Injury Status Research Articles

Factors That Impact the Long-Term Outcome of Postconcussive Dizziness Among Post-9/11 Veterans.

The primary aim of this study was to examine the factors associated with long-term outcomes of postconcussive disruptive dizziness in Veterans of the post-9/11 wars. For this observational cohort study, the Neurobehavioral Symptom Inventory-Vestibular subscale (NSI-V) score was used as an outcome measure for dizziness in 987 post-9/11 Veterans who indicated disruptive dizziness at an initial Veterans Health Administration Comprehensive Traumatic Brain Injury Evaluation (CTBIE). An NSI-V change score was calculated as the difference in the scores obtained at the initial CTBIE and on a subsequent survey. Differences in the NSI-V change scores were examined for demographics, injury characteristics, comorbidities, and vestibular and balance function variables, and multiple linear regression analyses were used to explore associations among the variables and the NSI-V change score. The majority of Veterans (61%) demonstrated a decrease in the NSI-V score, suggesting less dizziness on the survey compared with the CTBIE; 16% showed no change; and 22% had a higher score. Significant differences in the NSI-V change score were observed for traumatic brain injury (TBI) status, diagnoses of post-traumatic stress disorder (PTSD), headache and insomnia, and vestibular function. Multivariate regressions revealed significant associations between the NSI-V change score and the initial CTBIE NSI-V score, education level, race/ethnicity, TBI status, diagnoses of PTSD or hearing loss, and vestibular function. Postconcussive dizziness can continue for years following an injury. Factors associated with poor prognosis include TBI, diagnoses of PTSD or hearing loss, abnormal vestibular function, increased age, identification as a Black Veteran, and high school education level.

Physical Treatments to Control Clostridium botulinum Hazards in Food.

Clostridium botulinum produces Botulinum neurotoxins (BoNTs), causing a rare but potentially deadly type of food poisoning called foodborne botulism. This review aims to provide information on the bacterium, spores, toxins, and botulisms, and describe the use of physical treatments (e.g., heating, pressure, irradiation, and other emerging technologies) to control this biological hazard in food. As the spores of this bacterium can resist various harsh environmental conditions, such as high temperatures, the thermal inactivation of 12-log of C. botulinum type A spores remains the standard for the commercial sterilization of food products. However, recent advancements in non-thermal physical treatments present an alternative to thermal sterilization with some limitations. Low- (<2 kGy) and medium (3-5 kGy)-dose ionizing irradiations are effective for a log reduction of vegetative cells and spores, respectively; however, very high doses (>10 kGy) are required to inactivate BoNTs. High-pressure processing (HPP), even at 1.5 GPa, does not inactivate the spores and requires heat combination to achieve its goal. Other emerging technologies have also shown some promise against vegetative cells and spores; however, their application to C. botulinum is very limited. Various factors related to bacteria (e.g., vegetative stage, growth conditions, injury status, type of bacteria, etc.) food matrix (e.g., compositions, state, pH, temperature, aw, etc.), and the method (e.g., power, energy, frequency, distance from the source to target, etc.) influence the efficacy of these treatments against C. botulinum. Moreover, the mode of action of different physical technologies is different, which provides an opportunity to combine different physical treatment methods in order to achieve additive and/or synergistic effects. This review is intended to guide the decision-makers, researchers, and educators in using physical treatments to control C. botulinum hazards.

EXAMINATION OF FUNCTIONAL MOVEMENT STATUS, INJURY HISTORY AND SPECIFIC MOTOR PERFORMANCE AMONG YOUNG ELITE FOOTBALL PLAYERS

Purpose: The primary aim of this study was to find any relationship between total and selected FMS scores, recent (within two years) injury status, and specific motor performance. The secondary purpose of the study was to examine, wheather is there any relationship between injuries of the hamstring muscle and injuries of the hip and knee joints of the body.&#x0D; Material and methods: Youth and junior football players were volunteered to take part in our examination. A total of 45 subjects participated in our study, their age varied from 16 to 19. We implemented a five to one scoring system to identify the status of injuries. Finally, a complete FMS testing and a single leg (unilateral) standing long jump test were performed, involving all participants.Beside evaluating the total FMS scores of the participants, we chose to specifically stress on five test batteries out of seven. Out of the five tests we further focused on three FMS tests.&#x0D; Results and conclusion: In this given population, we have not found significant relationship between total FMS scores and overall scores (5 to 1) of injury status. Our results also did not indicate any significant correlation between selected FMS scores and single leg standing long jump performance.

