Typical Injury Research Articles

EDITORIAL COMMENT

In this article the authors present their institution's experience with “early” vs “late” repair of iatrogenic ureteral injuries. Their cohorts did not display any significant differences in outcomes regardless of whether the repair was within 7 days from injury or later. It is commendable that the 2 groups had such extensive follow-up, likely related to the fact that these patients had iatrogenic injuries and not the typical traumatic injury. 1 Palmer LS Rosenbaum RR Gershbaum MD et al. Penetrating ureteral trauma at an urban trauma center: 10-year experience. Urology. 1999; 54: 34-36 Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar

Localized Axolemma Deformations Suggest Mechanoporation as Axonal Injury Trigger.

Traumatic brain injuries are a leading cause of morbidity and mortality worldwide. With almost 50% of traumatic brain injuries being related to axonal damage, understanding the nature of cellular level impairment is crucial. Experimental observations have so far led to the formulation of conflicting theories regarding the cellular primary injury mechanism. Disruption of the axolemma, or alternatively cytoskeletal damage has been suggested mainly as injury trigger. However, mechanoporation thresholds of generic membranes seem not to overlap with the axonal injury deformation range and microtubules appear too stiff and too weakly connected to undergo mechanical breaking. Here, we aim to shed a light on the mechanism of primary axonal injury, bridging finite element and molecular dynamics simulations. Despite the necessary level of approximation, our models can accurately describe the mechanical behavior of the unmyelinated axon and its membrane. More importantly, they give access to quantities that would be inaccessible with an experimental approach. We show that in a typical injury scenario, the axonal cortex sustains deformations large enough to entail pore formation in the adjoining lipid bilayer. The observed axonal deformation of 10–12% agree well with the thresholds proposed in the literature for axonal injury and, above all, allow us to provide quantitative evidences that do not exclude pore formation in the membrane as a result of trauma. Our findings bring to an increased knowledge of axonal injury mechanism that will have positive implications for the prevention and treatment of brain injuries.

Imaging Evaluation of Tracheobronchial Injuries.

Tracheobronchial injuries are a rare but potentially life-threatening cause of respiratory insufficiency, with high mortality rates. For patients with potentially survivable tracheobronchial injuries, imaging in the acute setting plays a key role in demonstrating the injuries and associated complications. The radiologist can improve outcomes by understanding typical injury patterns according to injury mechanism and the influence that imaging findings may have on treatment decisions. Chest radiography and cervical and thoracic CT are the mainstays of imaging in the acute setting and in follow-up, often as part of a whole-body trauma imaging series. The authors first consider the influence of normal tracheobronchial anatomy with regard to protective features, such as cartilaginous rings. They also discuss inherent points of vulnerability, such as points of relative fixation at the carina. A framework is then provided for understanding the typical distribution and morphology of tracheobronchial injuries according to cause. This includes penetrating, iatrogenic, and blunt force mechanisms, with consideration of potential complications. The authors highlight treatment strategies that require multidisciplinary collaboration, such as ventilation, minimizing injuries, and defining optimal surgical or nonsurgical treatment. ©RSNA, 2020.

P316 Hepatobiliary manifestations measured by vibration-controlled transient elastography in inflammatory bowel disease: A prospective hospital-based cohort study

