Substantial Injury Research Articles

Normal Tone-In-Noise Sensitivity in Trained Budgerigars despite Substantial Auditory-Nerve Injury: No Evidence of Hidden Hearing Loss.

Loss of auditory-nerve (AN) afferent cochlear innervation is a prevalent human condition that does not affect audiometric thresholds and therefore remains largely undetectable with standard clinical tests. AN loss is widely expected to cause hearing difficulties in noise, known as "hidden hearing loss," but support for this hypothesis is controversial. Here, we used operant conditioning procedures to examine the perceptual impact of AN loss on behavioral tone-in-noise (TIN) sensitivity in the budgerigar (Melopsittacus undulatus; of either sex), an avian animal model with complex hearing abilities similar to humans. Bilateral kainic acid (KA) infusions depressed compound AN responses by 40-70% without impacting otoacoustic emissions or behavioral tone sensitivity in quiet. Surprisingly, animals with AN damage showed normal thresholds for tone detection in noise (0.1 ± 1.0 dB compared to control animals; mean difference ± SE), even under a challenging roving-level condition with random stimulus variation across trials. Furthermore, decision-variable correlations (DVCs) showed no difference for AN-damaged animals in their use of energy and envelope cues to perform the task. These results show that AN damage has less impact on TIN detection than generally expected, even under a difficult roving-level condition known to impact TIN detection in individuals with sensorineural hearing loss (SNHL). Perceptual deficits could emerge for different perceptual tasks or with greater AN loss but are potentially minor compared with those caused by SNHL.SIGNIFICANCE STATEMENT Loss of auditory-nerve (AN) cochlear innervation is a common problem in humans that does not affect audiometric thresholds on a clinical hearing test. AN loss is widely expected to cause hearing problems in noise, known as "hidden hearing loss," but existing studies are controversial. Here, using an avian animal model with complex hearing abilities similar to humans, we examined for the first time the impact of an experimentally induced AN lesion on behavioral tone sensitivity in noise. Surprisingly, AN-lesioned animals showed no difference in hearing performance in noise or detection strategy compared with controls. These results show that perceptual deficits from AN damage are smaller than generally expected, and potentially minor compared with those caused by sensorineural hearing loss (SNHL).

Characterizing the Feeding Injury Caused by Phylloscelis rubra (Hemiptera: Dictyopharidae) to Cranberries.

Due to changes in pest management practices, farmers’ reports of severe feeding injury to cranberries, Vaccinium macrocarpon Aiton Ericales: Ericaceae, caused by the cranberry toad-bug, Phylloscelis rubra Ball, have increased in recent years in New Jersey (United States). Currently, however, limited information is available on the effects of P. rubra feeding or density of individuals needed to cause injury to cranberry vines and fruit. In 2015‒2017, we conducted studies to characterize injury to cranberry at a range of P. rubra densities by using cages in a screen-house and field, to establish a correlation between P. rubra density and crop injury in an open field experiment, and to measure the effects of P. rubra injury on the nutritional content (i.e., amounts of macro- and microelements) of cranberry vines. Phylloscelis rubra feeding on cranberry vines produced typical injury symptoms at relatively low densities (i.e., 2 individuals per vine in field cages or <10 individuals per sweep net sample in open fields), which included discolored (yellowish or reddish) or dead (brown) vines. This vine injury could lead to reductions in fruit mass and total fruit number. However, P. rubra injury to cranberry vines did not alter their nutritional composition. In general, this study highlights the ability of P. rubra to cause substantial injury to cranberry vines even when population densities were relatively low, which could result in declines in fruit production (quality and quantity). Therefore, infestations by P. rubra in cranberries must be considered when making pest management decisions in regions where this insect is present.

Raised Plasma Neurofilament Light Protein Levels After Rewarming Are Associated With Adverse Neurodevelopmental Outcomes in Newborns After Therapeutic Hypothermia.