Timely surgical fixation confers beneficial outcomes in patients' concomitant flail chest with mild-to-moderate traumatic brain injury: a trauma quality improvement project analysis - a cohort study.

Traumatic flail chest results in respiratory distress and prolonged hospital stay. Timely surgical fixation of the flail chest reduces respiratory complications, decreases ventilator dependence, and shortens hospital stays. Concomitant head injury is not unusual in these patients and can postpone surgical timing due to the need to monitor the status of intracranial injuries. Reducing pulmonary sequelae also assists in the recovery from traumatic brain injury and improves outcomes. No previous evidence supports that early rib fixation can improve the outcome of patients with concomitant flail chest and traumatic brain injury. Can early rib fixation improve the outcome of patients with concomitant flail chest and traumatic brain injury? Adult patients with blunt injuries from the Trauma Quality Improvement Project between 2017 and 2019 were eligible for inclusion. Patients were divided into two treatment groups: operative and nonoperative. Inverse probability treatment weighting was used to identify the predictors of mortality and adverse hospital events. Patients in the operative group had a higher intubation rate [odds ratio (OR), 2.336; 95% CI, 1.644-3.318; p <0.001), a longer length of stay (coefficient β , 4.664; SE, 0.789; p <0.001), longer ventilator days (coefficient β , 2.020; SE, 0.528; p <0.001), and lower mortality rate (OR], 0.247; 95% CI, 0.135-0.454; p <0.001). Timely rib fixation can improve the mortality rate of patients with flail chest and a concomitant mild-to-moderate head injury.

Single-Legged Triple-Hop Propulsion Strategies in Females With and Those Without a History of Anterior Cruciate Ligament Reconstruction.

The single-legged triple hop is a commonly used functional task after anterior cruciate ligament reconstruction (ACLR). Recently, researchers have suggested that individuals may use a compensatory propulsion strategy to mask underlying quadriceps dysfunction and achieve symmetric hop performance. To evaluate the performance and propulsion strategies used by females with and those without ACLR during a single-legged triple hop. Cross-sectional study. Laboratory. A total of 38 females, 19 with ACLR (age = 19.21 ± 1.81 years, height = 1.64 ± 0.70 m, mass = 63.79 ± 7.59 kg) and 19 without ACLR (control group; age = 21.11 ± 3.28 years, height = 1.67 ± 0.73 m, mass = 67.28 ± 9.25 kg). Hop distance and limb symmetry index (LSI) were assessed during a single-legged triple hop for distance. Propulsion strategies were evaluated during the first and second hops of the single-legged triple hop. Separate 2-way analysis-of-variance models were used to examine the influence of ACLR, joint, and their interaction on mechanical joint work, moment impulse, and the relative joint contributions to total work and moment impulse in females with and those without a history of ACLR. Despite achieving a mean LSI of approximately 96%, the ACLR group produced less total work in the reconstructed than the uninvolved limb during single-legged triple-hop propulsion (first hop: t18 = -3.73, P = .002; second hop: t18 = -2.55, P = .02). During the first and second hops, the reconstructed knee generated 19.3% (t18 = -2.33, P = .03) and 27.3% (t18 = -4.47, P < .001) less work than the uninvolved knee. No differences were identified between the involved and uninvolved limbs of the ACLR group in moment impulse (first hop: t18 = -0.44, P = .67; second hop: t18 = -0.32; P = .76). Irrespective of limb or group, the ankle was the largest contributor to both work and moment during both the first and second hops (P < .001). Clinicians should exercise caution when using a single-legged triple hop as a surrogate for restored lower extremity function in females post-ACLR. This recommendation is driven by the compelling findings that knee-joint deficits persisted in the reconstructed limb despite an LSI of approximately 96% and, regardless of previous injury status, single-legged triple-hop propulsion was predominantly driven by the ankle.

