Injury Patterns Research Articles

Cranio-cervical and traumatic brain injury patterns-do they differ between electric bicycle, bicycle, and motorcycle-induced accidents?

With the growing technical options of power transmission and energy-saving options in electric drives, the number of E-bike-related accidents especially in an elderly population has increased. The aim of the current study was to compare if the increased velocity in comparison to conventional bikes translates into different injury patterns in the cranio-cervical and head region. A retrospective cohort study was performed in patients admitted to our level one trauma center between 2009 and 2019 after being involved in an accident with either an E-bike, bicycle, or motorcycle and suffered cranio-cervical or traumatic brain injury. cranio-cervical/intracranial injury pattern. Data interpretation was conducted in an interdisciplinary approach. From 3292 patients treated in this period, we included 1068 patients. E-bikers were significantly older than bicyclists (or motorcyclists) and lay between the other two groups in terms of helmet use. Overall injury patterns of E-bikers resembled those found in motorcyclists rather than in bicyclists. E-bikers had a higher incidence of different cerebral bleedings, especially if no helmet was worn. Helmet protection of E-bikers resulted in a comparable frequency of intracranial bleeding to the helmeted bicyclists. The overall pattern of head and cervical injuries in E-bikers resembles more to that of motorcyclists than that of bicyclists. As they are used by a more senior population, multiple risk factors apply in terms of complications and secondary intracranial bleeding. Our study suggests that preventive measures should be reinforced, i.e., use of helmets to prevent from intracranial injury.

Lesion Network Mapping of New-onset Aggression/Agitation/Irritability After Focal Brain Injury Identifies Distinct Populations with Distinct Network Injury Patterns (P1-9.004)

Lesion Network Mapping of New-onset Aggression/Agitation/Irritability After Focal Brain Injury Identifies Distinct Populations with Distinct Network Injury Patterns (P1-9.004)

Civilian Ballistic Injuries to the Atlantoaxial Spine: A Single Institution Case Series.

Retrospective case series. Describe the injury characteristics of ballistic fractures involving the atlantoaxial spine. Civilian gunshot wounds to the spine are an increasingly common injury in the United States. Civilian studies have focused on ballistic injuries to the entire spine as opposed to a region-specific fashion. Only a single 10-patient case series investigating ballistic fractures to the upper cervical spine (C1 and C2) exists, leaving a large gap in the understanding of this injury complex. A retrospective chart review was performed. Extracted data included patient demographics, neurological status on presentation, fracture morphology, assessment of stability, other associated injuries, and surgical procedures performed. Proportional analysis was performed to characterize the fractures and their associated neurological injuries. Thirty-six patients were identified, with 86% being male with an average patient age of 30.0 ± 10.36 years (mean ± SD). Fracture morphology was characterized using proportional analysis. Initial neurological exams were either ASIA A or ASIA E, without any incomplete injuries noted. Patients who sustained a transcanal injury did not show any neurological improvement. The initial in-hospital mortality rate was 5.6%, with a 1-year mortality rate of 8.3%. There is a high incidence of associated vascular injury (66%) and mandible fracture (33%). Ballistic penetrating trauma to the atlantoaxial spine often results in complex injury patterns necessitating multidisciplinary care with high rates of morbidity and mortality. If neurological deficits are present initially, they are often complete. Two thirds of patients sustained an associated vascular injury, which should be screened for with CT angiography.

Impact of Patient Demographics and Injury Patterns on the Choice and Success of Proximal Femur Fracture Surgeries

Background: Understanding the influence of patient demographics and injury patterns on the choice and success of surgical interventions for stable extracapsular fractures of the proximal femur is crucial for optimizing treatment outcomes.
 Methods: This comparative study analyzed 50 patients undergoing CRIF with either Gamma Nail or PFN, focusing on how demographics, injury patterns, and socio-economic status impacted surgical choice and outcomes.
 Results: No significant differences were observed in age and socio-economic status between the two groups. Gender distribution and the mode of injury showed slight variations but did not substantially influence the surgical choice. Both Gamma Nail and PFN were utilized across a diverse patient population, suggesting the need for individualized surgical planning.
 Conclusion: The choice of surgical technique for treating stable extracapsular fractures of the proximal femur is multifaceted, influenced by a combination of technical, demographic, and injury-related factors.
 Keywords: Extracapsular fractures, proximal femur, Gamma Nail, Proximal Femoral Nail, patient demographics, injury patterns.

