Major Injury Research Articles

Needlesticks and sharp injuries and their associated factors among health care workers of Bule Hora University Teaching Hospital, Southern Ethiopia

BackgroundThis study assessed the prevalence and associated factors of needle sticks and sharp injuries among healthcare workers at the Bule Hora University Teaching Hospital, Southern Ethiopia from December 1 to 30, 2023. MethodsA self-administered questionnaire was used to gather information on sociodemographic factors and exposure status. Epi-Data and SPSS were used to enter and analyze data. Binary and multivariate logistic regression analyses were used to identify risk factors. A P value less than 0.05 was considered statistical significance. ResultsIn this study, the prevalence of at least one Needlesticks and sharp injuries in the last 12 months was 46.4 % (95 % CI: 39.3 %-53.6 %). Of most needlesticks and sharp injuries, 47.2 % were superficial skin injuries. The majority of injuries 45.8 % were due to the syringe needle. Factors such as needle recap (AOR=3.73, 95 % CI: 1.07–12.19), Recapping with two hands (AOR=2.78, 95 % CI: 1.36–10.02), working 40 h per week (AOR=2.18, 95 % CI: 0.98–6.86), lack of training in occupational safety practices (AOR=4.01, 95 % CI: 2.60–9.91), and lack of job satisfaction were factors significantly associated with the prevalence of needlesticks and sharp injuries. ConclusionThis study found that nearly half of the respondents experienced a sharp needle poke and injury at least once in the previous year; however, the volume of NSSI remains high in the study area. Healthcare personnel should receive on-the-job training, and hospital executives should set aside time for discussions on how to solve the problem.

From Sweat to Strain: An Epidemiological Analysis of Training-Related Injuries in CrossFit®.

This study aims to conduct an epidemiological investigation into the types and causes of injuries during CrossFit® training in Germany. Voluntary athletes from various German CrossFit® gyms participated, providing personal information, training habits, and details on injuries through a standardized questionnaire. The study involved 308 participants, with an equal sex split, a peak age of 20-40, and a BMI of 24.3 ± 3.3 kg/m2. Most participants trained for over two years (49.4%), primarily in supervised groups. Motivations for engaging in CrossFit® included health prevention (33.1%), athletic training (32.8%), and work-life balance support (17%). Injuries were reported by 28.6% of participants, with 61.4% experiencing single injuries. The majority of injuries (55.3%) occurred during the middle of workouts. Injury types included wounds (23.3%), contusions, sprains, or strains (cumulative 30.8%), and fractures (2.9%). Almost all injured individuals (96.5%) had a time-loss injury, with a return to sport ranging from a day to over three months. Treatments varied, with 50.6% not requiring medical intervention, 34.1% undergoing physiotherapy, 21.2% receiving medication and 8.2% needing surgery. Barbell exercises, notably Snatch and Clean, were main exercises with association to injuries, accounting for 36.3%. The Box Jump stood out as the exercise with the highest isolated injury prevalence (14.3%). Notable injury causes included falls during Pull-Ups and lumbar disc herniation linked to Deadlifts. Following injuries, 45.8% of participants made training adjustments. This study provides an epidemiological investigation into the types and causes of injuries during CrossFit® training in Germany. The shoulder and knee joint exhibited the highest injury prevalence. Barbell exercises, box jumps, and bar pull-ups were identified as major exercises with association to injuries. Prevention through technical training and the incorporation of soft boxes could reduce the risk of injuries in CrossFit®.

Vascular surgery experience for major vascular injuries in the Beirut Blast: Lessons learned