An Audit of Tracheostomy in Traumatic Brain Injury.

The timing of tracheostomy in traumatic brain injury is controversial. The benefits of early tracheostomy are early weaning from ventilation, and reduction in pneumonia. But some studies demonstrated increase in intracranial pressure during tracheostomy. The aims of the audit are to analyse the timing, benefits, complications, and the results of tracheostomy in patients with traumatic brain injury in the hospital in the period of 2012-2021. The number of patients was 34. The maximum number of tracheostomies(24) were between 6th to 14th days of admission. The complications were: worsening of Glasgow coma scale score - 3 (in the early group), bleeding - 2, subglottic stenosis-1, tracheocutaneous fistula-1. The main benefits obtained form tracheostomy were the easiness of weaning and tracheobronchial toilet. Twelve patients had pneumonia. Nine patients survived out of twelve. Six patients had acute respiratory distress syndrome. Five of them succumbed. The weaning time corresponded to the severity of injury and pulmonary status. The mortality according to the timing of tracheostomy were: 1/6(16.67%) in the group of first week, 9/19(47%) in the group of second week, and 3/8(37.5%) in the group of the third and fourth week. The mortality was less in the group of first week. The timing of tracheostomy in traumatic brain injury should be at the earliest after the control of raised intracranial tension. There was reversible worsening of Glasgow coma scale score for 2 points in 3 cases after early tracheostomy. Mortality was less in the group of early tracheostomy.

Clincal practice of pelvic exenteration for late complications of pelvic radiation injury

Pelvic radiation injury can potentially involve multiple pelvic organs, and due to its progressive and irreversible nature, its late stage can be complicated by fistulas, perforations, obstructions and other complications involved multiple pelvic organs, which seriously affect the long-term survival and the quality of life of patients. As a multidisciplinary surgical approach, pelvic exenteration has potential application in the treatment of late complications of pelvic radiation injury by completely removing the irradiated lesion, relieving symptoms and avoiding recurrence of symptoms. In clinical practice, we should advocate the concept of "pelvic radiation injury", emphasize multidisciplinary collaboration, fully evaluate the overall status of patients, primary tumor and pelvic radiation injury. We should follow the principles of "damage-control" and "extended resection", and follow the principle of enhanced recovery after surgery to achieve the goal of ensuring the surgical safety, relieving patients' symptoms and improving patients' quality of life and long-term survival.

Assessment of Oral Hygiene Status and Prevalence of Dental Caries and Traumatic Injuries to Anterior Teeth among Visually Impaired Children in Chennai City.

To assess the oral hygiene status and prevalence of dental caries and trauma to anterior teeth among visually impaired children in Chennai city. Settings and design-a cross-sectional study was conducted in institutionalized blind schoolchildren. A total of 130 children from two blind schools were selected based on the inclusion and exclusion criteria. Oral hygiene status was assessed using the oral hygiene index-simplified (OHI-S). Dental caries were assessed using decayed-missing-filled teeth (DMFT) and decayed, extracted due to carries, filled teeth (deft) index for permanent and primary dentition, respectively. Trauma to anterior teeth was assessed using Ellis and Davey classification. Statistical analysis used-all the data were analyzed using the Statistical Package for the Social Sciences (SPSS) software 20.0. The assessment of oral hygiene status showed that 54.6% of children had good oral hygiene, 45.4% had fair oral hygiene, and none had poor oral hygiene. The prevalence of dental caries in permanent and primary dentition was found to be 40 and 63.1%, respectively. The prevalence of trauma to anterior teeth was found to be 35.4%. Primary prevention approaches should be taught to parents and school teachers for early intervention of oral health problems. Kannappan J, Srinivasan D, Chiriyankandath JL, et al. Assessment of Oral Hygiene Status and Prevalence of Dental Caries and Traumatic Injuries to Anterior Teeth among Visually Impaired Children in Chennai City. Int J Clin Pediatr Dent 2023;16(1):93-96.