GAMBARAN POLA LUKA PADA KORBAN KECELAKAAN LALU LINTAS DI RUMAH SAKIT UMUM DAERAH RAJA AHMAD TABIB PROVINSI KEPULAUAN RIAU PERIODE JANUARI-DESEMBER TAHUN 2022

Background: Traffic accidents are a leading cause of death in developing countries, and the incidence continues to rise with population growth and increased transportation mobility. This study aims to analyze the pattern of injuries in traffic accident victims treated at Raja Ahmad Tabib Regional General Hospital, Riau Islands Province, during the period from January to December 2022. Methods: This study utilized a retrospective descriptive design with a cross-sectional approach. The population consisted of 1,533 traffic accident victims during the January-December 2022 period, and a sample of 318 individuals was selected using purposive sampling. Data analysis was conducted using descriptive statistics. Results: The study revealed that 69.5% of the victims were aged over 30 years, 66.7% were male, and 84.0% survived the accidents. The most common injury pattern among pedestrians was abrasions (37.9%), motorbike riders most frequently experienced abrasions (48.0%), car drivers mostly suffered from lacerations (43.4%), and car passengers predominantly had contusions (50.0%). Conclusion: This research concludes that the injury patterns in traffic accident victims at Raja Ahmad Tabib Regional General Hospital in the Riau Islands Province during 2022 show that abrasions are dominant among motorbike riders, lacerations are predominant among car drivers, and contusions are prevalent among car passengers.

A comprehensive investigation on the effect of UHI in Baripada city using geo‐spatial technique and MLTHP model

AbstractAccording to the Times of India, Baripada city recorded the highest temperature in the world on April 14, 2023, at 43.5°C. It is located in the south‐west direction of the Similipal Biosphere Reserve. Observing the third highest temperature in the world, we are interested in finding out the reasons affecting climate change. This paper investigates the reasons for the temperature change in Baripada city and its surroundings by considering factors like Normalized Difference Vegetation Index (NDVI), Normalized Multi‐band Drought Index (NMDI), Normalized Difference Water Index (NDWI), Normalized Difference Built‐up Index (NDBI), forest fires, rainfall patterns, wind patterns, and registration of motor vehicles. For this study, data has been collected from USGS (United States Geological Survey), NASA POWER, Forest Survey of India, ArcGIS Online, etc. The study of NDVI shows a significant relationship with the LST. Similarly, NMDI shows an abnormal change in the drought index from 0.092 in 1990 to 0.276 in 2022, and NDWI shows a continuous reduction of the water index of −0.382 in 1990 and −0.176 in 2010, followed by −0.212 in 2022. NDBI values show that the urban build‐up index is increased to an extent due to rapid urban settlements removing natural vegetation. The overall forest fire count found an abnormal rise in the Baripada region during 2011 and 2022 to 143 times. Focusing on all the above factors, an experimental study is finally carried out to confirm the rise in temperature using time‐series analysis and a multi‐layer locally tuned hidden layer perceptron (MLTHP) model to ensure the Times of India's report.

In Silico Investigation of Biomechanical Response of a Human Brain Subjected to Primary Blast.

The brain response to the explosion-induced primary blast waves is actively sought. Over the past decade, reasonable progress has been made in the fundamental understanding of blast traumatic brain injury (bTBI) using head surrogates and animal models. Yet, the current understanding of how blast waves interact with human is in nascent stages, primarily due to the lack of data in human. The biomechanical response in human is critically required to faithfully establish the connection to the aforementioned bTBI models. In this work, the biomechanical cascade of the brain under a primary blast has been elucidated using a detailed, full-body human model. The full-body model allowed us to holistically probe short- (<5 ms) and long-term (200 ms) brain responses. The full-body model has been extensively validated against impact loading in the past. We have further validated the head model against blast loading. We have also incorporated the structural anisotropy of the brain white matter. The blast wave transmission, and linear and rotational motion of the head were dominant pathways for the loading of the brain, and these loading paradigms generated distinct biomechanical fields within the brain. Blast transmission and linear motion of the head governed the volumetric response, whereas the rotational motion of the head governed the deviatoric response. Blast induced head rotation alone produced diffuse injury pattern in white matter fiber tracts. The biomechanical response under blast was comparable to the impact event. These insights will augment laboratory and clinical investigations of bTBI and help devise better blast mitigation strategies.