BackgroundThe Beirut Port Blast on August 4, 2020, was the largest non-nuclear blast in history. It heavily affected the fragile population already facing an ongoing political and socioeconomic crisis, and the coronavirus diease 2019 pandemic. This article is a review of major vascular injury patterns and mechanism, strategies of treatment, and physician experience. MethodsThis retrospective review was performed on all patients who presented to the Lebanese American University Medical Center—Rizk Hospital after the Beirut Blast owing to vascular injuries. All patients presenting with major vascular injuries requiring admission, operations, or who were deceased owing to vascular injuries were included. Basic identification and medical history data were extracted. The surgical procedures and postoperative care and outcomes were also recorded. ResultsEigtheen patients who presented to our institution during the day of the blast were included. Two patients passed away in the emergency room. The remaining 16 patients required surgeries. Most vascular injuries were caused by debris and shattered standard glass. The location of the vascular injuries were diverse; six patients (33.3%) had neck injuries, nine patients (50%) had upper extremity injuries, and three patients (16.6%) had lower extremity injuries. Furthermore, all patients had venous injuries (100%), and nine patients (50%) had arterial injuries. ConclusionsAfter the Beirut Blast, the major vascular injury seen was in the upper extremity, followed by the neck and lower extremity, mostly owing to shattered nonlaminated glass. Laminated or tempered glass should be considered superior to standard nonlaminated glass during Beirut renovation and areas at high risk for bombing, wars, and natural disasters like earthquakes. Awareness and knowledge of bleeding control is a must for people living in such risky environments. Venous injuries were more common and managed safely by ligation. Arterial injuries required a more extensive approach based on the location and extent of injury, but damage control surgery remains the mainstay strategy in disastrous situations.

The role of test results in the emergency department in the evaluation of major torso injury patients

We studied the role of laboratory tests in the emergency department (ED) for the prediction of outcomes in major torso injury patients. We hypothesized that the laboratory test results in the ED could predict worse outcomes and be complement of the TRISS (trauma and injury severity score) which serves a popular prediction model for trauma patients. Patients with major torso trauma who were sent to a level-I trauma center between January 2016 and December 2020 were retrospectively studied. Demographic information, TRISS, and laboratory data (glucose, lactate, base deficit (BD)) were collected and analyzed. The early death (death within 24 hours from the ED arrival) and the long intensive care unit (ICU) length of stay (LOS) (over seven days) were defined as the primary and secondary outcomes. A prediction model that integrated TRISS and the laboratory test results was created and evaluated by using the receiver operating characteristic (ROC) curve with the area under the curve (AUC). In total, 827 patients were studied. The glucose (255.2 ± 109.9 vs. 192.1 ± 77.0, p < 0.001) and lactate (77.2 ± 43.4 vs. 39.2 ± 26.4, p < 0.001) levels were significantly higher in patients who died early. The performance of glucose, lactate and BD in identifying those major torso trauma patients who would die early demonstrated acceptable discrimination (glucose: AUC = 0.687; lactate: AUC = 0.778; BD: AUC = 0.734). Furthermore, a model that integrated the TRISS and laboratory tests showed calibration of AUC = 0.863. Moreover, the levels of BD and glucose were also independent factors of long ICU LOS. In conclusion, checking lactate, BD and blood glucose is recommended in the evaluation of major torso trauma patients. Biochemical markers are beneficial in predicting worse outcomes for patients with major torso trauma and can complement the TRISS for these patients.

Electrospun Propolis-coated PLGA Scaffold Enhances the Osteoinduction of Mesenchymal Stem Cells.

Major injuries that are caused by trauma and cancer can not be repaired through bone remodeling. The goal of bone regeneration by tissue engineering approaches is to fabricate bone implants in order to restore bone structure and functions. The use of stem cells and polymer scaffolds provides the conditions for tissue regeneration based on tissue engineering. This study aimed to fabricate a combined matrix of poly(lactide-co-glycolide) (PLGA) and propolis extract, which is a mixture of pollen and beeswax collected by bees from certain plants and has long been used in traditional herbal medicine, to promote the osteogenic differentiation of human adipose- derived mesenchymal stem cells (AD-MSCs). The scaffold was fabricated through electrospinning and was immersed in a propolis extract solution. Then, AD-MSCs were cultured and differentiated into the osteogenic lineage. The cell viability on the scaffold was evaluated by MTT assay. Osteogenic differentiation of the seeded stem cells was detected by evaluating calcium content, alkaline phosphatase (ALP) activity, and the expression of bonespecific genes. The viability of cells was not affected by propolis-coated and uncoated fabricated scaffolds, while higher calcium content, ALP activity, and expression of RUNX-2, type I collagen, osteocalcin, and osteonectin were observed in cells differentiated on propolis-coated PLGA scaffold on days 7, 14, and 21 of differentiation compared to PLGA scaffold. The results of this study showed that the presence of propolis in the scaffold could lead to better cell attachment and strengthen the osteoinduction process in stem cells.