Abstract Background Intestinal mucosal injury is supposed to cause liver disease and inflammatory bowel disease (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) is a typical chronic injury of intestinal mucosa. Therefore, we investigated the hepatobiliary manifestation with liver ultrasonography (LUS) and vibration-controlled transient elastography (VCTE) in IBD. Methods IBD patients newly diagnosed in Kosin University Gospel Hospital were enrolled consecutively. Gross hepatobiliary abnormality was evaluated with LUS and simultaneous liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) were assessed to evaluate hepatic injury and steatosis with VCTE. Laboratory tests including hepatic biochemistries, anti-nuclear antibody (ANA), and faecal calprotectin level (FC) were taken. Results Eighty-two (37 patients of CD and 45 UC) patients were enrolled. Gallbladder abnormality was noted in 39 patients (47.5%) including stone in 7, sludge in 11, polyp in 10, wall thickening in 9 and collapsed in 2. CAP >233 dB/m was in 33 patients (40.2%) and LSM >5.5 kPa in 10 (12.2%). Nineteen patients (23.2%) were diagnosed fatty liver. FC was 382 ± 785 (mean ± SD). CAP >233 dB/m was significantly associated with lower FC (209.6 vs. 352.1, p = 0.038). The correlation coefficient was −0.316 between CAP and FC (p = 0.006). LSM >5.5 kPa tended to be lower FC but was not statistically significant (199.8 vs. 306.2, p = 0.283). ANA was positive in 14 patients (17.1%). In ANA positive patients, FC was significantly higher than ANA negative patients (609.5 vs. 319.4, p = 0.015). Conclusion In this prospective analysis, the major hepatobiliary manifestations in IBD patients were gallbladder abnormality and fatty liver and there could be an association between low hepatic fat amount and intestinal disease activity.

Разработка стенда для демонстрации поражения человека напряжениями прикосновения и шага вблизи воздушной линии 10 кВ

An objective to develop a labor protection engineering stand was set forth as part of the research and development work "Carrying out theoretical and experimental investigations and development of stands for demonstrating the danger of electric shock at a training ground" for visually demonstrating the danger of injuring a person by touch and step voltages in 3…35 kV medium voltage electric networks. The technical solutions for practically implementing the stand were adopted based on an analysis of regulatory documents, conditions under which dangerous touch and step voltages occur, the most typical human injury cases, and calculation results. Specialists of the National Research University Moscow Power Engineering Institute Department of High Voltage Engineering and Electrophysics, working jointly with specialists of PJSC Rosseti Moscow Region have developed, manufactured, tested, and put into operation a stand for demonstrating human injury by the touch and step voltages when a 10 kV wire falls on the ground, on a car, and when a fault of a live wire on the overhead line support occurs. With the stand having been put in use at the PJSC Rosseti Moscow Region Training Center Ground, this will allow the staff to form a clear understanding of the electric shock danger, to focus on the effects caused by voltage and current, and thereby significantly reduce electrical injuries.

Кривизна кривой как показатель оптимальности траектории движения в физической реабилитации. Эллиптические реабилитационные движения

The movement dynamic characteristics are the main parameters for physical exercise dosing during the athlete recovery process. However, taking into account the geometric characteristics of movement is no less important, especially when restoring the joint range of motion. The hypothesis of the study was the assumption that the use of movements’ geometric characteristics allows to “design” the optimal physiological rehabilitation patterns for movement volume restoration. Objective: to develop general principles and to create a mathematical model of the optimal trajectory characteristics for the restored part of the athlete’s musculoskeletal system. Materials and methods: We used 3D Qualisys Motion Capture and Analysis System in our investigation. The study involved 32 complex coordination sports athletes (age 9-15) with hip and ankle joint injuries (bruises, sprains strains). All they required a joint movement volume restoration. Results: The study revealed that joint movement volume restoration following the individually selected pathways involving effective mathematical modeling (study group) takes shorter time to restore the athletes than traditional physiotherapy methods (control group). For typical injuries (bruises, sprains and strains) of the hip joint area, the rehabilitation took 18±5 days for controls and 12±3 days for experimental group subjects. Nearly the same pattern was observed in restoration the ankle joint (12±4 days of recovery for controls versus 8±3 days for the experimental group). Conclusions: Restoring the joint movement volume, the workloads should be evaluated with geometric rather than dynamic indicators; for planar movement, that should be the distal limb path curvature relative to the restored joint.

New developments in neutrophil biology and periodontitis.