Outcomes of Surgical Management of Turf Toe: 12-Year Results.

Background "Turf toe" is a classical capsuloligamentous injury to the plantar surface of the metatarsophalangeal (MTP) joint of the great toe. The name is synonymous with injuries sustained on artificial turf or hard grounds. The classical injury pattern is a hyperdorsiflexion injury with an axial load. The outcomes of these injuries are unpredictable and there are no clear guidelines for the management of these injuries. These injuries are debilitating and can lead to long-term problems and inability to return to pre-injury activity level if missed. We present a long-term surgical follow-up of severe grade 3 turf toe injuries. Methods In the period from 2011 to 2022, we treated 20 patients with turf toe/MTP joint instability. There were 10 football injuries (50%), six running injuries (30%), two gymnastic injuries (10%), one motorcycle injury (0.5%), and one was a ballet dancer (0.5%). All the grade 1 and 2 injuries were treated conservatively with rest, ice application, and splinting of the toe. Grade 3 injuries were treated surgically and strict rehabilitation protocol was followed. Results The mean age at surgery was 32.7 years and the average patient follow-up was 7.5 months after surgery. The Manchester-Oxford Foot Questionnaire (MOXFQ) score showed a statistically significant improvement from a mean of 73.0 (median = 75) preoperatively to 28.1 (median = 28.6) postoperatively (median improvement = 46.4, P = 0.022). Similarly, there was a significant improvement in pain score, which showed an improvement from a mean of 72.9 (median = 70.0) preoperatively to a mean of 22.9 (median = 25.0) postoperatively (median improvement = 51.3, P = 0.022). Conclusion Turf toe is a serious injury that may prevent a high percentage of patients from resuming their previous physical activities. The correct identification, classification, and grading of the first MTP joint instability helps in decision-making and achieving good surgical outcomes.

Causes of Traumatic Spinal Cord Injury with Gender Distribution and Most Commonly Affected Age Group

Background: Spinal cord injury (SCI) has significant consequences, especially for young adults, requiring comprehensive support. Additionally, non-traumatic SCI is under-researched in Pakistan, highlighting the need for further investigation. Managing readmissions post-discharge remains a global challenge for SCI patients. This study conducted at Paraplegic Centre Peshawar aims to find the traumatic causes of spinal cord injury with gender and age distribution. Methods: A retrospective study was conducted at Paraplegic Center in Hayatabad and Prime Teaching Hospital, Peshawar. Over two months, 1843 patients were recruited from hospital records with permission from the department head. Data collection forms were designed to include age, gender, and cause of SCI, ensuring confidentiality by excluding personal identifiers. SPSS-V19 was used for data analysis. Results: Our study included 1843 patient records, with males comprising 80.7% and females 19.3%. Among different age groups, individuals aged 30 and older represented the highest proportion at 52.7%. The primary causes of spinal cord injury were falls from height (46.3%) and firearm injuries (25.9%). Paraplegic injuries were more prevalent, accounting for 87.9% of cases compared to quadriplegic injuries at 12.1%. These findings shed light on the demographics and patterns of spinal cord injuries, providing valuable insights for healthcare management and prevention strategies. Conclusion: Falls are major cause of spinal cord injury (SCI). Mean age patients suffers are 26. frequency of SCI is more in males then females. Paraplegia is more common then quadriplegia. The socioeconomic impact of SCI is eminence because it is affecting the youth population. It is important to understand the epidemiological features of SCIs which could lead to plan appropriate cost-effective prevention strategy in order to reduce the SCI prevalence and incidence in our community.

The employment of resuscitative endovascular balloon occlusion of the aorta in deployed settings.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been often used in place of open aortic occlusion for management of hemorrhagic shock in trauma. There is a paucity of data evaluating REBOA usage in military settings. We queried the Department of Defense Trauma Registry (DODTR) for all cases with at least one intervention or assessment available within the first 72 h after injury between 2007 and 2023. We used relevant procedural codes to identify the use of REBOA within the DODTR, and we used descriptive statistics to characterize its use. We identified 17 cases of REBOA placed in combat settings from 2017 to 2019. The majority of these were placed in the operating room (76%) and in civilian patients (70%). A penetrating mechanism caused the injury in 94% of cases with predominantly the abdomen and extremities having serious injuries. All patients subsequently underwent an exploratory laparotomy after REBOA placement, with moderate numbers of patients having spleen, liver, and small bowel injuries. The majority (82%) of included patients survived to hospital discharge. We describe 17 cases of REBOA within the DODTR from 2007 to 2023, adding to the limited documentation of patients undergoing REBOA in military settings. We identified patterns of injury in line with previous studies of patients undergoing REBOA in military settings. In this small sample of military casualties, we observed a high survival rate.