Injury Occurrence in Amateur Rugby: Prospective Analysis of Specific Predictors over One Half-Season.

Background and objectives: The incidence of injuries in rugby is extremely high, but studies have rarely examined the predictors of injury in amateur players. This study aimed to systematically analyse sports and injury factors as potential predictors of musculoskeletal injuries in senior-level amateur rugby players. Methods: The participants in this study were 101 senior-level rugby players from Croatia (average of 24.64 years old). At baseline, all participants were tested on sociodemographic and anthropometric parameters (age, body height and mass), consumption of dietary supplements, preseason injury status and training volume, and sport factors (position in game). Data on injury occurrence (dependent variable), prevalence of pain, training status, and characteristics of the played match were surveyed prospectively once a week during the three-month period (one half-season). Results: The logistic regression revealed a higher injury occurrence in forward players of the 1st row, 2nd row (OR = 5.07; 95% CI: 1.64-15.69), and center (OR = 4.72; 95% CI: 1.28-14.31), with reference to outside back players. When observed univariately, higher body mass, higher level of competition, more weekly training sessions, self-perceived pain, and playing with pain were significant injury risk factors. The multivariate logistic regression identified pre-season injury (OR = 1.30, 95% CI: 1.09-1.52), higher level of the game/match (OR = 1.44, 95% CI: 1.13-1.76), higher body mass (OR = 1.03, 95% CI: 1.01-1.05), and pain prevalence (OR = 5.71, 95% CI: 3.22-7.70) as multivariate predictors of injury occurrence over the season. Conclusion: The results of this study showed that among sport factors, the playing position, level of competition, and training exposure represent major injury risk factors. Therefore, in order to reduce the number of injuries, special emphasis should be placed on the specific tackling technique of forward players, which could both increase their situational efficiency and protect them from injuries. Additionally, perceived pain, injury history, and playing with injury were noted among injury factors as the ones that can be predictors of future injuries. In that manner, it is important that coaching and medical staff monitor players with previous injuries and with pain symptoms in order to act preventively against injury occurrence.

Clinical features of anemia in membranous nephropathy patients: a Chinese cohort study

Background Anemia is a common complication in patients with progressive chronic kidney disease. This cohort study evaluated the prevalence, clinical features and prognosis of membranous nephropathy (MN) with anemia. Methods We retrospectively analyzed a cohort of MN patients diagnosed using renal biopsy between February 2012 and February 2018. The clinical and pathological characteristics at baseline were recorded, and the outcomes (hemoglobin, proteinuria and renal function) during follow-ups were also evaluated. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for anemia in MN patients. The MN patients were divided according to the therapeutic effect they experienced as follows: without-anemia, completely corrected anemia, standard anemia treatment and nonstandard anemia treatment groups. We compared the rate of complete remission of MN and renal end-point events among the four groups. Results The median age of 483 patients was 42.43 (26.59, 50.20) years at the time of MN diagnosis. The prevalence of anemia at baseline was 23.81%, and the cumulative prevalence was 50.72%. There were 133 cases of mild anemia, 103 cases of moderate anemia and 9 cases of severe anemia; in addition, there were 228 cases of normocytic anemia and 17 cases of microcytic hypochromic anemia. Multivariate logistic regression indicated that acute renal tubule injury >5% (OR = 1.634, 95% CI 1.034, 2.581; p = 0.035), total protein level (OR = 0.949, 95% CI 0.923, 0.975; p < 0.001), cholesterol level (OR = 0.833, 95% CI 0.749, 0.926, p = 0.001), hypokalemia (OR = 2.612, 95% CI 1.227, 5.560, p = 0.013) and hypophosphatemia (OR = 2.653, 95% CI 1.303, 5.403, p = 0.007) were independent risk factors for anemia in MN patients. The complete remission rate of MN patients without anemia was significantly higher than that of anemia patients who exhibited treatment failure. The incidence of renal endpoint events was different among the four groups. Conclusion The anemia experienced by MN patients is mainly mild and moderate, normocytic anemia. The pathological features of acute renal tubular injury and clinical nutritional status are independent risk factors for anemia. There were differences in renal prognosis among anemia patients with different treatment outcomes.

