Non-injury Group Research Articles

A Predictive Model for Perinatal Brain Injury Using Machine Learning Based on Early Birth Data

Background/Objective: It is difficult to predict perinatal brain injury, and performing brain magnetic resonance imaging (MRI) based on suspected injury remains a clinical challenge. Therefore, we aimed to develop a reliable method for predicting perinatal brain injury using a machine learning model with early birth data. Methods: Neonates admitted to our institution from January 2017 to June 2024 with a gestational age of ≥36 weeks, a birth weight of ≥1800 g, admission within 6 h of birth, and who underwent brain MRI to confirm perinatal brain injury were included. Various machine learning models, including gradient boosting, were trained using early birth data to predict perinatal brain injury. Synthetic minority over-sampling and adaptive synthetic sampling (ADASYN) were applied to address class imbalance. Model performance was evaluated using accuracy, F1 score, and ROC curves. Feature importance scores and Shapley additive explanations (SHAP) values were also calculated. Results: Among 179 neonates, 39 had perinatal brain injury. There were significant differences between the injury and non-injury groups in mode of delivery, Apgar scores, capillary pH, lactate dehydrogenase (LDH) levels, and whether therapeutic hypothermia was performed. The gradient boosting model with the ADASYN method achieved the best performance. In terms of feature importance scores, the 1 min Apgar score was the most influential predictor. Additionally, SHAP analysis showed that LDH levels had the highest SHAP values. Conclusion: the gradient boosting model with ADASYN oversampling effectively predicts perinatal brain injury, potentially improving early detection for predicting long-term outcomes, reducing unnecessary MRI scans, and lowering healthcare costs.

Pattern of Injuries in Children with Epilepsy: A Hospital-Based Case-Control Study

Abstract Objective The aim of this study is to examine the profile and pattern of injuries in children with epilepsy (CWE) as compared with healthy controls. Methods This prospective, cross-sectional study conducted over 1 year in a tertiary care pediatric center included consecutive CWE aged 4 to 16 years who had active seizures during the preceding 1 year. A similar number of age- and sex-matched healthy controls were enrolled. Children with acute symptomatic seizures or degenerative neurologic disorders were excluded. Standardized scales were used to assess intelligent quotient, psychopathology, seizure severity, and restriction of daily activities. Results Two hundred and eight CWE (mean age: 107 ± 37months; range: 3.5–16 years) and an equal number of healthy controls (mean age: 108 ± 43 months; range: 3.5–16 years; p = 0.07) were evaluated. The majority of CWE had generalized epilepsy (n = 117, 59.6%) followed by focal epilepsy (n = 84, 40.3%). The mean duration of epilepsy was 47.4 ± 36.3 months. The prevalence of injury was significantly greater in CWE (n = 118/208, 56.7%) compared with controls (n = 56/208, 26.9%; p < 0.001). CWE suffered significantly greater number of 293 injuries in the past 1 year in contrast to 83 injuries in controls (p < 0.001). In CWE, the majority of injuries were unrelated to seizures (n = 85/118, 72%, 211 injuries), while only one-third (n = 33/118, 27.9%, 82 injuries) suffered seizure-related injuries. The incidence of injures unrelated to seizures and that of seizure-related injuries were similar (2.48 seizure-related injuries per person per year). Among CWE, a comparison of the injury versus noninjury group showed a significantly longer duration of epilepsy (53 ± 34 vs. 40 ± 38 months, p < 0.007), higher prevalence of underlying structural etiology in generalized epilepsy (34.7 vs. 13.3%, p < 0.001), higher mean seizure severity and restriction of daily activity scores, and higher prevalence of hyperactivity (36.4 vs. 18.9%, p = 0.006) and intellectual disability (35.6 vs. 10%, p < 0.001) in the injury group. Injuries on the head, face, and upper limb were significantly more in CWE as compared with controls, and tongue injuries were found only in CWE (p =< 0.05), and were seen significantly more as seizure-related injury (n = 7 vs. 1, p < 0.001) compared with non-seizure-related injuries. The majority of injuries in children with CWE and controls were mild in nature (n = 112, 53.8% vs. n = 54, 26%; p < 0.001). Conclusions The prevalence of injuries among CWE aged between 4 and 16 years is high and is significantly greater than in healthy controls, although the majority of injuries are mild in severity in both and are non-seizure-related injuries. Longer duration of epilepsy, higher seizure severity, and restriction of daily activities, and higher prevalence of underlying structural etiology, hyperactivity, and intellectual disability are associated with injuries in CWE.

Clinical significance of posterior talofibular ligament injury in chronic lateral ankle instability.