Aim: To determine the predictive value of plasma neurofilament light protein (NfL) as a prognostic marker for outcomes in babies who have undergone therapeutic hypothermia (TH) for hypoxic ischemic encephalopathy (HIE).Method: NfL levels from three groups of term newborns were compared: (1) those with mild HIE who did not receive TH, (2) newborns treated with TH who had minimal or no brain injury on MRI, and (3) newborns treated with TH who had substantial brain injury on MRI. Follow-up outcomes were collected from 18 months onward.Results: Follow-up was available for 33/37 (89%) of children. A cutoff NfL level >436 pg/ml after rewarming (median age 98 h) was associated with adverse outcome with a diagnostic sensitivity 75%, specificity 77%, PPV 75%, and NPV 77%. NfL levels at earlier time points were not predictive of outcome.Interpretation: This pilot study shows that persistently raised plasma NfL levels after rewarming are associated with adverse outcomes in babies with HIE who have undergone TH.

Review of Sepsis in Burn Patients in 2020.

Background: Severe burn injury results in substantial damage to the skin, inhibiting its ability to perform as the primary barrier to infection. Additionally, severe burn injury can lead to critical illness and extensive time in the intensive care unit (ICU). These two factors work to increase the risk of sepsis in the burn patient compared with other hospitalized patients. The increased risk of sepsis is compounded by the difficulty of diagnosing sepsis in severely burned patients because the pathophysiology of large burns mimics sepsis, leading to possible delay in diagnosis and initiation of treatment. Methods: A literature review was performed to discuss and review the diagnostic difficulties and criteria used to identify patients with sepsis. Additionally, the most current management of sepsis was reviewed and described in caring for burn patients with sepsis. Results: The incidence of sepsis in patients with more than 20% total body surface area (TBSA) burns is between 3% and 30% and is the most common cause of death in the burn patient, with pneumonia being the most common etiology. Several different diagnostic criteria for diagnosing sepsis in burn patients exist, however, none of these criteria have proven to be superior to clinical diagnosis by an experienced burn surgeon. As with sepsis in other patient populations, prompt diagnosis, initiation of antibiotic agents, and source control remain the standard management of sepsis in the burn patient. Conclusions: Because of the loss of the primary infection barrier function of the skin after a substantial burn injury, this patient population is at increased risk for sepsis. Because of the pathophysiology of burn injuries, diagnosing sepsis in the burn population remains challenging. Understanding the most common etiologies of sepsis in burn patients may help with more expedient diagnosis and initiation of treatment.

Epidemiology of Traumatic and Overuse Injuries in Swiss Professional Male Ice Hockey Players.

Background:Ice hockey injury patterns in Europe were last evaluated in the 1990s.Purpose:The aim of this study was to assess the frequency, type, location, and incidence of traumatic injuries, as well as the prevalence and relative effect of overuse injuries in professional male ice hockey players.Study Design:Descriptive epidemiology study.Methods:Traumatic injuries were assessed using a standardized injury report form over a 1-year period (including the preparatory phase and season). The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire was used to determine overall and substantial overuse injuries and their relative effect on ice hockey players.Results:Five Swiss National League teams participated in the study. From a total of 321 recorded injuries, 179 led to time loss from sport. The game-related time-loss injury incidence during the season was 88.6/1000 player-game hours.Time-loss injuries affected mainly the hip/groin/thigh region (23%), followed by the head (17%). Most time-loss injuries were classified as muscle strains (24%), followed by concussions (18%). The most common injury mechanism involved collision with an opponent’s body (31%), and right forward players (23%) were most likely to report a game-related injury. Most injuries (27%) occurred within the defending zone along the boards. The average prevalence rates of all overuse and substantial overuse injuries were 49% and 13%, respectively. The hip/groin displayed the highest average prevalence for all overuse problems (16%), translating to the highest relative effect.Conclusion:Muscle strains and concussions were the most frequent time-loss injuries in Swiss professional ice hockey players. The hip/groin was the most affected region for both traumatic and overuse injuries.

Tocilizumab versus the Covid19 tempest: All’s well that ends well or much ado about nothing?

Tocilizumab versus the Covid19 tempest: All’s well that ends well or much ado about nothing?