Severe thermal and major traumatic injury results in elevated plasma concentrations of total heme that are associated with poor clinical outcomes and systemic immune suppression.

Traumatic and thermal injuries result in a state of systemic immune suppression, yet the mechanisms that underlie its development are poorly understood. Released from injured muscle and lysed red blood cells, heme is a damage associated molecular pattern with potent immune modulatory properties. Here, we measured plasma concentrations of total heme in over 200 traumatic and thermally-injured patients in order to examine its relationship with clinical outcomes and post-injury immune suppression. Blood samples were collected from 98 burns (≥15% total body surface area) and 147 traumatically-injured (injury severity score ≥8) patients across the ultra-early (≤1 hour) and acute (4-72 hours) post-injury settings. Pro-inflammatory cytokine production by lipopolysaccharide (LPS) challenged whole blood leukocytes was studied, and plasma concentrations of total heme, and its scavengers haptoglobin, hemopexin and albumin measured, alongside the expression of heme-oxygenase-1 (HO-1) in peripheral blood mononuclear cells (PBMCs). LPS-induced tumour necrosis factor-alpha (TNF-α) production by THP-1 cells and monocytes following in vitro heme treatment was also examined. Burns and traumatic injury resulted in significantly elevated plasma concentrations of heme, which coincided with reduced levels of hemopexin and albumin, and correlated positively with circulating levels of pro and anti-inflammatory cytokines. PBMCs isolated from trauma patients 4-12 and 48-72 hours post-injury exhibited increased HO-1 gene expression. Non-survivors of burn injury and patients who developed sepsis, presented on day 1 with significantly elevated heme levels, with a difference of 6.5 µM in heme concentrations corresponding to a relative 52% increase in the odds of post-burn mortality. On day 1 post-burn, heme levels were negatively associated with ex vivo LPS-induced TNF-α and interleukin-6 production by whole blood leukocytes. THP-1 cells and monocytes pre-treated with heme exhibited significantly reduced TNF-α production following LPS stimulation. This impairment was associated with decreased gene transcription, reduced activation of extracellular signal-regulated kinase 1/2 and an impaired glycolytic response. Major injury results in elevated plasma concentrations of total heme that may contribute to the development of endotoxin tolerance and increase the risk of poor clinical outcomes. Restoration of the heme scavenging system could be a therapeutic approach by which to improve immune function post-injury.

Interpretable Severity Scoring of Pelvic Trauma Through Automated Fracture Detection and Bayesian Inference.

Pelvic ring disruptions result from blunt injury mechanisms and are potentially lethal mainly due to associated injuries and massive pelvic hemorrhage. The severity of pelvic fractures in trauma victims is frequently assessed by grading the fracture according to the Tile AO/OTA classification in whole-body Computed Tomography (CT) scans. Due to the high volume of whole-body CT scans generated in trauma centers, the overall information content of a single whole-body CT scan and low manual CT reading speed, an automatic approach to Tile classification would provide substantial value, e. g., to prioritize the reading sequence of the trauma radiologists or enable them to focus on other major injuries in multi-trauma patients. In such a high-stakes scenario, an automated method for Tile grading should ideally be transparent such that the symbolic information provided by the method follows the same logic a radiologist or orthopedic surgeon would use to determine the fracture grade. This paper introduces an automated yet interpretable pelvic trauma decision support system to assist radiologists in fracture detection and Tile grading. To achieve interpretability despite processing high-dimensional whole-body CT images, we design a neurosymbolic algorithm that operates similarly to human interpretation of CT scans. The algorithm first detects relevant pelvic fractures on CTs with high specificity using Faster-RCNN. To generate robust fracture detections and associated detection (un)certainties, we perform test-time augmentation of the CT scans to apply fracture detection several times in a self-ensembling approach. The fracture detections are interpreted using a structural causal model based on clinical best practices to infer an initial Tile grade. We apply a Bayesian causal model to recover likely co-occurring fractures that may have been rejected initially due to the highly specific operating point of the detector, resulting in an updated list of detected fractures and corresponding final Tile grade. Our method is transparent in that it provides fracture location and types, as well as information on important counterfactuals that would invalidate the system's recommendation. Our approach achieves an AUC of 0.89/0.74 for translational and rotational instability,which is comparable to radiologist performance. Despite being designed for human-machine teaming, our approach does not compromise on performance compared to previous black-box methods.