Although arthroscopic repair of the anterior talofibular ligament (ATFL) is widely performed, the effect of posterior talofibular ligament (PTFL) injury on clinical outcomes remains unclear. This study aimed to evaluate the magnetic resonance imaging (MRI) findings of the PTFL in chronic lateral ankle instability (CLAI) and determine whether the presence or absence of PTFL injury affected the postoperative outcomes of arthroscopic ATFL repair. Forty ankles of 35 patients who underwent arthroscopic repair for CLAI were included in this study as the experimental group, together with 25 ankles of 24 patients without CLAI as the control group. The PTFL thickness (PTFLT) and PTFL cross-sectional area (PTFLCSA) were measured using MRI and compared between the control and CLAI groups. The clinical outcomes of arthroscopic repair were compared between ankles with and without PTFL injuries. The mean PTFLT and PTFLCSA values were significantly higher in the CLAI group than in the control group. The PTFLT and PTFLCSA in the PTFL injury group were significantly larger than those in the non-injury group in the CLAI group. Postoperatively, there were no significant differences in clinical scores and talar tilt angles on stress radiographs between ankles with and without PTFL injury; however, instability recurrence was frequently observed in ankles with PTFL injury (32.1%) compared to the ankles without PTFL injury (16.7%). Poor-quality ATFL remnant, ATFL inferior fascicle, and calcaneofibular ligament injuries were frequently observed in ankles with PTFL injuries. Our findings indicate that PTFL injury is highly associated with CLAI but it does not affect postoperative clinical scores. However, postoperative instability recurrence was more often observed in ankles with PTFL injuries, given that they frequently have poor-quality ATFL remnants and CFL injuries. Level III.

Central nervous injury risk factors after endovascular repair of a thoracic aortic aneurysm with type B aortic dissection.

Aortic dissection is the deadliest disease of the cardiovascular system. Type B aortic dissection accounts for 30%-60% of aortic dissections and is mainly treated by endovascular repair of thoracic endovascular aneurysm repair (TEVAR). However, patients are prone to various complications after surgery, with central nervous system injury being the most common, which seriously affects their prognosis and increases the risk of disability and death. Therefore, exploring the risk factors of central nervous system injury after TEVAR can provide a basis for its prevention and control. To investigate the risk factors for central nervous system injury after the repair of a thoracic endovascular aneurysm with type B aortic dissection. We enrolled 306 patients with type B aortic dissection who underwent TEVAR at our hospital between December 2019 and October 2022. The patients were categorized into injury (n = 159) and non-injury (n = 147) groups based on central nervous system injury following surgery. The risk factors for central nervous system injury after TEVAR for type B aortic dissection were screened by comparing the two groups. Multivariate logistic regression analysis was performed. The Association between age, history of hypertension, blood pH value, surgery, mechanical ventilation, intensive care unit stay, postoperative recovery times on the first day after surgery, and arterial partial pressure of oxygen on the first day after surgery differed substantially (P < 0.05). Multivariate logistic regression analysis indicated that age, surgery time, history of hypertension, duration of mechanical ventilation, and intensive care unit stay were independent risk factors for central nervous system injury after TEVAR of type B aortic dissection (P < 0.05). For high-risk patients with central nervous system injury after TEVAR of type B aortic dissection, early intervention measures should be implemented to lower the risk of neurological discomfort following surgery in high-risk patients with central nervous system injury after TEVAR for type B aortic dissection.

Predictive Value of the KOJI AWARENESS Self-Evaluation System for Running Injuries in Elite Male Long-Distance Runners: A Prospective Cohort Study.

The KOJI AWARENESS (KA) test is a practical self-evaluation tool that assesses body movements and may help develop individual conditioning plans to improve movement function. However, the association between preseason KA scores and in-season injury occurrence remains unexplored. To investigate whether the KA self-screening test score can predict running-related injuries in elite long-distance runners. Cohort study; Level of evidence, 2. A total of 47 elite college male long-distance runners (age, 18-22 years) were enrolled in this study in June 2022. The participants underwent the KA self-screening test to assess preseason upper limb, core, and lower limb function. Running-related injuries with a training time loss of >3 weeks were tracked for 6 months during the season. The participants were divided into injury and noninjury groups, and between-group comparisons and receiver operating characteristic (ROC) curve analysis were used to determine the association between the KA scores and the injury incidence. Chi-square tests and risk ratios were calculated based on the cutoff value- and injury-based grouping. Among the runners, 10 (21.3%) sustained an injury. There were no significant differences in the demographic characteristics between the injury and noninjury groups. The injury group had significantly lower KA scores than the noninjury group (median, 44.5 [interquartile range, 43-46.8] vs median, 48 [interquartile range, 46-50], respectively; P = .009). The ROC curve analysis determined a cutoff value of 46.5 points (sensitivity, 73%; specificity, 63.6%), indicating that the KA scores exhibited a relatively high predictive value for running-related injuries (area under the ROC curve, 0.764 [95% CI, 0.600-0.930]). The risk ratio for group division based on the cutoff value was 2.590 (95% CI, 1.329-5.047). These findings demonstrated that the KA test is an effective self-screening tool for predicting the risk of running-related injuries in elite male long-distance runners.

