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Zhang R, Chen Z, Li C. Right Coronary Artery Occlusion Due to Foreign Body From Left Chest Traumatic Injury. JACC Cardiovasc Interv 2024; 17:940-941. [PMID: 38599700 DOI: 10.1016/j.jcin.2024.01.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 01/02/2024] [Indexed: 04/12/2024]
Affiliation(s)
- Ran Zhang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhongxiu Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Chen Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China.
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O’Connor KE, Shanholtz CE, Espeleta HC, Ridings LE, Gavrilova Y, Hink A, Ruggiero KJ, Davidson TM. Mental health symptoms and engagement in a stepped-care mental health service among patients with a violent versus nonviolent injury. J Trauma Acute Care Surg 2024; 96:650-657. [PMID: 37339343 PMCID: PMC10733549 DOI: 10.1097/ta.0000000000004078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
BACKGROUND Few studies have examined mental health symptom trajectories and engagement in mental health follow-up in relation to mechanism of injury. This study examined differences in engagement between survivors of nonviolent and violent injury in the Trauma Resilience and Recovery Program (TRRP), a stepped-care, technology-enhanced model that provides evidence-based mental health screening and treatment to patients admitted to our Level I trauma service. METHODS This study analyzed data from 2,527 adults enrolled in TRRP at hospital bedside between 2018 and 2022, including 398 patients (16%) with a violent injury and 2,129 patients (84%) with a nonviolent injury. Bivariate and hierarchical logistic regression analyses examined relations between injury type (violent vs. nonviolent) engagement in TRRP and mental health symptoms at 30 day follow-up. RESULTS Engagement in services at bedside was similar across survivors of violent and nonviolent traumatic injury. Patients with violent injury had higher levels of posttraumatic stress disorder and depressive symptoms 30 days postinjury but were less likely to engage in mental health screening. Among patients who screened positive for posttraumatic stress disorder and depression, patients with violent injury were more likely to accept treatment referrals. CONCLUSION Patients with a violent traumatic injury have higher levels of mental health needs yet face greater barriers to accessing mental health services following their injury relative to those with a nonviolent injury. Effective strategies are needed to ensure continuity of care and access to mental health care to promote resilience and emotional and functional recovery. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Kelly E. O’Connor
- Department of Surgery, Virginia Commonwealth University, PO Box 980141, Richmond, VA 23298 USA
| | - Caroline E. Shanholtz
- Department of Psychology, University of California, Los Angeles, 1285 Psychology Building BOX 951563, Los Angeles, CA 90095 USA
| | - Hannah C. Espeleta
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Leigh E. Ridings
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Yulia Gavrilova
- Department of Surgery, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425
| | - Ashley Hink
- Department of Surgery, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425
| | - Kenneth J. Ruggiero
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Tatiana M. Davidson
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
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Cronn S, Somasundaram K, Driesslein K, Tomas CW, Pintar F. Sex-related disparities in vehicle crash injury and hemodynamics. Front Public Health 2024; 12:1331313. [PMID: 38560436 PMCID: PMC10978633 DOI: 10.3389/fpubh.2024.1331313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/05/2024] [Indexed: 04/04/2024] Open
Abstract
Objective Multiple studies evaluate relative risk of female vs. male crash injury; clinical data may offer a more direct injury-specific evaluation of sex disparity in vehicle safety. This study sought to evaluate trauma injury patterns in a large trauma database to identify sex-related differences in crash injury victims. Methods Data on lap and shoulder belt wearing patients age 16 and up with abdominal and pelvic injuries from 2018 to 2021 were extracted from the National Trauma Data Bank for descriptive analysis using injuries, vital signs, International Classification of Disease (ICD) coding, age, and injury severity using AIS (Abbreviated Injury Scale) and ISS (Injury Severity Score). Multiple linear regression was used to assess the relationship of shock index (SI) and ISS, sex, age, and sex*age interaction. Regression analysis was performed on multiple injury regions to assess patient characteristics related to increased shock index. Results Sex, age, and ISS are strongly related to shock index for most injury regions. Women had greater overall SI than men, even in less severe injuries; women had greater numbers of pelvis and liver injuries across severity categories; men had greater numbers of injury in other abdominal/pelvis injury regions. Conclusions Female crash injury victims' tendency for higher (AIS) severity of pelvis and liver injuries may relate to how their bodies interact with safety equipment. Females are entering shock states (SI > 1.0) with lesser injury severity (ISS) than male crash injury victims, which may suggest that female crash patients are somehow more susceptible to compromised hemodynamics than males. These findings indicate an urgent need to conduct vehicle crash injury research within a sex-equity framework; evaluating sex-related clinical data may hold the key to reducing disparities in vehicle crash injury.