Morphine exposure and prematurity affect flash visual evoked potentials in preterm infants

ObjectiveThe present study aimed to explore first the impact of perinatal risk factors on flash-VEP waves and morphology in a group of preterm infants studied at term equivalent age (TEA). Second, to correlate VEP morphology with neurological outcome at 2 years corrected age (CA). MethodsInfants with a gestational age (GA) at birth <32 weeks, without major brain injury, were enrolled. Multivariate regression analyses were performed, and the models were run separately for each dependent variable N2, P2, N3 latencies and P2 amplitude. Logistic regression was applied to study N4 component (present/absent) and VEP morphology (regular/irregular). The predictors were GA, bronchopulmonary dysplasia (BPD), postmenstrual age at VEP registration, cumulative morphine and fentanyl dose, and painful procedures. Lastly, linear regression models were performed to assess the relation between the Bayley-III cognitive and motor scores at 2 years CA and VEP morphology, in relation to GA, BPD, painful procedures and cumulative morphine dose. ResultsEighty infants were enrolled. Morphine was the predictor of N2 (R2 = 0.09, p = 0.006), P2 (R2 = 0.11, p = 0.002), and N3 (R2 = 0.13, p = 0.003) latencies. Younger GA was associated with lower amplitude (R2 = 0.05, p = 0.029). None of the independent variables predicted the presence of N4 component, nor VEP morphology in the logistic analysis. VEP morphology was not associated with cognitive and motor scores at 2 years. ConclusionsMorphine treatment and prematurity were risk factors for altered VEPs parameters at TEA. In our cohort VEP morphology did not predict neurological outcome. SignificanceMorphine administration should be evaluated according to potential risks and benefits, and dosage individually accustomed, according to pain and comfort scores, considering the possible risk for neurodevelopmental impairment.

Total laparoscopic hysterectomy – Learning curve and its impact on surgical outcome of 773 case series from a single center

Abstract Study Objective: The objective of this study was to assess the learning curve of total laparoscopic hysterectomy (TLH) and its impact on surgical outcome of 773 consecutive cases between two decades. Design: This was a retrospective observational comparative study of 773 consecutive cases of TLH. Setting: This study was conducted at ILS Hospital, Kolkata, India, a private tertiary referral center for endoscopic surgery. Patients: Total 773 women with benign pelvic pathologies from 2000 to 2019 having similar demographic characteristics irrespective of uterus size and previous surgery were included while patients with malignancy and second-degree uterus prolapse were excluded. Interventions: TLH by ipsilateral technique. Materials and Methods: The study period was divided into two decades with 386 and 387 surgeries of TLH in the first and second decades, respectively, maintaining homogeneity within the periods. The CUmulative SUMmation (CUSUM) technique was used to construct a learning curve of operative time where learning point. Results: Learning Point was found at the 118th surgery. Overall complications decreased from 4.39% to 1.33% (P = 0.0096) between two decades, and major and minor complications decreased from 3.36% to 0.52% (P = 0.0042) and from 1.03% to 0.78% (P = 0.1416), respectively. No major vessel injury occurred. Five ureter injuries occurred in the first decade and none in the second decade. In-spite of significant increase in uterus size and double the number of Lower Uterine Caesarian Section (LUCS) in 2nd decade (P&lt;0.00001), bladder injuries occurred in 1st decade &amp; 2nd decade was 7 (1.81%) and 1 (0.26%) respectively (P=0.033). Total 56 conversions (7.56%) occurred: the first decade was 27 (6.97%) and the second decade 29 (7.51%) (P = 0.7814). Conclusion: Laparoscopic hysterectomy can be safely done by ipsilateral technique with low complication if one achieves a learning curve under supervised training. In our study, gained experience helped us to decrease major bladder, bowel, and ureteric injuries drastically by 90.91% in spite of increased complexity of cases in the second decade.

Does Preoperative Radiation Therapy Performed for Metastatic Spine Cancer at the Cervical Spine Increase Perioperative Complications of Anterior Cervical Surgery?