Urinary α 1-microglobulin and β 2-microglobulin as markers of early kidney injury in HIV-positive male patients on tenofovir-based antiretroviral therapy.

A retrospective study was conducted to explore the urinary expression of α 1-microglobulin (α1MG) and β2-microglobulin (β2MG) in patients with human immunodeficiency virus (HIV) infection, aiming to evaluate their predictive capability for renal injury. One hundred and five male HIV-infected patients treated with Tenofovir (TDF) regimen (TDF+3TC or the third drug TDF/FTC+) were selected between March 1, 2021, and March 1, 2022, in Wuhan Jinyintan Hospital. Three months after TDF treatment, the renal function injury was evaluated with the standard creatinine clearance rate. The urinary levels of α1MG and β2MG were compared between the initiation of TDF treatment and three months thereafter. Spearman correlation was utilized to analyze the correlation between the urinary expression of α1MG and β2MG and renal injury in HIV patients. The logistic regression was used to analyze the predictive value of urinary α1MG and β 2-microglobulin expression in renal injury. Up to the first follow-up, 29 (27.6%) cases of the 105 male HIV patients had varying degrees of renal function injury, including 14 (13.3%) mild injury, 9 (8.6%) moderate injury, and 6 (5.7%) severe injury cases. Patients with severe renal injury had the highest levels of urinary α1MG and β2MG expression while those with mild injury demonstrated higher levels compared to the non-injury group (P < 0.05). Spearman correlation analysis indicated that urinary α1MG and β2MG were positively correlated with renal impairment in HIV patients (Rho = -0.568, and -0.732; P < 0.001). The ROC curve analysis demonstrated that the area under the curve (AUC) for urine α1MG and β2MG in predicting kidney damage among HIV patients were 0.928, 0.916, and 0.889, respectively. The sensitivity values were 96.55%, 82.76%, and 89.66% while the specificity values were 84.07%, 94.51%, and 89.29% for urine α1MG and β2MG, respectively. The expression level of urinary α1MG and β2MG in HIV patients was significantly higher compared to normal people. Detection of these two indexes can enable early determination of renal injury and its severity in HIV patients.

Effect of thoracolumbar fascia injury on reported outcomes after percutaneous vertebroplasty.

Thoracolumbar fascia injury is often associated with poor early pain relief after percutaneous vertebroplasty (PVP). This study will evaluate the effects of thoracolumbar fascia injury on early pain relief and time to get out of bed after PVP. A total of 132 patients treated with PVP for osteoporotic vertebral compression fractures (OVCF) were included and divided into injured group (52 cases) and non-injured group (80 cases) according to the existence of thoracolumbar fascia injury. Before surgery, 1 day, 3 days, 1 week, 1 month, and 3 months after surgery, and at the last follow-up, the primary patient-reported outcome measures (PROMs) were the visual analogue scale (VAS) of pain while rolling over and standing, and the secondary PROMs was the Oswestry disability index (ODI). Meanwhile, the achieved rate of minimal clinically important differences (MCID) and patient acceptable symptom states (PASS) of the above measures in both groups was evaluated at the last follow-up. Except for the postoperative 3 months and the last follow-up, there were statistically significant differences in VAS-standing and ODI between the two groups at other time points after surgery (P < 0.05), and the non-injured group was significantly better than the injured group. At the last follow-up, there was no statistically significant difference in the MCID and PASS achievement rates of the above measures between the two groups (P > 0.05). In addition, the proportion of patients who got out of bed 1 and 3 days after surgery in the non-injury group was significantly higher than that in the injury group (P = 0.000 for both). Thoracolumbar fascia injury significantly affected early pain relief and extended time of getting out of bed after PVP. Attention should be paid to preoperative evaluation of thoracolumbar fascial injury in order to better predict the postoperative efficacy of PVP.

Goal Orientation and Desire for Approval Were Associated With Sports Injuries Among Young Japanese Athletes

IntroductionThis study aimed to clarify the relationship between psychological factors (goal orientation and desire for approval from others) and the severity of sports injuries experienced by young Japanese athletes. Methods560 young Japanese athletes (males = 328 and females = 232) aged 18–24 years completed an online survey in 2022–2023. A web questionnaire was used to investigate participants’ task and ego orientations, desire for approval from others (e.g., coaches and friends/families), and history of injury. The samples were then split into three groups based on the rest duration due to the injury: non-injury group (0 days), mild-to-moderate injury group (1–27 days), and severe injury group (> 28 days). Spearman's test examined a correlation between task and ego orientation scores among all samples. The Mann-Whitney U-test was used to compare the scores between the severe injury and non-injury groups. ResultA significant positive correlation was found between task and ego orientation scores from all samples (rho = 0.27, p < 0.001). The severe injury group had significantly higher task orientation scores and desire for approval scores than those of the non-injury group (ཐ=0.001, p < 0 .001). ConclusionsJapanese young athletes with high task orientation and approval desire may be at risk of severe sports injuries requiring more than 4 weeks to return to sports. The goal orientation profiles should be interpreted with caution. Future research should examine contextual effects such as the perceived motivational climate, in addition to the goal orientation profiles.