Risk-sharing in the context of fishery mutual insurance: Learning from China

Although China remains the largest producer in the fishery industry worldwide, it faces substantial personal injuries and economic losses created by this sector. Considering insurance is a mechanism that potentially could deal with fishery-related losses, China set up private fishery insurance in the 1980s, but it largely failed in the 1990s. Over the past twenty-six years, China has developed an alternative financial mechanism, called fishery mutual insurance (FMI) to spread out risks, among which a large number of members are individual fishermen and owners of small-scale fishing vessels. Since 2008, there has been increasing financial support for FMI provided by the government. Guided by non-profitable FMI associations, FMI becomes a model of sharing risks among fishermen that create risks, which is substantially more like a risk-sharing agreement than a form of insurance. The paper analyzes the potential of this risk-sharing agreement in minimizing the total social costs of fishery-related activities in comparison to private insurance. Special interest is also given to identifying the problems that will constrain the promotion of FMI in the context of China.

Effectiveness of an e-health tennis-specific injury prevention programme: randomised controlled trial in adult recreational tennis players

BackgroundDespite reported injury rates of up to 3 per 1000 hours exposure, there are no evidence-based prevention programmes in tennis.PurposeTo evaluate the effectiveness of an e-health prevention programme for reducing...

Barriers of access and utilization of reproductive health services by adolescents-Khartoum state-Sudan-2020: study protocol

BackgroundAdolescence is widely defined as the time in life when the developing individual attains the skills and attributes necessary to become a productive and reproductive adult. Most adolescents are healthy, but there is still substantial premature death, illness, and injury among adolescents. Illnesses can hinder their ability to grow and develop to their full potential. Alcohol or tobacco use, lack of physical activity, unprotected sex and/or exposure to violence can jeopardize not only their current health, but also their health as adults or even health of their future children.MethodCommunity and institutional-based cross sectional study will be conducted in Khartoum State the seven localities will be included. This state is the national capital of Sudan, which has an area of 22,122 km2. The sample size of participant is estimated using the population formula (n = N/1+ (n*d2)). The sample will be drawn using multistage cluster sampling. Also the concerned bodies involved in the delivery of reproductive health services for adolescents included in this study. Data will be collected using interviews with key informants and administered pre-coded, pretested closed ended questionnaire with community participants. Data will be managed and analyzed using Statistical Package for Social Sciences version 21. Analysis is mostly univariate descriptive and bi-variate with Chi Square & Fischer Exact test analysis to find associations between variables of interest.DiscussionThe census of adolescents mounted to 25% of the population and thus it is important to care for such significant portion of the population to document their reproductive health problems and their access to health care services. The study is expected to generate base-line indicators about barriers of access to reproductive health services by adolescents that can be used for better planning, monitoring and evaluation of the delivered services. The research about barriers of access to reproductive health services by adolescents in Sudan is still limited and the information is scanty and scattered. Thus, it is necessary to conduct such study to enrich the current database.

Synergic Viral-Bacterial Co-Infection in Catalase-Deficient COVID-19 Patients Causes Suppressed Innate Immunity and Lung Damages Due to Detrimental Elevation of Hydrogen Peroxide Concentration

We propose a top-down approach for elucidating novel COVID-19 disease which caused unprecedented social and economic devastations globally. Detrimental outcome of antioxidant enzyme deficiency and synergism between SARS-CoV-2 virus and a bacterial pathogen, Streptococcus pneumoniae is the most likely cause of COVID-19-associated mortalities. As we age, production of the antioxidant catalase enzyme, which catalyzes the decomposition of hydrogen peroxide (H2O2) to water and oxygen, tails off; as a result, H2O2 starts to accumulate in body. Additional production of H2O2 by the bacteria increases H2O2 concentration up to a critical level in respiratory tract. The elevated H2O2 causes damages in lungs and oxidizes key components of the innate immune system, halts inflammasome activation process, and eventually suppresses it. Having suppressed innate immune response along with substantial lung injuries, synergic viral-bacterial co-infection leads to fast colonization of pathogens at the respiratory tract. The adaptive immune system kicks in too early and overreacts, and which results in overwhelming local and systemic cytokines release and hyperinflammations in the lungs. We have tested the validity of our proposal by analyzing recent clinical data on COVID-19, age- and gender-dependent COVID-19 death rates, H2O2 accumulation and antioxidant enzyme activities in cells, and the correlation between antioxidant-rich intake and COVID-19 death rate in various countries. Based on our analysis, it might be possible to explain COVID-19 peculiarities including why and how the immune system fails, why some infected people do not develop severe respiratory illness, why older people are affected the most, why male death rate is significantly higher than female death rate, why certain comorbidities are related with COVID-19 mortality, and why some Asian countries have very low death rates. We anticipate that the proposed mechanism might uncover the mystery of COVID-19 and may pave the way for finding a cure and vaccine for the coronavirus pandemic, and for understanding the viral-bacterial co-pathogenesis and related respiratory tract diseases.