Musculoskeletal disorders in padel: from biomechanics to sonography

Padel is a racket sport, combining high-frequency and low-intensity athletic gestures, that has been gaining growing scientific interest in recent years. Musculoskeletal injuries are very common among padel players with an incidence rate of 3 per 1000 h of training and 8 per 1000 matches. To the best of our knowledge, a comprehensive collection describing the most common sonographic findings in padel players with musculoskeletal injuries is lacking in the pertinent literature. In this sense, starting from the biomechanical features of padel-specific gestures we have reported the ultrasonographic patterns of most frequent injuries involving the upper limb, the trunk, and the lower limb. Indeed, comprehensive knowledge of the biomechanical and clinical features of musculoskeletal injuries in padel is paramount to accurately perform a detailed ultrasound examination of the affected anatomical site. So, the present investigation aims to provide a practical guide, simple and ready-to-use in daily practice, to optimize the sonographic assessment of padel players by combining it with the clinical findings and the biomechanical features of athletic gestures.

Leash-related injuries associated with dog walking: an understudied risk for dog owners?

The topic of dog-walking injuries has recently gained notoriety through major media outlets in North America, including the Washington Post, NPR, and US News and World Report. In this review, we have compiled data from the main studies published in the past 2 decades that assess the incidence, demographics, and injury patterns related to dog leash walking. The available papers indicate that dog leash-related injuries have increased, particularly among women over 65. The most common causes of injury are dog-pulling behavior, which can result in tripping or tangling, with or without a fall, as well as upper extremity injuries. However, there is a lack of information regarding dog size, breed, training status, the type of leash used at the time of injury, and the role each factor may have in the incidence of injuries. The available data did not allow for evaluation of the impact of weather conditions on injury incidence. Information about the involved dogs, type of lead device, and weather conditions could be useful in identifying risk factors associated with dog ownership and guide prospective pet owners and their families to mitigate the risk of injuries.

Pedestrians injuries in the north east region of Jamaica: a cross sectional study

To describe the sociodemographic data of injured pedestrians, temporal patterns of injury, injury patterns, and the independent predictors of hospital admission. A two year cross-sectional study was conducted at the Saint Ann’s Bay Regional Hospital in pedestrians with injuries post collision with a motor vehicle. A census was performed in all patients who received either emergency room treatment, hospital admission, or surgical intervention. A 30-item interviewer questionnaire was administered to collect the data. A logical regression model was used to determine independent predictors for hospital admission. Ninety pedestrians were included. Age range: 6-86 years old (Mean=39.9). Males were 63.3%, 75.6% were employed, 31% had a chronic illness and 27% reported marijuana use. Most injuries occurred in April, lowest injury rates occurred in August and September. Twenty two percent of collisions occurred on Saturdays. Most injuries occurred at 5pm and 3pm. Many (54.4%) had a fracture, 73.5% were closed. Approximately 32% had contusions and 6.7% had lacerations. Independent predictors of admission were history of marijuana use and having a fracture. Those with history of marijuana use were 4.21 times more likely to be admitted. Those with fractures were 7.10 times more likely to be admitted. Injury patterns spanned a wide age range. They often involved a high energy mechanism of injury as evidenced by the frequency of fractures, hospital admission and surgery intervention rates. The data also suggests a need to implement marijuana testing programmes in our road users.

Across two phylogeographic breaks: Quaternary evolutionary history of a mountain aspen (Populus rotundifolia) in the Hengduan Mountains