Neutrophils have been historically associated with antimicrobial functions in acute infections but are now appreciated as functionally versatile cells with critical roles in chronic inflammation. Recent advances in neutrophil biology have contributed to a better understanding of periodontal disease pathogenesis and, reciprocally, the study of periodontitis has led to important insights into neutrophil regulation and function. Here, the contributions by our group to this field through interdisciplinary collaboration are discussed. The study of leukocyte adhesion deficiency-associated periodontitis has revealed that the connection of neutrophils with destructive inflammation may involve mechanisms beyond the typical bystander injury dogma. In this regard, neutrophils are required for important immunomodulatory functions and their absence from the periodontium leads to dysregulated overproduction of interleukin-17, which drives inflammatory bone loss. We have also discovered that both the production of neutrophils in the bone marrow and their recruitment to peripheral tissues, including the periodontium, are homeostatically regulated by a secreted protein designated developmental endothelial locus-1. However, developmental endothelial locus-1 expression, and hence developmental endothelial locus-1-dependent homeostasis, declines considerably with aging and contributes to an increased susceptibility to periodontitis in old age. Moreover, our work has mechanistically supported the concept that periodontitis is a dysbiotic disease and we have shown that neutrophils become targets of immune subversion by periodontal bacteria in a manner that promotes dysbiosis. The mechanism involves microbial exploitation of key neutrophil receptors (complement C5a receptor-1 and toll-like receptor-2), leading to crosstalk signaling that uncouples neutrophil-mediated killing (which is impaired) from neutrophil-induced inflammation (which is enhanced). These studies have collectively established new mechanisms governing the protective and destructive functions of neutrophils in periodontitis and offered targeted host-modulation approaches for the treatment of periodontal diseases.

Fireworks injuries of the eye: an overview of current diagnostic and treatment options

Fireworks can cause very different eye injuries. The injury patterns range from spontaneously healing conjunctival and corneal lesions up to a burst eyeball with very severe injuries in the posterior ocular section and traumatic enucleation. The precise initial diagnosis in an emergency situation can be a challenge for the ophthalmologist. Children and adolescents are often affected. The patient history with respect to the circumstances of the accident is particularly important to be able to estimate the extent of the injury and to initiate a conservative or, if necessary, emergency operative treatment. This article provides an overview of typical injury patterns and advice for the diagnostics, treatment and complication management.

Analysis Regarding the Risk of Injuries of Soldiers Inside a Vehicle during Accidents Caused by Improvised Explosive Devices

This article presents the description of the mechanism of selected dysfunctions of the human skeletal system and internal organs. The problem is wide and requires extensive experimental and numerical research. This article presents the outline of the problem regarding the creation of personal injuries of soldiers inside armored vehicles. The explanation of the mechanism of injuries caused as a result of strong effects of pulse forces, resulting from both the consequences of the wave of pressure created during an explosion, as well as high accelerations of the vehicle’s hull, is presented herein. Examples of the results of numerical analyses of the pressure wave impact from an explosion are presented in the Article. LS-Dyna software was used to perform the numerical calculations. The analyses were carried out using the Conwep algorithm implemented in the calculation code. The significance of calculation methods, thanks to which it is possible to recreate a simulation in which there is a risk of injuries of soldiers without posing a threat to their health and life, should be noted here. The main parts of the human body, such as the bottom limb, the pelvic belt, the cervical spine and the abdomen, have been considered. Mechanisms causing typical injuries of soldiers inside vehicles under which explosives are detonated have been analyzed for particular body parts through multiple numerical simulations. The analysis of the process of injury creation has been conducted on the basis of the statistical data regarding the most common injuries of soldiers. The validation process of numerical analyses was carried out using the results of experimental research.