Radiation therapy (RT) performed before anterior cervical spine surgery (ACSS) may cause fascial plane fibrosis, decreased soft-tissue vascularity, and vertebral body weakness, which could increase the risk of esophageal and major vessel injuries, wound complications, and construct subsidence. Therefore, this study aimed to evaluate whether preoperative RT performed for metastatic spine cancer (MSC) at the cervical spine increases perioperative morbidity for ACSS. Forty-nine patients who underwent ACSS for treatment of MSC at the cervical spine were retrospectively reviewed. All the patients underwent anterior cervical corpectomy via the anterior approach. Patient demographics, surgical factors, operative factors, and complications were recorded. Results of patients who were initially treated with RT before ACSS (RT group) were compared with those who did not receive RT before ACSS (non-RT group). Eighteen patients (36.7%) were included in the RT group, while the remaining 31 (63.3%) were included in the non-RT group. Surgery-related factors, including operation time (p = 0.109), estimated blood loss (p = 0.246), amount of postoperative drainage (p = 0.604), number of levels operated (p = 0.207), and number of patients who underwent combined posterior fusion (p = 0.768), did not significantly differ between the 2 groups. Complication rates, including esophageal injury, dural tear, infection, wound dehiscence, and mechanical failure, did not significantly differ between the RT and non-RT groups. Early subsidence was significantly greater in the non-RT group compared to that in the RT group (p = 0.012). RT performed before surgery for MSC does not increase the risk of wound complication, mechanical failure, or vital structure injury during ACSS. The surgical procedural approach was not complicated by previous RT history. Therefore, surgeons can safely choose the anterior approach when the number of levels or location of MSC favors anterior surgery, and performing a posterior surgery is unnecessary due to a concern that previous RT may increase complication rates of ACSS.

Clinical Associated Factors of Tile B/C Type of Pelvic Ring Fractures; a Retrospective Cross-sectional study.

Pelvic ring fractures categorized under Tile Categories B and C denote partially and fully unstable fractures, respectively. This study aimed to identify the clinically associated factors of Tile B/C pelvic ring fractures. This retrospective cross-sectional study reviewed medical records from the Emergency Medicine department at Ramathibodi Hospital in Bangkok, Thailand. The study included individuals aged ≥ 15 who experienced accidents from 2012 to 2021. To investigate the associations between the clinical variables and three critical outcomes, including Tile B/C pelvic ring fractures, major vascular injuries, and the necessity for surgical or radiological interventions, multivariable logistic regression analysis was employed. A total of 198 patients were included in the study, among whom 34.8% were diagnosed with Tile B/C pelvic ring fractures. The analysis revealed several significant predictors of Tile B/C fractures, including the presence of pelvic tenderness (adjusted odds ratio [aOR] = 15.25, 95% confidence interval [CI] = 5.86-39.66, p < 0.001), and a shock index (SI) ≥1 (aOR = 4.2, 95% CI = 1.24-14.22, p = 0.021). Moreover, Tile B/C pelvic ring fractures were associated with an increased incidence of major vascular events and the imperative requirement for surgical or radiological interventions. Clinical findings of pelvic tenderness and an SI ≥1 are strong predictive clinical factors associated with Tile B/C pelvic fractures. Early diagnosis, application of an pelvic binder, provision of initial resuscitation, and prompt transportation to a definitive care facility are crucial components of management.

Role of Mesohepatectomy for Pediatric Centrally Located Liver Tumors.

Mesohepatectomy (MH) or central hepatectomy (CH) is a recognized surgical technique for centrally located pediatric liver tumors. This technique of liver resection avoids extended liver resections and thereby helps in the preservation of liver parenchyma. In this article, we aim to analyze our experience and outcome with this technique of liver resection. A retrospective analysis of patients who underwent MH from January 2015 to June 2023 at our institute was performed. The variables analyzed include demographics, preoperative treatment, perioperative management, and postoperative outcome. A total of five patients underwent CH. Four patients had hepatoblastoma, and one patient had mesenchymal hamartoma. All four patients with hepatoblastoma received neoadjuvant chemotherapy. All five patients had negative surgical margins, and one of the five developed disease recurrences necessitating resurgery and ultimately died of metastasis. one patient sustained intraoperative major bile duct injuries, and one patient had postoperative Abnormal, well-circumscribed, extra-biliary collection of bile. MH with clear margins is feasible in the selected subset of pediatric liver tumors involving segments IV, V, and VIII with outcomes equivalent to extended hepatic resections.