Limited Coping Skills, Young Age, and High BMI Are Risk Factors for Injuries in Contemporary Dance: A 1-Year Prospective Study.

This study investigated potential risk factors (coping, perfectionism, and self-regulation) for substantial injuries in contemporary dance students using a prospective cohort design, as high-quality studies focusing on mental risk factors for dance injuries are lacking. Student characteristics (age, sex, BMI, educational program, and history of injury) and psychological constructs (coping, perfectionism, and self-regulation) were assessed using the Performing artist and Athlete Health Monitor (PAHM), a web-based system. Substantial injuries were measured with the Oslo Sports Trauma Research Center (OSTRC) Questionnaire on Health Problems and recorded on a monthly basis as part of the PAHM system. Univariate and multivariate logistic regression analyses were conducted to test the associations between potential risk factors (i.e., student characteristics and psychological constructs) and substantial injuries. Ninety-nine students were included in the analyses. During the academic year 2016/2017, 48 students (48.5%) reported at least one substantial injury. Of all factors included, coping skills (OR: 0.91; 95% CI: 0.84–0.98), age (OR: 0.67; 95% CI: 0.46–0.98), and BMI (OR: 1.38; 95% CI: 1.05–1.80) were identified as significant risk factors in the multivariate analysis. The model explained 24% of the variance in the substantial injury group. Further prospective research into mental risk factors for dance injuries with larger sample sizes is needed to develop preventive strategies. Yet, dance schools could consider including coping skills training as part of injury prevention programs and, perhaps, providing special attention to younger dancers and those with a higher BMI through transitional programs to assist them in managing the stress they experience throughout their (academic) career.

Injuries And Injury-related Pain Relationships To NSAID Use And Abuse In Collegiate Athletes

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used by athletes to treat musculoskeletal pain and injuries. The relationship between NSAID use and current pain and injuries in collegiate athletes in unknown. Understanding this relationship is important due to the potential for athletes to improperly obtain and abuse NSAIDs. PURPOSE: To investigate how pain and injury effects current collegiate athlete NSAID use during both in and out of season. METHODS: Athletes from all 3 NCAA Divisions self-reported data on in and out of season NSAID use, purchase, and dosage. The Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC) was used to evaluate current level of participation and pain. Logistic regressions were used to assess the relationship between current NSAID use and OSTRC total score. Models were adjusted for age, gender, NCAA division, history of orthopaedic surgery, and history of major injury, with unadjusted and adjusted Odds Ratios (OR) with 95% confidence intervals (95% CI). χ2 and Kruskall Wallis tests assessed the relationship between NSAID use and OSTRC overuse and substantial overuse injuries in and out of season. RESULTS: 252 athletes (age of 19.43 ± 1.2 years; Male: 28%; D1: 101, D2: 74, D3: 77) completed the survey. 33% currently used NSAIDs, 48% self-purchased, and 53% took two pills per dose. 36% did not answer where NSAIDs were obtained and 34% did not answer what dosage was taken. The OSTRC median score was 0 (IQR: 0-22). 53% had overuse injuries, while 20% had substantial overuse injuries. Current NSAID users had greater odds of having increased OSTRC scores (1.03 (95% CI: 1.02, 1.04), p<0.001). OSTRC overuse and substantial overuse injured athletes were more likely to use NSAIDs (over use: χ2 = 34.0, p<0.001; substantial overuse: χ2 = 28.2, p<0.001) and use them out of season (over use: χ2 =24.4, p<0.001; substantial overuse: χ2 = 21.4, p<0.001) as compared to non-overuse and non-substantial overuse injured athletes. CONCLUSION: NSAID use is high and the majority of athletes purchase their own NSAIDs, instead of receiving them from a medical professional. Injured athletes are more likely to use NSAIDs both in and out of season. Sports medicine professionals needs to monitor NSAID use and abuse in order to mitigate potential NSAID-related negative health impacts.