High voltage electrocution injury – A case report

High voltage electrical injuries are comparatively unusual but show a high rate of mortality. A dead body of a truck driver who died while his truck trapped in overhead high-voltage cables was brought for post-mortem examination. The autopsy revealed typical electrocution injuries with first and second-degree burns, peeled off epidermis and flash burns around the body at different areas. The severity of electric shock varies between simple harmless shock to death. The passage of electric current through the body produces wide range of effects, varying from insignificant localized spasm, little or no contact burns, fatality with little or no burns or extreme severe burning. This case report discusses the injuries sustained by a young adult drive while driving a truck, due to accidental contact of vehicle with overhead high-tension wire. Keywords: High-voltage electrocution, Accidental contact, Burns, Electrical injuries.

Non-adult Fracture Patterns in Late and Post-medieval Flanders, a Comparison of a Churchyard and a Church Assemblage

ABSTRACTThe study of trauma in non-adults (<18 years) from archaeological assemblages is relatively recent, partly because immature bones present distinct injury patterns, while rapid healing and remodelling can erase macroscopic evidence. However, non-adult trauma provides information about age-related differences in risk, and the lifestyles and social roles of immature individuals. This study recorded possible fractures in 135 non-adults from a churchyard and a church assemblage from medieval and post-medieval Flanders, to evaluate the presence of fractures and analyse type, prevalence, age distribution, and socio-economic differences. Eighteen individuals presented lesions, including typical non-adult injuries. Prevalence was generally low , but some trends emerged. The churchyard had a higher prevalence, and these individuals likely had a lower social background compared to the church, suggesting socio-economic differences. In the churchyard assemblage older non-adults showed an increased prevalence, possibly related to occupational risks since many children and particularly adolescents, worked as servants, labourers, or apprentices.

Involvement of ABA and antioxidant system in brassinosteroid-induced water stress tolerance of grapevine (Vitis vinifera L.)

The objective of this study was to investigate the role of the ascorbate-glutathione (AsA-GSH) cycle and abscisic acid (ABA) in brassinosteroids (BRs)-induced water tolerance in grape seedlings. The grape seedlings were treated with half-strength Hoaglands nutrient solution, polyethylene glycol (PEG-6000) and PEG combination with 24-epibrassinolide (EBR). The results showed that water stress led to typical drought injury symptoms and significantly increased in the contents of hydrogen peroxide (H2O2), the production rate of superoxide radicals (O2−) and the decrease in the contents of ascorbic acid, reduced glutathione in grape seedlings. However, application of EBR alleviated the water stress injury symptoms, reduced the H2O2 content and O2− production rate and enhanced the contents of antioxidants and the activities of antioxidases involved in the AsA–GSH cycle. Interestingly, the ABA content, the transcriptional activation of some key genes involved in ABA biosynthesis including VviNCED1, VviNCED2 and VviZEP and ABA signaling-key genes (VviSnRK2.6, VviPP2C4, VviABF1 and VviABF2) were further enhanced with EBR treatment under water stress. Taken together, we speculate that there is a more complex mechanism in the crosstalk of BR and ABA under drought stress in grape seedlings and ABA is involved in brassinosteroids-induced antioxidant defense.