Identification of major hemorrhage in trauma patients in the prehospital setting: diagnostic accuracy and impact on outcome

BackgroundHemorrhage is the most common cause of potentially preventable death after injury. Early identification of patients with major hemorrhage (MH) is important as treatments are time-critical. However, diagnosis can be...

A Study of Functional Outcome and Assessment of Role of Proximal Humerus Internal Locking System (Philos) Plating in Elderly Population with Proximal Humerus Fracture: A Case Series.

The purpose of the study was to assess the functional outcome of proximal humerus fractures (2 part, 3 part, and 4 part) managed with a proximal humerus internal locking system (PHILOS). This retrospective study included 27 cases of proximal humerus fractures managed surgically between February 2021 and February 2022 with a proximal humerus internal locking system (PHILOS) plate. NEER classification was used to categorize the fractures. Functional assessment was done using Constant Murley's shoulder score and disabilities of the arm, shoulder, and hand. Subjects having metastatic and pathological fractures; associated fractures in the ipsilateral limb; having major nerve injury and cases of open fracture were excluded from this study. The mean age was 55.63 ± 10.37 years. Of the total 27 cases of proximal humerus fractures, functional outcome was excellent (score 85-100) in 3.70% (n = 1) cases, good (score 71-85) in 81.49% (n = 22) cases, moderate (score 56-70) in 14.81% (n = 4), and poor (score 0-55) in none of the (n = 0) cases. In 92.60% of cases, follow-up showed no complications. Varus collapse and subacromial impingement, both occurring in 3.70% (n = 1) of the subjects, were noted in this study. Based on the findings of this retrospective study, it can be opined that PHILOS plating appears to be a secure option for proximal humerus fracture cases. It offers solid fixation, prompt mobilization, and excellent functional outcomes as observed in this study. In addition, very few post-operative complication rates again support our conclusion.

Surgery of strictured major bile duct injury: analysis of a monocentric series

Surgery of strictured major bile duct injury: analysis of a monocentric series

Percutaneous TENS in Pediatric diaphyseal femoral fractures- Respects biology and ends happily

Femoral shaft fractures are amongst the most common major pediatric injuries treated by orthopaedic surgeons. They represent 1-2% of all fractures in the paediatric population. Paediatric males are affected more commonly than females. [1] There are various methods available for operative stabilization of paediatric femoral shaft fractures, which include external fixation, compression plating and rigid and flexible intramedullary nailing. [2] There is no uniform consensus on the treatment modality for femoral shaft fracture in school-aged children between 6 years to16 years. Titanium elastic nailing system (TENS) is a recent and widely used technique which allows stable reduction, maintenance of reduction and early mobilization. [3] American Academy of Orthopaedic Surgeons (AAOS) recommends with strong evidence based support in favour of the use of flexible intramedullary nailing for treating children age five to eleven years diagnosed with diaphyseal femur fractures. [4, 5] This device exploits a child’s denser bone, rapid healing and ability to remodel during period of bone growth. Here, we establish this axiom by a detailed case presentation, who was successfully treated with flexible intramedullary nailing for diaphyseal fracture of the femur.

Spatial Hotspots and Sociodemographic Profiles Associated With Traumatic Brain Injury in Nova Scotia.