Completeness of Pediatric Versus Adult Patient Assessment Documentation in the National Emergency Medical Services Information System

Background Pediatric prehospital encounters are proportionally low-frequency events. National pediatric readiness initiatives have targeted gaps in prehospital pediatric assessment and management. Regional studies suggest that pediatric vital signs are inconsistently obtained and documented. We aimed to assess national emergency medical services (EMS) data to evaluate completeness of assessment documentation for pediatric versus adult patients and to identify the documentation of condition-specific assessments. Methods We performed a retrospective cross-sectional analysis of EMS encounters from the National Emergency Medical Services Information System for 2019, including all 9-1-1 encounters resulting in transport. Our primary outcome was the proportion of encounters with complete vital signs (heart rate, respiratory rate, and systolic blood pressure) documented by pediatric age category relative to adult encounters. Pediatric patients were considered as those less than 18 years old. Our secondary outcome was condition-specific assessments for encounters with respiratory emergencies, cardiac complaints, and trauma. We performed multivariable logistic regression to calculate odds ratios (OR) and 95% confidence intervals (95% CI) for vital signs documentation by age after adjusting for sex, injury status, transport type (advanced vs basic life support), census region, urbanicity, organization nonprofit status, and organization type. Results Of 18,918,914 EMS encounters, 6.4% involved pediatric patients. Documentation of complete vital signs was lowest in those <1 month old (30.8%) and rose with increasing age (highest in adults; 91.8%). Relative to adults, the adjusted odds of documented complete vital signs in patients <1 month old was 0.03 (95% CI 0.03–0.03) and increased with age to 0.76 (95% CI 0.75–0.77) in those 12–17 years old. Among those patients with respiratory, cardiac, and traumatic complaints, children had lower proportions of documented pulse oximetry, monitor use, and pain scores, respectively, compared to adults. Conclusion Documentation of complete vital signs and condition-specific assessments occurs less frequently in children, especially in younger age groups, as compared to adults, which is a finding that exists across urbanicity, region, and level of response. These findings provide a benchmark for clinical care, quality improvement, and research in the prehospital setting.

Associations between sleep disorder symptoms, self-compassion, and basic psychological needs in Swiss elite athletes

Introduction Sleep is an important topic in competitive sports, however, there is only limited data from Switzerland in terms of prevalence of sleep disorders in athletes. Many factors may affect sleep, including demographic factors (e.g., age), current stressful events (e.g., injuries), but also factors like basic psychological need satisfaction and frustration as well as self-compassion. It is unclear to what extent all these factors are associated with sleep problems. Methods A representative sample of Swiss athletes (N = 1,003, Mage = 21.69, SDage = 7.09, 54% women, 37% team sports, 10% injured) answered questions about of sleep disorder symptoms, extent of basic need satisfaction and frustration, and self-compassion. Results The prevalence on symptoms of sleep disorders (18%) is comparable to elite sport samples from other countries. A multiple regression was conducted in order to evaluate central factors related to sleep disorder symptoms. Results show that older athletes (β = 0.16, p &lt; .001) and athletes who report need frustration (β = 0.20, p &lt; .001) experience more sleep disorder symptoms, while self-compassionate athletes address less symptoms (β = -.22, p &lt; .001). Need satisfaction, type of sport, gender and injury status were unrelated to sleep disorder symptoms (all βs &lt; 0.04, all ps &gt; .25). In total, all factors explained only 16% of the variance in sleep disorder symptoms. Discussion/Conclusion Interventions that prevent basic need frustration and increase self-compassion may be potential targets for improving sleep quality in athletes. In addition, other factors that are more strongly associated with sleep problems should be considered.