PATHOGENETIC PARTICULARITIES OF THE ROAD TRAFFIC INJURIES OF THE PRESENT

The purpose of the work is to analyze the structure and characteristics of injuries resulting from traffic accidents, which will undoubtedly contribute to the development of pathogenetically grounded treatment measures and will reduce the level of negative consequences. Materials and methods. The severity of road accidents in Ukraine and the Sumy region was investigated by determining the F't factor, calculated as the ratio of the number of casualties and deaths to the total number of accidents. In order to assess the severity of injuries suffered by the victims, a standardized PTS-Hannover Damage Assessment System was used. To determine the causes and nature of the traffic accident, there was carried out an inspection and an anonymous non-personal survey of 124 traumatized patients who were undergoing treatment in the medical institutions of the Sumy region. Results. The reasons and circumstances under which traffic accidents occurred, with 124 people being injured, the structure and character of the damage they received have been analyzed. It has been established that the integral ten-year value of F't in Ukraine is (0.23 ± 0.004), and in the Sumy region it is (0.41 ± 0.013). The trend is determined to increase the severity of accidents both in the Sumy region and in Ukraine as a whole. The main causes of road accidents were violations of the road safety rules by the drivers (54.03 %) and driving in the state of alcoholic intoxication (16.94 %). In most cases, the victims suffered multiple and combined injuries. Most often there was a combination of skeletal and craniocerebral trauma (18.55 %), and skeletal trauma connected to the craniocerebral injury and trauma of the chest (11.29 %). When studying the variety of lesions, the changes in nosological structure of characteristic and specific road traffic injuries were noted. Conclusions. The main causes of the road accident occurrence were the violations of traffic safety rules by the drivers and driving in a state of intoxication. Most often, the victims had a combination of skeletal and craniocerebral trauma, and a skeletal trauma connected to the craniocerebral injury and trauma of the chest. Over the past 10 years there have been changes in the structure of specific and typical road traffic injuries, which, in our opinion, are due to the constructive features of a modern motor transport vehicle, means of internal and external passive safety.

Critical Care Specific Medical Materials Preparedness in the Emergency Department for Mass Shooting Disasters

Introduction:There has been a dramatic increase in the number of mass shootings (loosely defined as an incident with four or more indiscriminate victims) in the United States (1). Additionally, the use of high-caliber, military-style weapons, has become more common in civilian shootings. These trends should influence how emergency departments prepare for disasters, including an inventory of what critical care medical materials (supplies) are readily available in the event of a disaster.Aim:To demonstrate the need for the adoption of medical materials planning for disasters to account for new injury patterns from mass shootings.Methods:A review of injury patterns from recent mass shootings was conducted using available literature (2). The average number of victims presenting to the emergency department in these events was reviewed. Estimation of critical care specific medical materials in the emergency department required for the management of an “average” number of victims with the typical injury pattern of these events was conducted.Results:Some critical care specific medical materials: intubation equipment, chest tubes, and central venous catheters may be in short supply during a mass shooting event.Discussion:Emergency physicians must anticipate and prepare for new disaster trends such as mass shootings and high caliber weapons injuries. This includes having specialty medical supplies readily available in sufficient amount. Normal stocking of critical care specific medical materials may be inadequate in a mass shooting event based on the available literature.

Fracture energy threshold in parry injuries due to sharp and blunt force.

Blows with axes, machetes or blunt objects such as baseball bats, truncheons, etc. are often parried, resulting in typical parry injuries, or so-called nightstick fractures to the ulna. In this study, we sought to assess the impact energy required to break the ulna in such parry incidents in an experimental setting using semisynthetic and fully synthetic models. Twenty-seven sheep radii and 33 polyurethane synthetic bones were cast into gelatin prior to being fired at with missiles made of a section of an axe blade or steel rod at different firing velocities using a compressed-nitrogen cannon. Each model was then examined as to the presence of hair-line fractures or complete fractures. Sheep bones and synthetic bones displayed comparable results when struck by the axe missile; here, a clear fracture threshold was evident between 14.00 and 15.26J. When struck by the rod missile, only the synthetic bones produced significant results, namely a fracture threshold between 20.15 and 23.59J. In conclusion, our results show an ulnar fracture threshold of approximately 15J when struck by an axe. The experiments regarding blows with a rod displayed a fracture threshold of around 22J, but, as this could not be validated with biological bones, this result is questionable.

Child Abuse or Bleeding Disorder-An Interdisciplinary Approach.

Children with an unexplained bleeding tendency are frequently referred to a haemostaseologist for further evaluation. Careful standardized history taking and clinical evaluation should allow for distinguishing bleeds after minor injury and trauma which are very common in all children. However, in two groups of children bleeding symptoms may be more significant than expected: those with an underlying coagulation disorder and those who have been subjected to physical child abuse. The coexistence of child abuse and a bleeding disorder must always be considered. An extended coagulation diagnostic is required if the morphology of bleedings is not clearly suspicious for child abuse and in the absence of typical concomitant injuries, e.g., bone fractures. An interdisciplinary approach involving a forensic pathologist and a paediatric haemostaseologist for assessment of bleeding symptoms, the explanation of the clinical findings, and the critical evaluation of laboratory results are essential in such cases. This review is focussed on symptoms in accidental and nonaccidental injuries in children assisting haemostaseologists in decision making in cases of child protection issues.

