique population that undergo substantial physiologic stresses related to training, performance, and, at times, reduced energy availability that can result in elevated incidences of injury relative to their male counterparts and, even more so, the general population. However, there are currently no population-specific cut-offs based on dual energy X-ray absorptiometry (DEXA), bone mineral density (BMD), bone mineral content (BMC), and body composition (lean mass, LM; fat mass, FM) in relation to injury risk for appropriate screening and identification of those who might benefit from nutritional or activity-based interventions for injury prevention. The objective of this investigation was to develop population-specific DEXA cut-offs for BMD and body composition in professional female ballet performers based on injury risk. Methods: All procedures for this investigation were approved by the IRB. A total of 132 DEXA scans among 48 female professional ballet dancers from a single dance company taken during yearly physicals between 2017-2022 were collected for BMD and body composition (body mass, lean mass, fat mass). The electronic hospital record (EHR) was reviewed for each performer. The year of injury, level of injury, anatomic location, and diagnosis were collected if an injury was identified for the year following DEXA and physical. Level of injury was recorded. The data was de-identified and categorized by gender and year of injury. A female ballet population-matched Z-score was generated for total and regional BMD and body composition measures whereby Zb = (Measure – Ballet Population Measure) / SD of the ballet population. Logistic regression was used to determine Zb-score cut-offs whereby a significant increase in injury metrics (frequency & severity) would occur. Next, a T-test was used to compare injury severity scores between those above and below the cut-off. Chi-square analysis was then used to compare injury level frequencies between those above and below the cut-off. Significance was set at p<0.05 for all analyses. Corresponding BMD and body composition measures to each established Zb cut-off were also calculated. Results: Results are presented in Figure 1. Analysis revealed a strong association between Zb-scores for body mass index (BMI, kg/m2) and increased incidence of level 1 injuries. Weaker associations for Zb-scores for total BMD and total lean mass index (LMI, kgLM/m2) with all-cause injury severity and frequency rates (P<0.05) were also found. For total BMD, a Zb-score threshold of -0.5 was observed to be the point at which injury severity (P=0.039) and frequency of higher-level injuries (Level 2& 3, P<0.05) was observed to significantly increase. This cut-off corresponded to a total BMD value of 1.100 g/cm2. For total LMI, a Zb-score threshold of -0.5 was observed to be the point at which injury severity (P=0.046) and overall injury frequency (P=0.023) was observed to increase. This cut-off corresponded to a total LMI value of 13.86 kgLM/m2. For BMI, a Zb-score threshold of -0.4 was observed to be the point at which injury severity (P=0.047) and frequency of level higher level injuries (>Level 1, P=0.002) was observed to significantly increase. No significant injury cut-offs for % body fat or fat mass index were observed. This cut-off corresponded to a BMI value of 18.40 kg/m2. Conclusions: Reduced total bone density (BMD <1.100 g/cm2), lean mass (LMI < 13.86 kgLM/m2), and body mass (BMI < 18.40 kg/m2) may increase injury risk in elite professional female ballet performers. The cut-offs identified here may be used to better evaluate injury risk (as it pertains to DEXA assessment) in a manner that is specific to this population as opposed to generalizing to general population norms. Investigation remains ongoing regarding male dancers as well as how regional DEXA measures may relate to specific injury locations. The methods used here may also be utilized to find similar body composition and BMD injury risk cut-offs among other athlete populations and may greatly enhance the value of densitometry-based screening.

Spinal Injuries Due to Falls from Height

Abstract Background: Traumatic spinal injuries (TSIs) due to falls from heights are characterized by unique injury mechanisms, morphological features, and severity. In this study, we conducted an analysis of the epidemiological, clinical, and radiological data of TSI patients caused by falls from heights. We compared these findings with those of patients injured by other mechanisms. Materials and Methods: During a five-year period (2015–2019), all patients with traumatic spinal injuries who received treatment at a tertiary-level trauma center were categorized into two groups: those injured by falls from height (group 1) and those injured by other modes (group 2). Their medical records were reviewed for analysis. Results: Falls from height (group 1) constituted the predominant cause of TSI, affecting 51.8% (1069/2065) of spine trauma patients. The average age in group 1 (44.45 ± 16.76) was significantly higher than in group 2 (42.33 ± 15.81) (P = 0.003). In group 1, the most common level of injury was the lumbar spine (48.6%, n = 520), whereas in group 2, it was the cervical spine (48%, n = 478). Multiple levels of injury were more common in group 1 than in group 2 (25.2% vs. 19.2%, P = 0.002). The most common type of spine injury was AO type B in group 1 (35.43%, n = 377) and AO type C in group 2 (32%, n = 319). Other associated organ system injuries were significantly higher in group 2 than in group 1 (P < 0.05), except for pelvic injuries. Additionally, spinal injury-related complications were higher in group 2 (16.7%) than in group 1 (11.6%) (P = 0.001). The length of hospital stay was significantly higher in group 2 (9.71 ± 9.03 days) compared to group 1 (8.09 ± 7.26 days). Conclusion: Our study has revealed significant demographic and epidemiological variances in TSI caused by falls from heights compared to other injury mechanisms. This information is crucial in understanding the mechanism and injury pattern in TSI due to falls from height, as well as for formulating effective management strategies.

