Stingray spear injury to the pediatric spinal cord: case report and review of the literature

Emergency Management Strategies and Antimicrobial Considerations for Nonmammalian Marine Vertebrate Penetrating Trauma in North America, the Caribbean, and Hawaii: A Review Article

There are numerous emergency department visits in the United States for all types of marine animal injuries each year. These injuries may result in significant morbidity or mortality if not managed appropriately. Accurate identification of the offending species, thorough wound hygiene, and judicious use of antibiotics are important for preventing infections. This review aims to describe management strategies and antimicrobial considerations for nonmammalian marine vertebrate penetrating trauma in North America, the Caribbean, and Hawaii. A literature search was performed to identify studies on this subject. This literature consisted of clinical case reports and case series. Reports extracted included those on sharks, barracuda, eels, catfish, stingrays, lionfish, stonefish, and scorpionfish. The majority of reported trauma occurred to beachgoers, fishermen, or commercial aquarium employees who routinely handle these animals. Injury patterns depended on the species but most commonly affected the lower extremities. Infections were seen from saltwater bacteria, human skin flora, or marine animal oral flora. After thorough wound irrigation and exploration, most authors recommended prophylactic antimicrobials to cover Vibrio species, in addition to other gram-negative and gram-positive species. The literature is notable for the lack of controlled studies. Some authors recommended radiographic and/or ultrasonographic imaging to identify retained foreign bodies, such as spines, sand, or teeth.

Systematic Nursing Interventions Combined with Continuity of Care in Patients with a Spinal Fracture Complicated with a Spinal Cord Injury and Its Effect on Recovery and Satisfaction

Objective. The aim of this study is to examine the application value of systematic nursing interventions combined with continuity of care in cases with a spinal fracture complicated with a spinal cord injury and its effect on recovery and satisfaction. Methods. We identified ninety cases with a spinal fracture complicated with a spinal cord injury who were admitted to local hospital from May 2019 to May 2021 as research subjects and assigned them into an experimental group (systematic nursing combined with continuity of care, n = 45) and a control group (conventional nursing, n = 45) according to their admission order. The level of life of all groups between intervention was evaluated with reference to the Generic Quality of Life Inventory-74 (GQOLI-74) Rating Scale. The Hospital Anxiety and Depression (HAD) scale was used to assess the emotional status of patients before and after intervention. The complication rates, nursing outcomes, nursing satisfaction, and rehabilitation outcomes of all cases were calculated. Results. The GQOLI-74 score of the experimental group was higher than that of another group ( $P<0.05$ ). Lower HAD scores of experimental group were observed than that of another group ( $P<0.05$ ). The experimental group obtained remarkably higher nursing effective rates and higher nursing satisfaction than another group ( $P<0.05$ ). Rehabilitation outcome of the experimental group outperformed that another group ( $P<0.05$ ). Conclusion. The use of systematic nursing intervention combined with continuity of care for cases with spinal fracture complicated with a spinal cord injury can enhance the nursing effect, effectively relieve cases’ psychological pressure, improve patients’ level of life and nursing satisfaction, and contribute to the maintenance of a good nurse-patient relationship, which merits clinical promotion.

Dental pathologies in lamniform and carcharhiniform sharks with comments on the classification and homology of double tooth pathologies in vertebrates

Double tooth pathologies are important indicators of trauma, disease, diet, and feeding biomechanics, and are widely documented in mammals. However, diagnosis of double tooth pathologies in extinct non-mammalian vertebrates is complicated by several compounding factors including: a lack of shared terminology reflecting shared etiology, inconsistencies in definitions and key features within and outside of mammals (e.g., gemination, fusion, twinning, concrescence); differences in tooth morphology, heterodonty, regeneration, and implantation between mammals and non-mammalian vertebrates; and the unmet need for diagnostic criteria that can be applied to isolated teeth, which are common in the fossil record. Here we report on double tooth pathologies in the lamniform and carcharhiniform Cenozoic sharks Otodus megalodon (NCSM 33639) and Carcharhinus leucas (NCSM 33640, 33641). All three teeth bear a singular bifid crown with mirrored halves and abnormal internal microstructure-a single, bifurcating pulp cavity in C. leucas and a more than tripling of vessels in O. megalodon (from two to seven main ascending canals). We identify these abnormalities as likely examples of gemination due to their symmetry, which rules out fusion of tooth buds in one tooth file in different developmental stages in polyphyodont taxa; however, we note that incomplete forms of mesiodistal tooth fusion can be morphologically indistinguishable from gemination, and thus fusion cannot be rejected. We further compile and recategorize, when possible, the diversity of tooth pathologies in sharks. The identification of double tooth pathologies in O. megalodon and C. leucas has paleobiological implications. Such pathologies in sharks are largely hypothesized to stem from trauma to developing tooth buds. Carcharhinus leucas is known to feed on prey documented to cause feeding-related oral traumas (e.g., rays, sawfish, spiny fish, and sea urchins). However, O. megalodon, is considered to have largely fed on marine mammals, and perhaps turtles and/or fish, raising the possibility that the dietary diversity of this species is, as of yet, underappreciated. The genetic underpinnings of tooth morphogenesis and regeneration is highly conserved throughout vertebrate evolution, suggesting a homologous framework can be established. However, more research is needed to link developmental, paleobiological, and/or paleoenvironmental factors to gemination/fusion in polyphyodont taxa. We argue that the definitions and diagnostic criteria for dental pathologies in vertebrates require standardization in order to advance macroevolutionary studies of feeding trauma in deep time.