Biogeographical barriers to gene flow are central to plant phylogeography. In East Asia, plant distribution is greatly influenced by two phylogeographic breaks, the Mekong-Salween Divide and Tanaka-Kaiyong Line, however, few studies have investigated how these barriers affect the genetic diversity of species that are distributed across both. Here we used 14 microsatellite loci and four chloroplast DNA fragments to examine genetic diversity and distribution patterns of 49 populations of Populus rotundifolia, a species that spans both the Mekong-Salween Divide and the Tanaka-Kaiyong Line in southwestern China. Demographic and migration hypotheses were tested using coalescent-based approaches. Limited historical gene flow was observed between the western and eastern groups of P. rotundifolia, but substantial flow occurred across both the Mekong-Salween Divide and Tanaka-Kaiyong Line, manifesting in clear admixture and high genetic diversity in the central group. Wind-borne pollen and seeds may have facilitated the dispersal of P. rotundifolia following prevalent northwest winds in the spring. We also found that the Hengduan Mountains, where multiple genetic barriers were detected, acted on the whole as a barrier between the western and eastern groups of P. rotundifolia. Ecological niche modeling suggested that P. rotundifolia has undergone range expansion since the last glacial maximum, and demographic reconstruction indicated an earlier population expansion around 600 Ka. The phylogeographic pattern of P. rotundifolia reflects the interplay of biological traits, wind patterns, barriers, niche differentiation, and Quaternary climate history. This study emphasizes the need for multiple lines of evidence in understanding the Quaternary evolution of plants in topographically complex areas.

Comparison of Air Pollutants during the Two COVID-19 Lockdown Periods in Winter 2019 and Spring 2022 in Shanghai, China

During the winter of 2019, the global outbreak of COVID-19 prompted extensive research on urban air pollution under lockdown measures. However, these studies predominantly focused on winter conditions, thereby limiting investigations into changes in urban air pollutants during other seasons that were also subject to lockdown restrictions. Shanghai, China, has undergone two COVID-19 lockdown periods in two seasons: winter 2019 and spring 2022. The seasonal variations and human activities were represented by meteorological factors and nighttime light brightness in this paper, respectively. The reduction in human-related emissions during the two lockdown periods was estimated based on the targets outlined in China’s Air Pollution Prevention and Control Action Plan. The results showed significant reductions in NO2 and PM particles during the two lockdown periods, both accompanied by a notable increase in O3 concentration. In comparison to the winter lockdown, there was an approximate 40% decrease in the NO2 and PM2.5 concentrations in the spring, while the O3 concentration exhibited an increase of 48.81%. Furthermore, due to shifting wind patterns during the two lockdowns from winter to spring, the high-pollution core areas shifted 20–25 km southeastward in the spring. The PM particles and NO2 concentrations exhibited a considerable impact from human activities, whereas the O3 concentration was affected mostly by seasonal change and interactions among air pollutants. Compared to the corresponding non-lockdown condition, the concentration of CO decreased during the winter lockdown; however, it increased during the spring lockdown. The different change in CO concentration during the two lockdown periods was found to have a lower effect on the O3 concentration than that caused by changes in meteorological factors and nitrogen oxide (NO, NO2) concentrations. In summary, the impact of COVID-19 lockdown periods on urban air pollutants was more pronounced in spring compared to winter, and the interactions among air pollutants also underwent alterations.

Accident Analysis Using Case Studies of Finger Injuries at PT X Mining Company in 2020-2022

Mining activities are known as high-risk working environments and operational activities, they are categorized as one of the most dangerous activities in modern industry today. The mining industry ranks among the highest producers of injuries and lost working days. There are many types of injuries that contribute to this lost working days, finger injury is one of them. Fingers are reported to be one of the most injured body parts. This research carried out on a mining company in Indonesia, PT X, within a period of three years (2020-2022). Statistical analysis was performed to look for patterns of finger injury based on year of occurrence, classification, type, and source of injury, number of lost working days, type of employee, and business unit involved. There is an alarming upward trend in the number of finger injuries and lost working days resulting from them, although overall the number of injuries has decreased. This calls for immediate preventive measures to focus on finger injuries and focuses on changing worker behavior towards safe work behavior, applied to both permanent employees and contractor employees.

Pattern and clinical profile of patients with ocular trauma presenting to the emergency department of a teaching hospital in India: A prospective observational study.