Risk factors for diaphragmatic injury in subxiphoid video-assisted thoracoscopic surgery.

Subxiphoid video-assisted thoracoscopic surgery (VATS) is considered a safe and feasible operation for anterior mediastinal mass resection. However, diaphragmatic injury, presented as tearing or puncturing, may occur during subxiphoid VATS despite of low incidence. This study aims to explore risk factors for diaphragmatic injury in subxiphoid VATS, as well as strategies to reduce occurrence of the injury. We retrospectively reviewed clinical records of 44 consecutive adult patients who underwent subxiphoid VATS. These patients were divided into two groups: diaphragmatic injury group and non-injury group. Perioperative outcomes and anatomic features derived from 3D CT reconstructions were compared between the two groups. Significant differences were observed in operation time (223.25 ± 92.57 vs. 136.28 ± 53.05, P = 0.006), xiphoid length (6.47 ± 0.85 vs. 4.79 ± 1.04, P = 0.001) and length of the xiphoid below the attachment point on the diaphragm (24.86 ± 12.02 vs. 14.61 ± 9.25, P = 0.029). Odds ratio for the length of the xiphoid below the attachment point on the diaphragm was 1.09 (1.001-1.186), P = 0.048 by binary logistic regression analysis. We identified the length of the xiphoid below the attachment point on the diaphragm as an independent risk factor for diaphragm injury during subxiphoid VATS. Prior to subxiphoid VATS, a 3D chest CT reconstruction is recommended to assess the patients' anatomic variations within the xiphoid process. For patients with longer xiphoid process, a higher incision at the middle and upper part of the xiphoid process, and partial xiphoid process resection or xiphoidectomy is preferred.

Diagnostic value of multi-parameter ultrasound evaluation in sepsis complicated by acute kidney injury

Background This study aimed to discuss the diagnostic value of multi-parameter ultrasound evaluation in sepsis complicated with acute kidney injury (AKI). Methods Patients were divided into an AKI group (n = 50) and a non-injury group (n = 50) based on the presence of AKI. The clinical characteristics were collected, and renal function parameters between the two groups were compared, including 24-h urine volume, serum creatinine, urea, serum cystatin C (CysC), renal parenchymal thickness (RPT), renal artery resistance index (RI), and multi-parameter ultrasound scoring (MPUS). Additionally, logistic regression analysis was conducted to determine the influencing factors of sepsis complicated with AKI. The prediction value was evaluated using a receiver operating characteristic (ROC) curve. Results In the AKI group, creatinine, CysC, urea, MPUS score, RPT, and RI values were significantly higher, while the 24-h urine volume was lower than those in the non-injury group (p < 0.01). Moreover, multivariate logistic analysis indicated that high CysC and RI values were independent risk factors, whereas high 24-h urine volume and low MPUS were independent protective factors for sepsis-induced AKI. The ROC curve demonstrated that RI (AUC = 0.906) was more effective than 24-h urine volume (AUC = 0.797), CysC (AUC = 0.730), and MPUS (AUC = 0.794) in identifying sepsis-induced AKI. Conclusion High RI values increase the risk of sepsis-induced AKI, whereas low MPUS may reduce it. RI showed high diagnosis values for sepsis complicated with AKI.

Factors influencing magnetic resonance imaging changes associated with pelvic bone injury after high-intensity focused ultrasound ablation of uterine fibroids: a retrospective case-control study.