Silica Cross-Linked Micelle-Based Theranostic System for the Imaging and Treatment of Acute and Chronic Kidney Injury.

Acute kidney injury (AKI) is a common and serious disease with high mortality and morbidity, and the persistent inflammatory environment brought about by AKI promotes its deterioration into chronic kidney disease (CKD). An efficient and timely targeted drug delivery to the renal tubules is crucial for AKI treatment. Here, we prepared silica cross-linked micelles (SCLMs) with different sizes and studied their targeting ability to the injured kidney. It is found that the SCLMs with a size of 13 nm could rapidly accumulate and remain in the damaged kidney. Immunofluorescence results confirmed that SCLMs are selectively located in the damaged tubular cells but cannot be found in healthy renal tissue. Therefore, fluorescent dye-labeled SCLMs were used for the imaging of the injured kidney, which could reflect the status of the kidney injury. Furthermore, atorvastatin, an antioxidative and anti-inflammatory drug, was loaded in SCLMs as the therapeutic agents for the treatment of ischemia/reperfusion-induced AKI and CKD. Renal function indexes, such as tubular necrosis, collagen deposition, and inflammation, were effectively improved after the treatment.

Musculoskeletal Injury Risk in a Military Cadet Population Participating in an Injury-Prevention Program.

Background and Objectives: Musculoskeletal injuries are a major health hazard among military personnel. Previous research has proposed several exercise-based strategies for prevention. The purpose of this study was to investigate the effect of an exercise-based injury-prevention program on the incidence of musculoskeletal injury, motor performance and psychosocial status. Materials and Methods: Thirty-six Estonian Military Academy cadets were randomly assigned into either an intervention or control group. The intervention group followed a neuromuscular exercise-based injury-prevention warm-up program, three times per week for 6 months. The control group continued with the usual warm-up. The main outcome measure was injury incidence during the study period. Additionally, evaluation of isokinetic lower-extremity strength, postural sway, physical fitness and psychosocial status was included pre- and post-intervention. Results: During the 6-month study period, the musculoskeletal injury incidence was 43% in the intervention group and 54% in the control group (RR = 0.8; 95% CI = 0.41 to 1.99). The noted 20% risk reduction was not statistically significant (p = 0.59). Furthermore, there were no statistically significant differences between the intervention and control group in motor performance or psychosocial status measures. Conclusions: In conclusion, no effect of the exercise-based injury-prevention program on injury risk, motor performance or psychosocial status could be detected.

An exploratory study of salient family risk factors in relation to preschoolers’ unintentional injury in northwest China

Unintentional injury among Chinese preschoolers is an under-researched area. This study examined four salient risk factors underlying unintentional injury; these risk factors have been studied in samples of older children, but not preschoolers, in China. In light of an ecological systems theory, these factors can be conceptualized as three microsystem characteristics (only child status, main caregivers, and family mobility) and one mesosystem characteristic (residential area). We tested the hypotheses that only child status, having caregivers other than two parents, family mobility, and rural residential area would be associated with increased risk for unintentional injury in preschoolers. Caregivers of 217 preschoolers in northwest China completed a questionnaire on their family characteristics and their children’s injury status over the last year. Age, gender, and family SES were controlled for in the analyses. Logistic regression showed that urban children and those in high mobility families were more than twice as likely to have unintentional injuries than rural children and those in low mobility families. Tests of moderation showed that being in a high mobility family, and being cared for by other than two parents, each increased the injury risk for rural preschoolers. The results are discussed in terms of the importance of studying the micro- and mesosystems of preschoolers in the context of China’s rapid economic growth, as well as the importance of designing research-based prevention programs to reduce preschoolers’ risk of unintentional injury.