One major contributor to avoidable ocular morbidity is ocular trauma (OT). The study aimed to document the epidemiological factors, pattern of injury, and outcome among patients with OT presenting to the emergency department (ED). This was a prospective observational study conducted in the ED of a tertiary care teaching hospital in Eastern India after due approval from the institutional ethics committee. The data were collected during the period from March 2021 to February 2022. Data pertaining to age, sex, type of injury, mechanism of injury, time and place of injury, details of tissue involvement, visual acuity, any prior history of injury, initial diagnosis, and management were noted. To estimate the severity of the injury and the probable visual outcome, we calculated through OT score (OTS), including one raw score and OTS. Statistical analysis was performed using the R, version 4.6.1. A total of 180 patient's data were included for final analysis. The median (interquartile range) age of the patients was 32 (24-45) years. The majority were males (n = 147 [81.6%]) with a male-female ratio of 4.5:1. Road traffic accidents (RTA) were the common cause of injury (n = 122 [67.7%]). Unilateral eye involvement was the most common (n = 147 [81.6%]). In the pattern of injury, most of the patients sustained closed globe injuries (CGIs) (n = 158 [87.7%]). Among the CGIs, injury to the ocular adnexa and conjunctiva (n = 141 and 127, respectively) was the most common. Injury to the retina and choroids occurred in 20 (11%) patients. The vision was not affected in most of the cases (n = 125 [69.4%]) with a visual acuity of > 6/18. The majority (n = 120 [67%]) of the patients had an OTS of grade-4, followed by grade-2 (n = 22 [12%]). Most of the patients required only medical management (n = 100 [56%]), whereas 77 (43%) patients required surgical interventions. OT was a common presentation in the ED. Male patients with monocular injuries involved in RTAs were mostly affected. The vision was preserved in most of the cases.

IJCM_149A: Profile of injuries among children admitted to a tertiary care hospital of Mangalore city, South India.

Background: Childhood injuries represent a significant public health concern worldwide, with a considerable impact on morbidity and mortality rates among children. Understanding the epidemiology and patterns of childhood injuries is crucial for developing effective prevention strategies. This retrospective study aimed to analyse the demographic and clinical patterns of childhood injuries among children admitted to Government Wenlock Hospital in Mangalore, Karnataka, India. Methodology: A hospital-based retrospective study design was employed, utilizing records of children aged 12 and below who were admitted with injuries during the study period. Data were collected using a structured proforma and analysed using SPSS version 11.5. Demographic and clinical variables were assessed, including age, gender, location of injury occurrence, type of injury, cause of injury, and outcomes. Results: A total of 359 cases of childhood injuries were analysed, with children aged 1-5 years being the most vulnerable age group. Male children experienced a higher number of injuries compared to females. The most common types of injuries were burns and poisoning, with road traffic accidents being the leading cause of injury. Home was identified as the primary location where injuries occurred. Most children were discharged without disability, although a significant number were discharged against medical advice. Conclusion: This study provides valuable insights into the epidemiology and patterns of childhood injuries in Mangalore, Karnataka. The findings underscore the importance of implementing targeted prevention strategies, such as increased parental supervision, traffic safety education, and proper storage of hazardous substances, to reduce the burden of childhood injuries. Additionally, efforts should focus on raising awareness among parents about the importance of seeking medical care promptly to mitigate the risk of adverse outcomes.

To investigate the pattern of neck injuries and the role of toxicology in cases of hanging and manual/homicidal ligature strangulation in Ireland between 2016 – 2020: A retrospective review and analysis

The pattern of neck injuries sustained in fatal cases of external compression to the neck is recorded during Post Mortem Examinations (PME), to assist in the interpretation of the circumstances that led to death. In this study, the PMEs performed for 298 cases of hanging and strangulation occurring between 2016 and 2020 in Ireland were retrospectively reviewed for the purpose of recording and collating the external and internal neck injuries observed during each PME, as well as the toxicology results for each decedent. Statistical analysis was performed to investigate potential novel associations between anthropometric variables pertaining to the decedents and the PME findings in cases of hanging and strangulation, serving to add further data to the existing body of research in this area and to assist in the resolution of future cases of hanging or strangulation where there are conflicting findings. In completing statistical analysis, it was found that there was no discernible association between the occurrences of cartilaginous neck fractures (CNFs) with increasing ligature width. Positive associations between increasing weight and BMI of the decedents were identified, and a significantly positive association between the increasing height of the decedent and the incidence of CNFs were identified. Analysis of the toxicology demonstrated that antipsychotics were implicated most frequently in cases of incomplete and complete hanging associated with CNFs and that opioids were implicated most frequently in cases of manual and ligature strangulation associated with CNFs. ObjectiveTo record the pattern of neck injuries sustained in retrospective cases of hanging and manual/ligature strangulation and to collate these findings so as to provide scientific evidence to support the interpretation of the findings in future cases of suicidal hanging and homicidal manual/ligature strangulation for the purpose of medicolegal investigation. To analyse the associations between the occurrence of neck fractures and anthropometric variables pertaining to the victims in cases of complete hanging. Study designThe reports of 298 Post Mortem Examinations (PMEs) performed for cases of hanging and manual/homicidal ligature strangulation between 2016 and 2020 in Ireland were retrospectively reviewed. Pseudoanonymised data sets were recorded for each report, which included the following parameters: neck injuries (soft tissue and cartilaginous), weight, height, BMI and ligature width, toxicology, noose position, ligature material, tongue protrusion, sex and age. Permission for the use of this data was sought from the pathologists and coroners involved in these cases. The data was analysed according to descriptive statistical methods and logistic regression analysis. ResultsLogistic regression analysis was undertaken to examine the associations between unit increases in ligature width and increases in a set of physical characteristics of the decedents (weight, BMI and height) with the occurrence of CNFs. Increasing ligature width was not found to increase the likelihood of a CNF occurring, where the Odds Ratio (OR) for this event occurring was 0.9596. Unit increases in body weight and BMI were found to increase the likelihood of the occurrence of a CNF with ORs of 1.0166 and 1.0607 respectively. Increasing height of the decedent yielded an OR = 4.64, demonstrating that CNFs are significantly more likely to occur with increasing height (CI 95 %: 0.2915, 73.9559). ConclusionsAccording to the statistical analysis performed for this study, increasing weight, height and BMI are parameters of the decedents which increase the likelihood of the occurrence of CNFs in cases of complete hanging.