The Effect Of Injuries And Pain On Athletic Identity Across NCAA Divisions

There is a high prevalence of pain and injury in collegiate athletes, which can affect playing time and performance. Previous studies have observed that surgery and concussions can affect athletic identity. Currently, there is a paucity of research investigating how current pain and injury affect athletic identity. PURPOSE: To determine how current collegiate athlete pain and injury affect athletic identity and how these relationships differ across NCAA divisions. METHODS: NCAA division 1 (D1), 2 (D2), and 3 (D3) athletes were administered a questionnaire through an encrypted database. The Athletic Identity Questionnaire (AIM) and Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC) were used within the survey. AIM estimates self-perceived athletic identity while OSTRC measures level of participation, training volume, performance, and pain. Athletes were further classified by OSTRC scores into overuse and substantial overuse injuries. Multivariable and logistic regressions assessed the relationship between Aim, OSTRC scores, and overuse injury. Models were adjusted for age, gender, NCAA division, history of orthopedic surgery, and history of major injury, with unadjusted and adjusted coefficients and Odds Ratios (OR) with 95% confidence intervals (95% CI). RESULTS: 252 athletes (age of 19.4 years (1.2); female: 181, male: 70; D1: 101, D2: 74, D3: 77) participated. Mean AIM scores were D1: 37.98 (7.61), D2: 37.03 (37.03), and D3: 38.86 (6.98). The OSTRC median score was 0 (IQR: 0-22). 127 (50%) athletes had an overuse injury while 47 (19%) had a substantial overuse injury. Adjusted total OSTRC score was -0.67 (95% CI: -2.4, 1.1; p=0.474). Adjusted OR for OSTRC overuse injury was 1.00 (95% CI: 0.97, 1.04; p=0.589) and substantial overuse injury was 0.95 (95% CI: 0.91, 0.99; p=0.036). Similar results were observed between gender and division subgroups. CONCLUSION: After adjusting for confounding variables, it was determined that substantial overuse injuries negatively affected athletic identity, regardless of gender or NCAA division. Sports medicine professionals need to consider the possibility of lost athletic identity when an athlete sustains an injury. Measures should be taken to ensure that athletes continue to have meaningful contribution to sport following pain or injury.

The Effect Of Injuries And Pain On Athletic Identity Across NCAA Divisions

There is a high prevalence of pain and injury in collegiate athletes, which can affect playing time and performance. Previous studies have observed that surgery and concussions can affect athletic identity. Currently, there is a paucity of research investigating how current pain and injury affect athletic identity. Purpose: To determine how current collegiate athlete pain and injury affect athletic identity and how these relationships differ across NCAA divisions. METHODS: NCAA division 1 (D1), 2 (D2), and 3 (D3) athletes were administered a questionnaire through an encrypted database. The Athletic Identity Questionnaire (AIM) and Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC) were used within the survey. AIM estimates self-perceived athletic identity while OSTRC measures level of participation, training volume, performance, and pain. Athletes were further classified by OSTRC scores into overuse and substantial overuse injuries. Multivariable and logistic regressions assessed the relationship between Aim, OSTRC scores, and overuse injury. Models were adjusted for age, gender, NCAA division, history of orthopedic surgery, and history of major injury, with unadjusted and adjusted coefficients and Odds Ratios (OR) with 95% confidence intervals (95% CI). RESULTS: 252 athletes (age of 19.4 years (1.2); female: 181, male: 70; D1: 101, D2: 74, D3: 77) participated. Mean AIM scores were D1: 37.98 (7.61), D2: 37.03 (37.03), and D3: 38.86 (6.98). The OSTRC median score was 0 (IQR: 0-22). 127 (50%) athletes had an overuse injury while 47 (19%) had a substantial overuse injury. Adjusted total OSTRC score was -0.67 (95% CI: -2.4, 1.1; p=0.474). Adjusted OR for OSTRC overuse injury was 1.00 (95% CI: 0.97, 1.04; p=0.589) and substantial overuse injury was 0.95 (95% CI: 0.91, 0.99; p=0.036). Similar results were observed between gender and division subgroups. CONCLUSION: After adjusting for confounding variables, it was determined that substantial overuse injuries negatively affected athletic identity, regardless of gender or NCAA division. Sports medicine professionals need to consider the possibility of lost athletic identity when an athlete sustains an injury. Measures should be taken to ensure that athletes continue to have meaningful contribution to sport following pain or injury.