The application of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids is becoming increasingly widespread, and postoperative collateral thermal damage to adjacent tissue has become a prominent subject of discussion. However, there is limited research related to bone injury. Therefore, the aim of this study was to investigate the potential factors influencing unintentional pelvic bone injury after HIFU ablation of uterine fibroids with magnetic resonance imaging (MRI). A total of 635 patients with fibroids treated with HIFU in the First Affiliated Hospital of Chongqing Medical University were enrolled. All patients underwent contrast-enhanced MRI (CE-MRI) pre- and post-HIFU. Based on the post-treatment MRI, the patients were divided into two groups: pelvic bone injury group and non-injury group, while the specific site of pelvic bone injury of each patient was recorded. The univariate and multivariate analyses were used to assess the correlations between the factors of fibroid features and treatment parameters and pelvic bone injury, and to further analyze the factors influencing the site of injury. Signal changes in the pelvis were observed on CE-MRI in 51% (324/635) of patients after HIFU. Among them, 269 (42.4%) patients developed sacral injuries and 135 (21.3%) had pubic bone injuries. Multivariate analyses showed that patients with higher age [P=0.003; odds ratio (OR), 1.692; 95% confidence interval (CI): 1.191-2.404], large anterior side-to-skin distance of fibroid (P<0.001; OR, 2.297; 95% CI: 1.567-3.365), posterior wall fibroid (P=0.006; OR, 1.897; 95% CI: 1.204-2.989), hyperintensity on T2-weighted imaging (T2WI, P=0.003; OR, 2.125; 95% CI: 1.283-3.518), and large therapeutic dose (TD, P<0.001; OR, 3.007; 95% CI: 2.093-4.319) were at higher risk of postoperative pelvic bone injury. Further analysis of the factors influencing the site of the pelvic bone injury showed that some of the fibroid features and treatment parameters were associated with it. Moreover, some postoperative pain-related adverse events were associated with the pelvic bone injury. Post-HIFU treatment, patients may experience pelvic injuries to the sacrum, pubis, or a combination of both, and some of them experienced adverse events. Some fibroid features and treatment parameters are associated with the injury. Taking its influencing factors into full consideration preoperatively, slowing down treatment, and prolonging intraoperative cooling phase can help optimize treatment decisions for HIFU.

Factors associated with thermal injury of abdominal skin in focused ultrasound ablation of uterine fibroids

Objective To investigate the factors which may cause thermal injury of abdominal skin in patients with uterine fibroids (UFs) who underwent ultrasound-guided focused ultrasound ablation surgery (FUAS). Method A total of 123 patients were enrolled in the injury group. In contrast, 246 patients without thermal injury were assigned to the non-injury group. The relationship between patient and treatment parameters and injury were explored using univariate analysis and multiple logistic regression analyses. In addition, the factors influencing the degree of thermal injury were analyzed using Kruskal–Wallis H. Results (1) Abdominal scars (p = .007, OR = 2.187, 95% CI: 1.242–3.849), abdominal wall thickness (p < .001, OR = 1.042, 95% CI: 1.019–1.067), fundus fibroids (p = .038, OR = 1.790, 95% CI: 1.033–3.100), UFs with hyperintense/mixed T2-weighted imaging (T2WI) signals (p = .022, OR = 1.843, 95% CI: 1.091–3.115), average sonication power (AP) (p = .025, OR = 1.021, 95% CI: 1.003–1.039), and treatment time (TT) (p < .001, OR = 1.017, 95% CI: 1.011–1.023) were independent risk factors for thermal injury, while treatment volume (TV) (p = .002, OR = 0.775, 95% CI: 0.661–0.909) was a protective factor for injury. (2) Four groups were subdivided according to the degree of thermal injury(Group A: without skin injury. Group B: with changed T2WI signal in the abdominal wall, Group C: mild skin injury, Group D: severe skin injury), comparison of each with every other showed that the abdominal wall in Groups A and D was thinner than Groups B and C, with statistically significant differences (PAB<0.05, PAC<0.01, PDC<0.05, PDB<0.05); Group A was slightly thicker than D, however, without statistical difference. The ratio of sonication time (ST) to TV in Group A was the lowest of all (PAB, PAC, PAD all < 0.05). And as the level of thermal injury rose, the ratio gradually increased, however, without statistical difference. Conclusions Based on our limited results, the following conclusion was made. (1) Abdominal scars, abdominal wall thickness, fundus fibroids, UFs with T2WI hyperintense/mixed signals, AP and TT were independent risk factor. (2) Neither too thick nor too thin abdominal walls would be recommended, as both might increase the risk of skin injury. (3) Noticeably, the risk of skin injury might increase considerably when the ST was longer and the sonication area was more fixed.

Integrative analysis of miRNA in cartilage-derived extracellular vesicles and single-cell RNA-seq profiles in knee osteoarthritis

Extracellular vesicular miRNAs (EV-miRNAs) play essential roles as intercellular communication molecules in knee Osteoarthritis (OA). We isolated cartilage-derived extracellular vesicles (EVs), to perform miRNA sequencing, which revealed EV-miRNA profiles and identified differentially expressed miRNAs (DE-miRNAs) between cartilage injury and cartilage non-injury groups. The target genes of known and novel DE-miRNAs were predicted with multiMiR package in 14 miRNA-target interaction databases. Meanwhile, single-cell RNA sequencing (scRNA-seq) was performed to identify chondrocyte clusters and their gene signatures in knee OA. Then we performed comparative analysis between target genes of the cartilage-derived EV-DE-miRNAs target genes and cluster-specific maker genes of characteristic chondrocyte clusters. Finally, the functional analysis of the cartilage-derived EVs DE-miRNA target genes and cluster-specific marker genes of each cell population were performed. The EV-miRNA profile analysis identified 13 DE-miRNAs and 7638 target genes. ScRNA-seq labelled seven clusters by cell type according to the expression of multiple characteristic markers. The results identified 735, 184, 303 and 879 common genes between EV-DE-miRNA target genes and cluster-specific marker genes in regulatory chondrocytes (RegCs), fibrocartilage chondrocytes (FC), prehypertrophic chondrocytes (PreHTCs) and mitochondrial chondrocytes (MTC), respectively. We firstly integrated the association between the cartilage-derived EV-DE-miRNA target genes and distinguished cluster-specific marker genes of each chondrocyte clusters. KEGG pathway analysis further identified that the DE-miRNAs target genes were significantly enriched in MAPK signaling pathway, Focal adhesion and FoxO signaling pathway. Our results provided some new insights into cartilage injury and knee OA pathogenesis which could improve the new diagnosis and treatment methods for OA.