Model-based analysis of the acute effects of transcutaneous magnetic spinal cord stimulation on micturition after spinal cord injury in humans.

After spinal cord injuries (SCIs), patients may develop either detrusor-sphincter dyssynergia (DSD) or urinary incontinence, depending on the level of the spinal injury. DSD and incontinence reflect the loss of coordinated neural control among the detrusor muscle, which increases bladder pressure to facilitate urination, and urethral sphincters and pelvic floor muscles, which control the bladder outlet to restrict or permit bladder emptying. Transcutaneous magnetic stimulation (TMS) applied to the spinal cord after SCI reduced DSD and incontinence. We defined, within a mathematical model, the minimum neuronal elements necessary to replicate neurogenic dysfunction of the bladder after a SCI and incorporated into this model the minimum additional neurophysiological features sufficient to replicate the improvements in bladder function associated with lumbar TMS of the spine in patients with SCI. We created a computational model of the neural circuit of micturition based on Hodgkin-Huxley equations that replicated normal bladder function. We added interneurons and increased network complexity to reproduce dysfunctional micturition after SCI, and we increased the density and complexity of interactions of both inhibitory and excitatory lumbar spinal interneurons responsive to TMS to provide a more diverse set of spinal responses to intrinsic and extrinsic activation of spinal interneurons that remains after SCI. The model reproduced the re-emergence of a spinal voiding reflex after SCI. When we investigated the effect of monophasic and biphasic TMS at two frequencies applied at or below T10, the model replicated the improved coordination between detrusor and external urethral sphincter activity that has been observed clinically: low-frequency TMS (1 Hz) within the model normalized control of voiding after SCI, whereas high-frequency TMS (30 Hz) enhanced urine storage. Neuroplasticity and increased complexity of interactions among lumbar interneurons, beyond what is necessary to simulate normal bladder function, must be present in order to replicate the effects of SCI on control of micturition, and both neuronal and network modifications of lumbar interneurons are essential to understand the mechanisms whereby TMS reduced bladder dysfunction after SCI.

Designing of an Innovative Multiplex Model to Control Insects/Pests (Whitefly) in Okra Crop Fields and Assessment for its Efficacy in Control Viral Diseases

Whitefly (Bemisia tabaci) destroys a great proportion of crops in India. Whitefly is the carrier of begomovirus which causes okra yellow vein mosaic viral disease. Preventing the pest infestation without the use of chemical fertilizers and pesticides is the need of the hour. Integrated Pest Management (IPM) involves strategies that maintain pest population below Economic Injury Level (EIL). In the present study a multiplex insect catching trap was constructed with the aim of controlling pest infestation in a sustainable and eco-friendly manner. The multiplex trap was prepared using yellow sticky papers and Methyl Eugenol pheromone as an insect/pest attractant. The traps were placed in field and thereafter plants were tested for the presence of viral DNA using PCR. The fields in which traps were placed showed negligible or few instances of viral infection while the fields in which no traps were placed showed considerable virus infection. Additionally, the fields with the trap showed a higher yield percentage of crop compared to the field with no trap.

Combined effect of timing, position and management on Halyomorpha halys feeding injury assessment on apple cultivars

AbstractHalyomorpha halys is an invasive stink bug, native to east Asia, responsible for extensive economic loss in numerous crops. Since several factors can influence the severity of the recorded injury level, we performed field and semi‐field experiments in commercial apple orchards to monitor their interaction. To establish how position (both in the orchard and on the canopy), management and cultivar interact in determining pre‐harvest injury levels, more than 100,000 apples, distributed over 106 orchard blocks, were examined in the field. Apples located higher in the canopy, on edge rows and in orchards with organic management had a higher number of external injuries and such factors were more relevant when occurring in combination, and on mid and late‐season cultivars. Exclusion cages were used to assess if the injury severity changed with the apple growth stage and with the life stage of H. halys, exposing Red delicious apples to adults and nymphs for 48 hours, from May to July. Early‐season injuries did not evolve in distinct depressions nor in wide areas with necrotic tissue. Later in season, the injury severity was higher and similar for adults and older nymphs (fourth and fifth instars), with the development of depressions externally and necrotic tissue internally. Thus, even a low number of individuals could cause severe damage, over a short exposure period, when it happened near full maturation. The combined results offer new insights to support the development of informed and sustainable control strategies.