The Relationship Between Flourishing, Pain, And Injury In Collegiate Athletes

Flourishing encompasses a holistic representation of physical, psychological, and social health. However, pain and injury can negatively affect health. Currently, there is little research on flourishing within collegiate athletes. PURPOSE: To evaluate the relationship of pain and injury with flourishing in NCAA athletes and to compare by division. METHODS: NCAA division 1 (D1), 2 (D2), and 3 (D3) athletes were given a questionnaire incorporating the flourishing scale and the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC). Athletes were further classified by OSTRC scores into overuse and substantial overuse injuries. Multivariable regressions with logarithmic transformations and ANCOVAs were performed to investigate the relationship between flourishing and OSTRC pain and flourishing, overuse and substantial overuse injury. Confounders controlled for included age, gender, history of orthopaedic surgery and major injury, hours of sleep, and non-steroidal anti-inflammatory use. Unadjusted and adjusted effect size and 95% confidence intervals (95% CI) were reported. RESULTS: 253 athletes (Age: 19.43 (1.18) years; Male: 70; D1: 102, D2: 74, D3: 77; 7-8 hours of sleep: 157) participated. Mean flourishing scores were D1: 48.59 (10.43), D2: 50.08 (5.31), and D3: 48.58 (8.09). The median OSTRC score was 0 (0-22). 124 reported an overuse injury and 47 a substantial overuse injury. There was a unadjusted negative relationship between OSTRC total score and flourishing (-5.2% (95% CI: -10%, 1%), p=0.037); however there was no relationship after controlling for confounders (0.1% (95% CI: -2.6%, 2.7%), p=0.989). There was no relationship between overuse injury and flourishing (-0.23 (95% CI: -2.57, 2.11), p= 0.848). There was an unadjusted negative relationship between substantial overuse injuries and flourishing (-2.77 (95% CI: -5.43, -0.12), p=0.042), but there was no relationship after controlling for confounders (1.97 (95% CI: -4.95, 1.01), p=0.196). These relationships were similar by division. CONCLUSION: College athletes have high flourishing, and have similar flourishing between all NCAA divisions. Pain and injury have a negative relationship to flourishing; however, these relationships are confounded by surgical and injury history, and lifestyle.

Epidemiology of Injuries in Elite Female Futsal Players: A Prospective Cohort Study.

Injuries are one of the worst case scenarios for an athlete and a team. The aim of this study was to analyze the injury incidence, characteristics and burden among a cohort of elite female futsal players. A prospective cohort study was designed over a season. Eighty-nine players from seven elite female futsal teams were monitored during the whole season. Eight different variables were recorded when an injury happened, as well as exposure time. A total of 90 injuries were recorded so that 54 out of 89 players (60.6%) sustained an injury. The overall injury incidence was 5 injuries per 1000 h of futsal play exposure. Moderate injuries were the most frequent (1.7 injuries per 1000 h of futsal play exposure). The quadriceps and ankle were the regions where most injuries occurred. Contact injuries were more common during matches than training, and usually happened at the end of the season. Elite female futsal players are exposed to a substantial injury risk, especially on ankle and quadriceps with moderate severity, occurring at the end of the sessions, especially during matches. These results highlight the need of new preventive strategies to reduce the high injury incidence in female futsal players.

Patient-reported outcomes in young patients with isolated fracture of the hip.