Bone mineral density in patients with chronic spinal cord injury: An observational study

Background: Spinal cord injury (SCI) is accompanied by loss of bone mass caused by accelerated bone remodeling, with bone resorption exceeding bone formation which causes net bone loss. The significance of osteoporosis after SCI is that it results in skeletal fragility and an increased risk of fractures. Complications from fractures lead to an increase not only in the associated morbidity and mortality, but also in the health-care costs that they generate. Aims and Objectives: The objective of the study was to evaluate bone mineral density (BMD) in patients with SCI in Indian population and to determine the effects of the neurological level, severity of injury, and mobility status on BMD. Materials and Methods: This study was a prospective and observational study conducted on 52 chronic SCI patients. After detailed history and examination, patients were assessed using American spinal injury association impairment scale following which BMD was assessed by Dual Energy X-ray Absorptiometry Scan. Correlation between the T score and neurological level, severity of injury and mobility status was assessed. P&lt;0.05 was considered statistically significant. Results: Out of 52 patients included, 41 were having complete SCI and 35 were non-ambulatory. T score was significantly (P&lt;0.001) lower in lumbar spine and both femur in complete SCI patients. The T score was indicative of increased osteoporosis in non-ambulatory patients. BMD did not differ significantly (P&lt;0.059) in patients with relation to various neurological levels. Conclusion: From this study, we conclude that osteoporosis is commonly present in patients with complete SCI and non-ambulatory was more affected. Early mobilization of these patients reduces the development of osteoporosis.

VATS VERSUS LAPAROSCOPY TRAUMATIC DIAPHRAGMATIC INJURY REPAIR

Introduction:Diaphragmatic injury is usually missed in case of trauma patient, clinical picture is usually masked by other abdominal or thoracic injuries. CXR (chest X ray), abdominal ultrasound have a high rate of missing. High index of suspicion is required to diagnose diaphragmatic injury. Discussion:Comparison between 20 cases of traumatic diaphragmatic injury. Surgery is the only treatment. Different approaches are used, taking advantage of the wide spread practice of minimal invasive surgeryVATS (Video assisted thoracoscopic surgey) and laparoscopy. Overlooked injuries are usually on the right side and after blunt trauma in these cases open surgery is favoured.Prolene stitch repair (primary repair) was the main modality of repair, mesh repair was used in larger tears with poor quality tissues .Quality of life improves remarkably after repair with most patients discharged from hospital within few days. Conclusion:VATS and Laparoscopy show efficiency in both diagnosis and treatment of diaphragmatic injuries. Conversion to open surgery may be needed in case of severe visceral injuries.Combined approach needs good communication between thoracic and general surgeonsOutcome is usually favourable with competent long term repair. Uunfavourable outcome is associated with multiple visceral organ injury and critical pre operative status.

Evaluation of Non-fatal Forensic Vascular Injuries

In the forensic report, whether the injury includes "vascular injury" or not, the life-threatening situation is important for the investigation. In this study, it was aimed to evaluate the vascular injury status and share the data with the literature in cases related to forensic traumatology, which were reflected in the Forensic Medicine Department of Eskişehir Osmangazi University Faculty of Medicine. In the 5-year period between 2015 and 2019, the cases with vascular injury, who applied to the Eskişehir Osmangazi University Faculty of Medicine, Department of Forensic Medicine, were retrospectively analyzed. Report contents and demographic data of the cases were evaluated. It was determined that 52 (1.2%) of 4378 forensic cases evaluated within the scope of the study had vascular injury. 90.3% of the patients with vascular injury were male, they were most frequently in the 19-29 age group, 69.3% of the cases were stab wounds, and the most commonly injured vessel was a.femoralis and its branches (n=11, %21.2). The data obtained in the study were found to be compatible with the literature. It was thought that in-service trainings on this subject were important, especially for emergency room doctors to be more attentive in issuing forensic reports, to take necessary measures to prevent them from being held responsible in cases of vascular injury and other forensic cases, to protect the legal rights of victims.