Tendon and muscle imaging in sports injuries

Imaging modalities demonstrate a specific pattern for sports injuries that is related to the biomechanical impact. The concept of the musculo-tendino-osseous chain was developed for sports injuries and is helpful to understand the expected injury pattern of the musculoskeletal system. At up to 55%, the incidence of muscle lesions in acute and chronic sports injuries is relatively high and mainly involve the hip and pelvis. In adolescence injury of the apophysis is common, whereas in younger patients musculotendinous injuries appear. Ultrasound is recommended for assessment of muscle haematoma or seroma, and partial or full thickness tears of the muscles and tendons. In particular the evaluation of the integrity of the musculotendinous unit or muscle hernia is a strength of ultrasound. Magnetic Resonance Imaging is superior in hyperacute muscle injuries and delayed onset muscle soreness. Learning objectives: 1. Impact of ultrasound for imaging musculotendinous injuries. 2.Interpretation and differential diagnosis in acute and chronic trauma. 3. Concept of musculo-tendinous-osseous chain. 4. Typical injury patterns in sports injuries.

Physicians of Gladiators in the Ancient Rome

Gladiators in ancient Rome were an integral part of the Roman world and were a unique phenomenon. Their bloody fight presumably originated from the cult of the dead. Later it was a feature of the self-portrayal of many Roman noblemen, especially during the election campaigns. Eventually it became an imperial privilege. Legally, gladiators were slaves. They were trained in specially equipped schools (ludus, plural: ludi). Also, special schools existed that trained fighters to compete in the arena against wild animals. Doctors at the ludi took care of the fighters: They prepared them for the fight or treated injuries. The gladiator cemeteries of Ephesus and York clearly demonstrate typical injury patterns. The most prominent and best-known gladiator physician is - due to his eminent self-portrayal - Galenus. Even though he looked after the gladiators of his hometown Pergamon only for a brief time. From ancient inscriptions we know the names of several other physicians who took care of gladiators. Especially these largely forgotten doctors are referenced in this article.

ANALYSIS OF TYPICAL DAMAGES AT THE DIFFERENT GROUPS OF VICTIMS WITH POLYTRAUMA

An analysis of typical injuries in 487 victims was conducted, depending on the conditions of injury in road traffic accidents — pedestrian, driver, passenger. Established major injuries in groups characterize the nature of high-energy trauma. Multislice Computed tomography is the method of choice in the diagnosis of associated trauma, it has a high diagnostic efficiency in comparison with other diagnostic methods.

Injury In Preschool-Age Children: A Population-Based Study

A study on the type and frequency of injuries in preschool-age children was conducted in a sample of households representing population of Purworejo district. A two stages cluster (wilcah) method was used to select 4.354 preschool-age children living in 12,721 households in the district. The mother or other child caretakers provided responses about injuries occurring during the 3 months period to interview. Injuries among these preschool-age children included trauma by cutting or sharp object (6.5%), falls (5.7%), bums (0.6%), bites (0.4%), traffic accident (0.4%), unconsciousness (0.2%) and poisoning (0 .1 %). The typical injury in under the 12 months olds was falls. Children aged 12 to 23 month accounted for 18% of the injury episodes which were typical fall and trauma. Children aged 24 to 59 months accounted for 76.6% of injury episodes which were typically trauma, falls, bums, bites and traffic accident. No statistical differences in the frequency and type on injuries were observed between urban and rural areas. The relative frequency in age-grouped and type of injuries from this population-based study can be used in planning injury prevention especially for family health education program.