Potentially inappropriate medications in older adults with Parkinson disease before and after hospitalization for injury

BackgroundParkinson disease (PD) patients are at increased risk of serious injury, such as fall-related fractures. Prescription medications are a modifiable factor for injury risk. ObjectivesTo determine the extent to which a serious injury requiring hospitalization affects prescribing of potentially inappropriate medications (PIMs) among older adults with PD. MethodsWe conducted a quasi-experimental difference-in-difference (DID) study using 2013–2017 Medicare data. The cohort consisted of beneficiaries with PD hospitalized for injury versus for other reasons. PIMs were classified into PD and injury-relevant categories (CNS-active PIMs, PD motor symptom PIMs, PD non-motor symptom PIMs, PIMs that reduce bone mineral density). We estimated mean standardized daily doses (SDDs) of medications within each PIM category before and at 3, 6, and 12 months after hospitalization. We used generalized linear regression models to compare changes in mean SDDs for each PIM category between the injury and non-injury group at each timepoint, adjusting for biological, clinical and social determinants of health variables. ResultsBoth groups discontinued PIMs and/or reduced PIM doses after hospitalization. There were no between-group differences in mean SDD changes, after covariate adjustment, for any PIM category, except for the CNS-active PIMs category at 3 months (DID p-value = 0.00) and for the category of PIMs that reduce bone mineral density at all timepoints (DID p-values = 0.02, 0.04, 0.02 at 3, 6, and 12 months). ConclusionsSimilar patterns of PIM among persons with PD after hospitalization for serious injury versus for other reasons may represent a missed opportunity to deprescribe high-risk medications during care transitions.

Change In Fall Risk-Increasing Drug Use Among Individuals with Parkinson Disease Before and After a Serious Injury (P2-5.032)

<h3>Objective:</h3> To describe fall risk-increasing drug (FRID) use before and after an unintentional traumatic injury or fall-related fracture and examine the extent to which hospital encounters affect medication prescribing in individuals with Parkinson disease (PD). <h3>Background:</h3> Individuals with PD are at increased risk of falls and fractures. FRIDs represent a major modifiable factor that can potentially reduce the risk of subsequent events. <h3>Design/Methods:</h3> We identified persons with PD hospitalized for injury or fracture and matched each person to up to 4 individuals with PD who were hospitalized for other reasons using 2013–2017 U.S. Medicare data. A difference-in-difference design was used to compare FRID dispensing before and after hospitalization between the two groups. We examined the changes in standardized daily doses of FRIDs in the two groups upon hospital admission and at 3-, 6-, and 12-months post-discharge, adjusting for covariates. Exploratory analyses were performed to evaluate potential medication discontinuation and tapering following discharge. <h3>Results:</h3> We identified 9,437 persons with PD who had a qualifying hospitalization for injury or fracture and 32,487 matched individuals. While both groups experienced reductions in standardized daily doses of FRIDs, the differences in dose reductions were minimal (−1.94, 95% CI [−2.05, −1.82] in the injury group vs. −1.91, 95% CI [−1.97, −1.84] in the non-injury group; p=0.66 at 12 months). Over 40% of subjects discontinued FRIDs at 3 months in both groups, and ~2/3 to 3/4 of these sustained discontinuations through one year. <h3>Conclusions:</h3> There were no clinically significant differences in FRID dose reductions pre- to post-hospitalization between PD individuals with injury or fracture versus those without. More efforts are needed to enhance deprescribing practices during transition of care, especially after a sentinel event, to prevent subsequent unintentional injuries or fractures. <b>Disclosure:</b> The institution of Dr. Pham Nguyen has received research support from National Institute of Health. The institution of Dr. Pham Nguyen has received research support from National Institute of Health. Dr. Gray has nothing to disclose. Mr. Newcomb has nothing to disclose. Miss Liu has nothing to disclose. The institution of Dr. Hamedani has received research support from Michael J. Fox Foundation. The institution of Dr. Hamedani has received research support from NIH. The institution of Dr. Hamedani has received research support from Biogen. The institution of Dr. Hamedani has received research support from Biohaven. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Intercept Pharmaceuticals. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medullary Thyroid Cancer Consortium. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Provention Bio, Inc. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bluebird bio, Inc. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amylyx Pharmaceuticals. Dr. Hennessy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ipsen Bioscence Inc.. The institution of Dr. Hennessy has received research support from US Food and Drug Administration. The institution of Dr. Hennessy has received research support from US National Institutes of Health. The institution of Dr. Hennessy has received research support from US Centers for Disease Control and Prevention. Dr. Wright Willis has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Pharmacoepidemiology and Drug Safety. The institution of Dr. Wright Willis has received research support from NIH. The institution of Dr. Wright Willis has received research support from NIA. The institution of Dr. Wright Willis has received research support from Biogen. The institution of Dr. Wright Willis has received research support from Parkinson Foundation. The institution of Dr. Wright Willis has received research support from Arcadia.