Cost-effectiveness analysis of overground robotic training versus conventional locomotor training in people with spinal cord injury

BackgroundFew, if any estimates of cost-effectiveness for locomotor training strategies following spinal cord injury (SCI) are available. The purpose of this study was to estimate the cost-effectiveness of locomotor training strategies following spinal cord injury (overground robotic locomotor training versus conventional locomotor training) by injury status (complete versus incomplete) using a practice-based cohort.MethodsA probabilistic cost-effectiveness analysis was conducted using a prospective, practice-based cohort from four participating Spinal Cord Injury Model System sites. Conventional locomotor training strategies (conventional training) were compared to overground robotic locomotor training (overground robotic training). Conventional locomotor training included treadmill-based training with body weight support, overground training, and stationary robotic systems. The outcome measures included the calculation of quality adjusted life years (QALYs) using the EQ-5D and therapy costs. We estimate cost-effectiveness using the incremental cost utility ratio and present results on the cost-effectiveness plane and on cost-effectiveness acceptability curves.ResultsParticipants in the prospective, practice-based cohort with complete EQ-5D data (n = 99) qualified for the analysis. Both conventional training and overground robotic training experienced an improvement in QALYs. Only people with incomplete SCI improved with conventional locomotor training, 0.045 (SD 0.28), and only people with complete SCI improved with overground robotic training, 0.097 (SD 0.20). Costs were lower for conventional training, $1758 (SD $1697) versus overground robotic training $3952 (SD $3989), and lower for those with incomplete versus complete injury. Conventional overground training was more effective and cost less than robotic therapy for people with incomplete SCI. Overground robotic training was more effective and cost more than conventional training for people with complete SCI. The incremental cost utility ratio for overground robotic training for people with complete spinal cord injury was $12,353/QALY.ConclusionsThe most cost-effective locomotor training strategy for people with SCI differed based on injury completeness. Conventional training was more cost-effective than overground robotic training for people with incomplete SCI. Overground robotic training was more cost-effective than conventional training for people with complete SCI. The effect estimates may be subject to limitations associated with small sample sizes and practice-based evidence methodology. These estimates provide a baseline for future research.

Reliability and repeatability of a modified thoracolumbar spine injury classification scoring system.

On the basis of the Thoracolumbar Injury Classification and Severity Score (TLICS), an modified TLICS classification system was presented, its reliability and repeatability were assessed, and the factors influencing classification consistency were examined. Five spinal surgeons were chosen at random. The clinical data of 120 patients with thoracolumbar fractures admitted to the Department of Spine Surgery, Ningbo Sixth Hospital from December 2019 to June 2021 were categorized using the modified TLICS system. After 6 weeks, disrupt the order of data again. Using unweighted Cohen's kappa coefficients, the consistency of the modified TLICS system was assessed in five aspects: neurofunctional status, disc injury status, fracture morphology, posterior ligament complex (PLC) integrity, and treatment plan. In terms of reliability, the average kappa values for the subclasses of the modified TLICS system (neurofunctional status and disc injury status) were 0.920 and 0.815, respectively, reaching the category of complete confidence. Fracture morphology and treatment plan had average kappa values of 0.670 and 0.660, respectively, which were basically reliable. The average kappa value of PLC integrity was 0.453, which belonged to the category of moderate confidence. The average kappa coefficients of each subcategory (neurological status, disc injury status) had excellent consistency, and the kappa values were 0.936 and 0.879, respectively, which belonged to the completely credible category. The kappa values of fracture morphology and treatment plan repeatability were 0.772 and 0.749, respectively, reaching the basic credibility category. PLC integrity repeatability kappa value is low, 0.561, to moderate credibility category. The modified TLICS system is intuitive and straightforward to understand. The examination of thoracolumbar fracture injuries is more exhaustive and precise, with excellent reliability and repeatability. The examination of neurological status and disc injury status is quite reliable and consistent. The consistency of fracture morphology is slightly poor, which is basically credible; the PLC integrity consistency is poor, reaching a reliability level of moderate, which may be associated with the subjectivity of clinical evaluation of PLC.