Chronic villitis as a distinctive feature of placental injury in maternal SARS-CoV-2 infection

BackgroundSARS-CoV-2 infection during pregnancy is associated with increased risk of stillbirth, preeclampsia and preterm birth. However, this does not appear to be due to intrauterine fetal infection, as vertical transmission is rarely reported. There is a paucity of data regarding associated placental SARS-CoV-2 histopathology and their relationship to timing and severity of infection. ObjectiveTo determine if maternal SARS-CoV-2 infection is associated with specific patterns of placental injury and whether these findings differ by gestational age at time of infection or disease severity. Study DesignA retrospective cohort study was performed at University of California San Diego between 03/2020 to 02/2021. Placentas from pregnancies with a positive SARS-CoV-2 test were matched to two sets of controls: one set was time-matched by delivery date and sent to pathology for routine clinical indications, and the other was chosen from a cohort of placentas previously collected for research purposes without clinical indications for pathologic examination prior to the SARS-CoV-2 outbreak. Placental pathologic lesions were defined based on standard criteria and included maternal and fetal vascular malperfusion, and acute and chronic inflammatory lesions. Bivariate analysis was performed with independent Student’s T test and Pearson’s chi-square. Logistic regression was used to control for relevant covariates. Regions of SARS-CoV-2-associated villitis were further investigated using protein-based digital spatial profiling (DSP) assays on the GeoMx platform, validated by immunohistochemistry, and compared to cases of infectious villitis and villitis of unknown etiology. Differential expression analysis was performed to identify protein expression differences between these groups of villitis. ResultsWe included 272 SARS-CoV-2 positive cases, 272 time-matched controls, and 272 historical controls. The mean age of SARS-CoV-2 affected subjects was 30.1 ± 5.5 years and the majority were Hispanic (53.7%) and parous (65.7%). SARS-CoV-2 placentas demonstrated a higher frequency of the four major patterns of placental injury (all p<.001), compared to historical controls. SARS-CoV-2 placentas also showed a higher frequency of chronic villitis (CV) and severe CV (p=.03 for both) compared to time-matched controls, which remained significant after controlling for gestational age at delivery (aOR 1.52, 95% CI 1.01-2.28; aOR 2.12, 95% CI 1.16-3.88, respectively). DSP revealed programmed death-ligand 1 (PD-L1) to be increased in villitis-positive regions of the SARS-CoV-2 (logFC 0.47, adj p-value=0.002) and VUE (logFC 0.58, adj p-value=0.003) cases, but conversely decreased in villitis-positive regions of the infectious villitis group (log FC -1.40, adj p-value<0.001). ConclusionsCV appears to the most specific histopathological finding associated with SARS-CoV-2 maternal infection. CV involves damage to the vasculosyncytial membrane of the chorionic villi, involved in gas/nutrient exchange, suggesting potential mechanisms of placental (and perhaps neonatal) injury, even in the absence of vertical transmission. Surprisingly, changes in protein expression in SARS-CoV-2-associated villitis appear to be more similar to VUE rather than infectious villitis.