The Underlying Mechanisms in the Association Between Traumatic Brain Injury in Childhood and Conduct Disorder Symptoms in Late Adolescence

The present study examined i) the direct association between traumatic brain injury (TBI) in childhood and conduct disorder symptoms in adolescence, ii) whether this effect is mediated by impulsivity and/or callous unemotional traits (CU traits), and iii) whether these indirect effects are moderated by childhood family adversity and adolescent substance use. Utilising data from the Avon Longitudinal Study of Parents and Children (ALSPAC), participants with head injury information up to 12 years (4.5 years, 5.4 years, 6.5 years, 8.6 years, 11.7 years) were identified and categorised into a TBI (n = 409), orthopaedic injury (n = 1469) or non-injury group (n = 5685). Psychosocial factors such as impulsivity at 13 years, CU traits at 13 years, childhood family adversity (between birth to 4 years) and substance use at 14 years were collated for moderated mediation analyses. Conduct disorder symptoms were assessed at 16 years of age. TBI and conduct disorder symptoms were positively associated, and this association was mediated by impulsivity but not CU traits. The indirect effects were higher in magnitude for individuals with higher levels of childhood family adversity. Adolescent substance use was not found to moderate the indirect effects between TBI and conduct disorder symptoms. These results were specific to TBI individuals, and not in participants with orthopaedic injury and no reported injuries. Targeting impulsivity and early family adversity may alleviate the risk of conduct disorder symptoms following TBI in childhood. These findings have important implications for informing neuro-rehabilitative and preventative measures in clinical and community settings.

Sacral injury and influencing factors after ultrasonic ablation of uterine fibroids ≤30 mm from the sacrum

To study sacral injuries and influencing factors after ultrasonic ablation of uterine fibroids no more than 30 mm from the sacrum. A total of 406 patients with uterine fibroids who underwent percutaneous ultrasound ablation were analyzed retrospectively. All patients underwent contrast-enhanced magnetic resonance imaging (MRI) scans before and after high-intensity focused ultrasound. The abnormal signal intensity (low signal intensity on T1WI and high signal intensity on T2WI) on the postoperative MRIs was indicative of a sacral injury. The patients were divided into a sacrum injury group and a sacrum non-injury group. The relationship between fibroid characteristics, ultrasound ablation parameters, and injury was analyzed using univariate and multivariate analyses. There were 139 cases of sacral injury (34.24%). When the distance from the fibroid's dorsal side to the sacrum was 0-10 mm, the risk assessment showed that the danger of sacral injury increased by 1.85 times and 3.03 times compared with that at a distance of 11-20 or 21-30 mm. Furthermore, the risk of sacral injury increased by 1.89 times and 3.23 times when the therapeutic dose (TD) of a fibroid was >500 KJ compared with that of a fibroid with TD= 250-500 KJ and <250 KJ. A distance of 10 mm or less and a TD of >500 KJ were significantly correlated with sacral injury. The distance from the fibroid's dorsal side to the sacrum and the TD were the main causes of injury to the sacrum. A distance of 10 mm or less and a TD of >500 KJ carried higher injury risks, while a distance of 21-30 mm and a TD of <250 KJ were the most appropriate circumstances to reduce the risk of sacral injury.

The role of endplate injury in intervertebral disc degeneration after vertebral augmentation in OVCF patients.