Traumatic brain injury (TBI) is a leading cause of death and disability, primarily caused by falls and motor vehicle collisions (MVCs). Although many TBIs are preventable, there is a notable lack of studies exploring the association of geographically defined TBI hotspots with social deprivation. Geographic information systems (GIS) can be used to identify at-risk neighborhoods (hotspots) for targeted interventions. This study aims to determine the spatial distribution of TBI by major causes and to explore the sociodemographic and economic characteristics of TBI hotspots and cold spots in Nova Scotia. Patient data for TBIs from 2003 to 2019 were obtained from the Nova Scotia Trauma Registry. Residential postal codes were geocoded and assigned to dissemination areas (DA). Area-based risk factors and deprivation status (residential instability [RI], economic dependency [ED], ethnocultural composition [EC], and situational vulnerability [SV]) from the national census data were linked to DAs. Spatial autocorrelation was assessed using Moran's I, and hotspot analysis was performed using Getis-Ord Gi* statistic. Differences in risk factors between hot and cold spots were evaluated using the Mann-Whitney U test for numerical variables and the χ2 test or Fisher's exact test for categorical variables. A total of 5394 TBI patients were eligible for inclusion in the study. The distribution of hotspots for falls exhibited no significant difference between urban and rural areas (p = 0.71). Conversely, hotspots related to violence were predominantly urban (p = 0.001), whereas hotspots for MVCs were mostly rural (p < 0.001). Distinct dimensions of deprivation were associated with falls, MVCs, and violent hotspots. Fall hotspots were significantly associated with areas characterized by higher RI (p < 0.001) and greater ethnocultural diversity (p < 0.001). Conversely, the same domains exhibited an inverse relationship with MVC hotspots; areas with low RI and ethnic homogeneity displayed a higher proportion of MVC hotspots. ED and SV exhibited a strong gradient with MVC hotspots; the most deprived quintiles displayed the highest proportion of MVC hotspots compared with cold spots (ED; p = 0.002, SV; p < 0.001). Areas with the highest levels of ethnocultural diversity were found to have a significantly higher proportion of violence-related hotspots than cold spots (p = 0.005). This study offers two significant contributions to spatial epidemiology. First, it demonstrates the distribution of TBI hotspots by major injury causes using the smallest available geographical unit. Second, we disentangle the various pathways through which deprivation impacts the risk of main mechanisms of TBI. These findings provide valuable insights for public health officials to design targeted injury prevention strategies in high-risk areas.

Xenotransplantation experiments in brain-dead human subjects–A critical appraisal

Brain-dead human subjects (decedents) were recently introduced as a potential preclinical experimental model in xenotransplantation. Brain death is associated with major pathophysiological changes, eg, structural injury and cell infiltration in vital organs, and major hormonal, metabolic, inflammatory, and hemodynamic changes. In 2 of the 3 initial experiments, the design of the experiments resulted in little or no new information becoming available. In the third, the experiment was unfortunately unsuccessful as neither of the 2 pig kidneys transplanted into the decedent functioned adequately. Failure may well have been associated with the effects of brain death, but an immune/inflammatory response to the xenograft could not be excluded. Subsequently, 2 further pig kidney transplants and 2 pig heart transplants have been carried out in human decedents, but again the data obtained do not add much to what is already known. In view of the profound changes that take place during and after brain death, it may prove difficult to determine whether graft failure or dysfunction results from the effects of brain death or from an immune/inflammatory response to the xenograft. A major concern is that, if the results are confusing, they may impact decisions relating to the introduction of clinical xenotransplantation.

Limited recovery following acellular nerve allograft reconstruction in major peripheral nerve injuries

Recent studies suggest that acellular nerve allografts (ANA) have similar efficacy as nerve autografts in certain applications of nerve surgery. However, multiple studies also demonstrate the limitations of nerve allografts, resulting in poor patient outcomes. This submission discusses a recent case series of patients who failed allograft use with subsequent histologic analyses of these allografts. Recommendations on the treatment of nerve gaps are presented, drawing from our current understanding of allograft and autograft utility in reconstruction. Factors taken into account include recipient critical nerve function, existent nerve gap, and nerve diameter.

Facial burn in children: a review

Burns are a common cause of injury among children. Children with facial burns often experience pain, regardless of the cause, size, or depth of the burn injury. Burns in the facial area may lead to fatal consequences because of the involvement of the upper airway and cosmetic deformity of the face. Major burn injury in the facial area remains a significant cause of morbidity and mortality in children. Burn scars on the face in children may disturb the self-image and psychosocial processes. Multi-disciplinary approaches and advances in burn care are often helpful to manage the burn injury in children and increase the survival of the patients. Pain has adverse emotional and physiological impacts, and adequate pain control is an important factor in improving outcomes. The goal of the treatment of facial burns in children is to achieve a good aesthetic outcome and also normal head movement with neck mobilization.