Effectiveness of respiratory management for mechanical ventilator weaning in traumatic spinal cord injury patients with prolonged ventilation

Background. Traumatic spinal cord injury is a medical condition which often results in disability and mortality. The most common lesion was cervical level, which is around 60-75% of all cases, where at this level there is a risk of respiratory problems which often require mechanical ventilation. Case report. In the case discussed, a 28-years-old male was referred from other hospital with traumatic cervical spinal cord injury (C5-C6) ASIA score A with a history of falling from a height of 3 meters. The patient underwent decompressive laminectomy on the tenth day of onset, followed by mechanical ventilation. During treatment, the patient received pharmacological therapy, tracheostomy, acupuncture, physiotherapy, and neuromuscular electrical stimulation for ventilator weaning. The patient was hospitalized for 66 days, with mechanical ventilation duration for 32 days. Conclusions. Factors that can influence the duration of ventilation weaning are the level and severity of spinal cord injury, time of transfer to a health facility, and complications related to ventilator installation. Multidisciplinary management, including pharmacological, physiotherapy, acupuncture, surgical, neuromuscular electrical stimulation, can increase the chances and decreasing the duration of mechanical ventilation, and reducing complications related to spinal cord injury and prolonged ventilation.

Activities of the militia in Ukraine to ensure road safety in the 1950s

In the 1950s, the daily functions of the militia continued to include combating violations of street traffic rules and controlling the decrease in motor vehicle accidents. The accident rate on the roads of the republic at that time remained high. An analysis of the current state of road safety shows that the level of accidents, injuries and deaths on the roads was influenced by such objective factors as the level of development of the regulatory framework, the technical condition of vehicles, the level of development of the road network, its quality, and weather and climatic conditions. Subjective factors included the level of legal culture of road users (drivers and pedestrians), the degree of their readiness to participate in traffic, the professional qualifications and material and technical equipment of the employees of the State Automobile Inspection. During this period, state bodies carried out significant, but ambiguous in quality, rule-making work, the purpose of which was to develop measures aimed at improving both objective and subjective conditions that affected the state of road safety and were of a mutually agreed nature. The established driver training mechanism was one of the important components of the effective operation of the road safety system. Therefore, the activities of state bodies, in particular the State Automobile Inspection of the Ministry of Internal Affairs of the Ukrainian SSR, were aimed at forming not only stable skills in driving vehicles among the drivers, but also behavioral stereotypes that require compliance with legal norms in the field of road safety. At the same time, it was necessary to develop and legally establish criteria for assessing the quality of their training in the relevant institutions. Militia bodies carried out quite active work to improve the situation with road accidents, which included measures of administrative influence, involvement of the public in monitoring violations of traffic rules, various propaganda activities, but its effectiveness was ultimately insignificant.

Cardiac Hemodynamic Features in Patients with Infective Endocarditis Complicated by Acute Heart Failure

Infective endocarditis (IE) is a rare but devastating disease. The main complications of IE are heart failure (HF), sepsis (in particular, due to perivascular spread of infection), and embolic events, most often those of cerebral local-ization. The diagnosis of IE combines various factors that are not specific to IE when considered separately. Echocardiog-raphy remains the first-line imaging modality for the diagnosis of IE. The aim. To determine the features of intracardiac complications that occur in patients with IE at the preoperative stage using ultrasound diagnostics. Materials and methods. The study included clinical data of 120 patients with IE who underwent examination and treatment from 01/01/2019 to 06/30/2020 at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The diagnosis of IE was established in accordance with the modified Duke/Eu-ropean Society of Cardiology 2015 criteria. The mean age of the studied patients was 46.3 ± 1.37 (19-69 years). Results. A high rate of nosocomial factors in the development of the disease was determined: 49 (40.9%) cases, of which 15 (12.5%) cases and 25 (20.8%) cases were urological and general surgical interventions, respectively. Preopera-tive HF was found in 16 (13.3%) cases. In the group of patients with acute HF, cases of left heart valve disease with peri-annular complications dominated: 9 (56.3%) cases of abscesses and 3 (18.8%) cases of fistulae. Significant differences were found in the assessment of the cardiac index: in the group of patients with IE without signs of HF, the cardiac index was 4.9 ± 0.2, and in the group of patients with preoperative HF it was 3.7 ± 0.4 (p = 0.098). Patients with acute HF were characterized by a higher level of acute kidney injury (creatinine 168.2 ± 40.7 μmol/L, urea 13.3 ± 2.5 mmol/L). Conclusions. The obtained results indicate a high incidence of intracardiac complications in patients with IE, in par-ticular, those caused by nosocomial infections and medical interventions. Ultrasound diagnostics (echocardiography) is an important tool for detecting and monitoring intracardiac complications at the preoperative stage, which can affect the treatment strategy and prognosis. A thorough examination of a patient with IE allows to identify critical features of cardiac hemodynamic disorders and ensure timely cardiac surgery.