Whether vertebral augmentation can induce or aggravate the degeneration of adjacent intervertebral discs remains controversial. The purpose of this study is to explore the role of endplate injury in intervertebral disc degeneration after vertebral augmentation. The imaging data of patients with single-segment osteoporotic vertebral compression fractures (OVCFs) were retrospectively analyzed. The upper and lower discs of the fractured vertebrae were defined as cranial and caudal discs, and the discs adjacent to the cranial discs were defined as control discs. According to the integrity of the cranial and caudal endplates, they were divided into an injury group and a noninjury group. At follow-up, the increase in the modified Pfirrmann score on MRI compared with the baseline grade was defined as the occurrence of a degenerative disc change (DDC). The changes in the disc height and the number of DDC cases on MRI during the follow-up in each group were analyzed. A total of 56 patients with OVCFs were included in this study, with an average follow-up time of 18.8 ± 14.1 months (3-62 months). In the cranial and caudal discs, the number of DDC cases in the endplate injury group was significantly higher than that in the noninjury group (P = 0.007 and P = 0.018). However, the number of DDC cases in the whole endplate injury group (including the cranial and caudal endplates) was significantly higher than that of the whole noninjury group (P = 0.000) and the control group (P = 0.000). The number of DDC cases in the whole noninjury group was not different from that of the control group (P = 0.192). At follow-up, the disc height of the cranial and caudal endplate injury group was significantly lower than the baseline (P = 0.000 and P = 0.001), but the disc height of the noninjury group was not significantly lower than the baseline (P = 0.074 and P = 0.082). Endplate injury is associated with adjacent intervertebral disc degeneration in OVCF patients after vertebral augmentation. Evaluation of endplate damage before vertebral enhancement in OVCF patients has an important reference value for predicting the outcome of adjacent intervertebral discs after surgery.

Phrenic nerve injury after the percutaneous microwave ablation of lung tumors: A single-center analysis.

This study aimed to analyze the cases of phrenic nerve injury caused by the percutaneous microwave ablation of lung tumors conducted at our center and to explore the risk factors. The data of 455 patients who underwent the percutaneous microwave ablation of lung tumors at the Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University from July 2017 to October 2021, were retrospectively analyzed. The cases of phrenic nerve injury after the percutaneous ablation were reported to analyze the risk factors involved, such as the shortest distance between tumor margin and phrenic nerve, tumor size, and ablation energy. The groups were divided based on the shortest distance between the tumor edge and the phrenic nerve into group 1, d ≤ l cm; group 2, 1 < d ≤2 cm; and group 3, d >2 cm. Lesions with a distance ≤2 cm were compared in terms of tumor size and ablation energy. Among the 455 patients included in this study, 348 had primary lung cancer, and 107 had oligometastatic cancer. A total of 579 lesions were detected, with maximum diameter of 1.27 ± 0.55 cm, and the ablation energy was 9,000 (4,800-72,000) J. Six patients developed phrenic nerve injury, with an incidence of 1.32%. For these six patients, the shortest distance from the lesion edge to the phrenic nerve was 0.75 ± 0.48 cm, and the ablation energy was 10,500 (8,400-34,650) J. There were statistically significant differences in phrenic nerve injury among groups 1, 2, and 3 (P < 0.05). In patients with a distance (d) ≤ 2 cm, there were no significant differences in tumor diameter and energy between the phrenic nerve injury group and the non-injury group (P = 0.80; P = 0.41). In five out of six patients, the diaphragm level completely recovered to the pre-procedure state, and the recovery time of the phrenic nerve was 9.60 ± 5.60 months. Another one was re-examined 11 months after the procedure, and the level of the diaphragm on the affected side had partially recovered. Phrenic nerve injury is a rare but not negligible complication of thermal ablation and is more likely to occur in lesions with a distance ≤2 cm from the phrenic nerve.

Osteoporotic vertebral compression fracture accompanied with thoracolumbar fascial injury: risk factors and the association with residual pain after percutaneous vertebroplasty

BackgroundTo explore the risk factors involved in the induction of thoracolumbar fascia (TLF) injury by osteoporotic vertebral compression fracture (OVCF), and the association between the residual pain after percutaneous vertebroplasty (PVP) and fascial injury.MethodsA total of 81 patients with single-segment OVCF, treated between January 2018 and January 2020 were included. The patients were grouped according to the existence of TLF injury. The patients’ general, clinical, and imaging data were accessed.ResultsThere were 47 patients in the TLF group and 34 in the non-injury group (NTLF group). In the TLF group, BMI (Body mass index) was significantly lower, while the prevalence of hypertension and sarcopenia were significantly higher (P < 0.05). The vertebral compression degree was higher, and the kyphosis angle of the injured vertebra was greater in the TLF group (P < 0.05). Cobb’s angle was not significantly different between groups. At 3-d after the operation, the VAS (Visual analogue scale) was 4.64 ± 1.78 and 3.00 ± 1.71, and the ODI (Oswestry disability index) was 67.44 ± 11.37% and 56.73 ± 10.59% in TLF and NTLF group, respectively (P < 0.05). However, at 3-m after the operation, the differences in the VAS score and the ODI between groups were not statistically significant. The area of fascial edema was not significantly associated with the pre- and post-operative VAS or ODI, but was positively correlated with the vertebral body compression degree (R = 0.582, P = 0. 029).ConclusionResidual back pain after PVP is associated with TLF injury. Low BMI, hypertension and sarcopenia are risk factors of TLF injury, and sarcopenia may be the major factor.