Hip fractures in patients < 60 years old currently account for only 3% to 4% of all hip fractures in England, but this proportion is increasing. Little is known about the longer-term patient-reported outcomes in this potentially more active population. The primary aim is to examine patient-reported outcomes following isolated hip fracture in patients aged < 60 years. The secondary aim is to determine an association between outcomes and different types of fracture pattern and/or treatment implants. All hip fracture patients aged 18 to 60 years admitted to a single centre over a 15-year period were used to identify the study group. Fracture pattern (undisplaced intracapsular, displaced intracapsular, and extracapsular) and type of operation (multiple cannulated hip screws, angular stable fixation, hemiarthroplasty, and total hip replacement) were recorded. The primary outcome measures were the Oxford Hip Score (OHS), the EuroQol five-dimension questionnaire (EQ-5D-3L), and EQ-visual analogue scale (VAS) scores. Preinjury scores were recorded by patient recall and postinjury scores were collected at a mean of 57 months (9 to 118) postinjury. Ethics approval was obtained prior to study commencement. A total of 72 patients were included. There was a significant difference in pre- and post-injury OHS (mean 9.8 point reduction (38 to -20; p < 0.001)), EQ-5D (mean 0.208 reduction in index (0.897 to -0.630; p < 0.001)), and VAS , and VAS (mean 11.6 point reduction (70 to -55; p < 0.001)) Fracture pattern had a significant influence on OHS (p < 0.001) with extracapsular fractures showing the least favourable long-term outcome. Fixation type also impacted significantly on OHS (p = 0.011) with the worst outcomes in patients treated by hemiarthroplasty or angular stable fixation. There is a significant reduction in function and quality of life following injury, with all three patient-reported outcome measures used, indicating that this is a substantial injury in younger patients. Treatment with hemiarthroplasty or angular stable devices in this cohort were associated with a less favourable hip score outcome. Cite this article: Bone Joint J 2020;102-B(6):766-771.

Toothbrushing for Dependent Neurological Patients in the Intensive Care Unit

Toothbrushing for Dependent Neurological Patients in the Intensive Care Unit

A review of the characteristics of tornadic wind fields through observations and simulations

Tornadoes are violently rotating columns of air that may be produced by convective clouds and storms, and can produce substantial property damage, injuries, and deaths. To mitigate these losses and encourage accurate modeling and research in the field of civil engineering, with the goal of improving civil structure design, a comprehensive review of field measurements, lab simulations, and computational fluid dynamics (CFD) simulations of tornadoes is conducted. From this review, several tornadoes are examined and their characteristics presented. Specifically, characteristics of these tornadoes are provided in the following form: velocity of the wind field, pressure distribution associated with the wind field, tornado core radius, and flow structure (i.e., single vortex versus multiple vortices; for single vortex, one-celled versus two-celled). In addition, the driving forces behind tornadoes and the relationships between damage and reported intensity are examined, and the physical and numerical simulation of tornadoes conducted in civil engineering are reviewed. This paper is intended to provide a baseline review so that more accurate simulations of tornadic wind fields in civil engineering research can be made by providing some field-measured data from the meteorology community. This will benefit individual safety, community resilience and awareness, and simulation accuracy for future research.

Lambda light chain crystalline proximal tubulopathy with probable light chain cast nephropathy and clonal plasma cell infiltrate – uncommon manifestations of a rare form of multiple myeloma

Light chain proximal tubulopathy (LCPT) is an uncommon renal disease characterized by the accumulation of monoclonal light chains within proximal tubular epithelial cells, with or without crystal formation. We report a rare case of lambda LCPT with crystals. Renal biopsy showed substantial acute tubular injury with unusual cytoplasmic changes affecting proximal tubules. In addition, abnormal tubular casts suggested concomitant light chain cast nephropathy. A clonal plasma cell infiltrate was present in the tubulointerstitial compartment. Immunofluorescence demonstrated strong staining for lambda light chain in tubular epithelial cells. Despite the absence of discernible crystals on light microscopy (LM), they were readily identified when ultrastructural evaluation was undertaken. Crystalline inclusions demonstrated positive immunogold labelling for lambda.