Prognostic value of tissue bridges in cervical spinal cord injury: a longitudinal, multicentre, retrospective cohort study

The accuracy of prognostication in patients with cervical spinal cord injury (SCI) needs to be improved. We aimed to explore the prognostic value of preserved spinal tissue bridges-injury-spared neural tissue adjacent to the lesion-for prediction of sensorimotor recovery in a large, multicentre cohort of people with SCI. For this longitudinal study, we included patients with acute cervical SCI (vertebrae C1-C7) admitted to one of three trauma or rehabilitation centres: Murnau, Germany (March 18, 2010-March 1, 2021); Zurich, Switzerland (May 12, 2002-March 2, 2019); and Denver, CO, USA (Jan 12, 2010-Feb 16, 2017). Patients were clinically assessed at admission (baseline), at discharge (3 months), and at 12 months post SCI. Midsagittal tissue bridges were quantified from T2-weighted images assessed at 3-4 weeks post SCI. Fractional regression and unbiased recursive partitioning models, adjusted for age, sex, centre, and neurological level of injury, were used to assess associations between tissue bridge width and baseline-adjusted total motor score, pinprick score, and light touch scores at 3 months and 12 months. Patients were stratified into subgroups according to whether they showed better or worse predicted recovery. The cohort included 227 patients: 93 patients from Murnau (22 [24%] female); 43 patients from Zurich (four [9%] female); and 91 patients from Denver (14 [15%] female). 136 of these participants (from Murnau and Zurich) were followed up for up to 12 months. At 3 months, per preserved 1 mm of tissue bridge at baseline, patients recovered a mean of 9·3% (SD 0·9) of maximal total motor score (95% CI 7·5-11.2), 8·6% (0·8) of maximal pinprick score (7·0-10·1), and 10·9% (0·8) of maximal light touch score (9·4-12·5). At 12 months post SCI, per preserved 1 mm of tissue bridge at baseline, patients recovered a mean of 10·9% (1·3) of maximal total motor score (8·4-13·4), 5·7% (1·3) of maximal pinprick score (3·3-8·2), and 6·9% (1·4) of maximal light touch score (4·1-9·7). Partitioning models identified a tissue bridge cutoff width of 2·0 mm to be indicative of higher or lower 3-month total motor, pinprick, and light touch scores, and a cutoff of 4·0 mm to be indicative of higher and lower 12-month scores. Compared with models that contained clinical predictors only, models additionally including tissue bridges had significantly improved prediction accuracy across all three centres. Tissue bridges, measured in the first few weeks after SCI, are associated with short-term and long-term clinical improvement. Thus, tissue bridges could potentially be used to guide rehabilitation decision making and to stratify patients into more homogeneous subgroups of recovery in regenerative and neuroprotective clinical trials. Wings for Life, International Foundation for Research in Paraplegia, EU project Horizon 2020 (NISCI grant), and ERA-NET NEURON.

A Nationwide Analysis on Major Upper Extremity Amputations and Replantations.

The loss of an upper extremity is a severely disabling condition made medically challenging by the limited window for replantation. This study aims to investigate the burden of traumatic major upper extremity amputations in the United States and uncover possibilities for improvements in treatment. The Healthcare Cost and Utilization Project's National Inpatient Sample was screened for International Classification of Diseases-9/10 diagnosis/procedure codes for traumatic and nontraumatic major upper extremity amputations and replantations within the years 2008 to 2017. The resulting pool of cases was analyzed for multiple variables, including level of injury, patient demographics, hospital type and location, length of stay, costs, comorbidities, and complications. A total of 15 155 major upper extremity amputations were recorded, of which 15.20% (n = 2305) were traumatic amputations-almost half of them related to the upper arm (49.6%; P = .0002). The great majority of replantations, however, was conducted at the lower arm level (87.4%; P < .0001), with an overall replantation rate of 22.3%. Nontraumatic amputations were overall associated with significantly higher burden of comorbidities relative to traumatic amputations except for long-term alcohol use (P < .0001). Both, amputations and replantations, were predominantly treated in large urban teaching hospitals, and were significantly more likely to occur in white men. The Southern region of the United States was handling the highest proportion of amputations in the United States, but had the lowest likelihood of replantation. This study provides an overview of the national trends in major traumatic upper extremity amputations and replantations, revealing potential health care shortcomings.