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Affiliation(s)
- Susan Cronn
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI, United States
- Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Karthik Somasundaram
- Neurosurgery Department, Medical College of Wisconsin, Milwaukee, WI, United States
- Joint Department of Biomedical Engineering, Marquette University/Medical College of Wisconsin, Milwaukee, WI, United States
- VA Medical Center-Research, Milwaukee, WI, United States
| | - Klaus Driesslein
- Neurosurgery Department, Medical College of Wisconsin, Milwaukee, WI, United States
- VA Medical Center-Research, Milwaukee, WI, United States
| | - Carissa W. Tomas
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Frank Pintar
- Neurosurgery Department, Medical College of Wisconsin, Milwaukee, WI, United States
- Joint Department of Biomedical Engineering, Marquette University/Medical College of Wisconsin, Milwaukee, WI, United States
- VA Medical Center-Research, Milwaukee, WI, United States
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Patterson JL, Bryan RT, Turconi M, Leiner A, Plackett TP, Rhodes LL, Sciulli L, Donnelly S, Reynolds CW, Leanza J, Fisher AD, Kushnir T, Artemenko V, Ward KR, Holcomb JB, Schmitzberger FF. Life Over Limb: Why Not Both? Revisiting Tourniquet Practices Based on Lessons Learned From the War in Ukraine. J Spec Oper Med 2024:V057-2PCH. [PMID: 38300880 DOI: 10.55460/v057-2pch] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The use of tourniquets for life-threatening limb hemorrhage is standard of care in military and civilian medicine. The United States (U.S.) Department of Defense (DoD) Committee on Tactical Combat Casualty Care (CoTCCC) guidelines, as part of the Joint Trauma System, support the application of tourniquets within a structured system reliant on highly trained medics and expeditious evacuation. Current practices by entities such as the DoD and North Atlantic Treaty Organization (NATO) are supported by evidence collected in counter-insurgency operations and other conflicts in which transport times to care rarely went beyond one hour, and casualty rates and tactical situations rarely exceeded capabilities. Tourniquets cause complications when misused or utilized for prolonged durations, and in near-peer or peer-peer conflicts, contested airspace and the impact of high-attrition warfare may increase time to definitive care and limit training resources. We present a series of cases from the war in Ukraine that suggest tourniquet practices are contributing to complications such as limb amputation, overall morbidity and mortality, and increased burden on the medical system. We discuss factors that contribute to this phenomenon and propose interventions for use in current and future similar contexts, with the ultimate goal of reducing morbidity and mortality.
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Chen K, Hynes KK, Dirschl D, Wolf JM, Strelzow JA. Depression, anxiety, and post-traumatic stress disorder following upper versus lower extremity fractures. Injury 2024; 55:111242. [PMID: 38044162 DOI: 10.1016/j.injury.2023.111242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Orthopaedic trauma has been linked to major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). Post-injury rates of psychiatric diagnoses and their relationship to various injury characteristics are not well characterized. We aimed to determine the association between orthopaedic trauma and MDD, GAD, and PTSD diagnoses at 5-year follow-up. METHODS A national insurance claims database was used to create upper extremity fracture (UEF) and lower extremity fracture (LEF) cohorts, with further stratification by isolated versus multiple fractures. Patient undergoing elective upper or lower extremity orthopaedic procedures served as controls. Rates of post-injury psychiatric diagnoses were calculated. Univariate logistic regression was conducted after matching in a 1:1 ratio based on relevant comorbidities such as psychiatric history. All significant variables were included in multivariate analysis. RESULTS A total of 308,578 UEF patients and 360,510 LEF patients were identified. Within the UEF cohort, the diagnosis rates following either isolated or multiple fractures were identified: MDD (25% to 30%), GAD (10% to 11%), and PTSD (4%). LEF cohort rates were as follows: MDD (30% to 38%), GAD (11% to 14%), and PTSD (4% to 7%). Compared to non-injured controls, both the UEF and LEF cohorts were associated with higher rates of all psychiatric diagnoses. In comparing UEF and LEF cohorts, isolated UEF was associated with MDD, GAD, and PTSD; however, multiple UEF was associated with MDD and GAD, whereas multiple LEF was associated with PTSD. CONCLUSION Psychiatric pathology is prevalent following orthopaedic trauma. Even after controlling for psychiatric history, orthopaedic trauma is independently associated with post-injury psychiatric diagnoses and may be more predictive of PTSD and GAD than of MDD. Upper extremity fractures may portend higher psychiatric risk. With negative stigma surrounding mental health and the early role of orthopaedic surgeons in providing care, it is imperative to normalize psychiatric care with patients and discuss warning symptoms that may indicate the onset of psychiatric disorders. LEVEL OF EVIDENCE Prognostic, Level III.
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Affiliation(s)
- Kevin Chen
- The University of Chicago, Pritzker School of Medicine, Biological Sciences Learning Center, 924 E. 57th St., Ste. 104, Chicago, IL 60637, USA.
| | - Kelly K Hynes
- The University of Chicago Medicine, Department of Orthopaedic Surgery and Rehabilitation Medicine, 5758 S. Maryland Ave., Dept. 4B, Chicago, IL, USA
| | - Douglas Dirschl
- Baylor College of Medicine, Department of Orthopaedic Surgery, 7200 Cambridge St., Ste. 10A, Houston, TX 77030, USA
| | - Jennifer Moriatis Wolf
- The University of Chicago Medicine, Department of Orthopaedic Surgery and Rehabilitation Medicine, 5758 S. Maryland Ave., Dept. 4B, Chicago, IL, USA
| | - Jason A Strelzow
- The University of Chicago Medicine, Department of Orthopaedic Surgery and Rehabilitation Medicine, 5758 S. Maryland Ave., Dept. 4B, Chicago, IL, USA
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Garg G, Umeano L, Iftikhar S, Alhaddad SF, Paulsingh CN, Riaz MF, Khan S. Breaking It Down: A Systematic Review Unravelling the Impact of Attention Deficit Hyperactivity Disorder and Methylphenidate on Childhood Fractures. Cureus 2024; 16:e56833. [PMID: 38654766 PMCID: PMC11036031 DOI: 10.7759/cureus.56833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
Limb fractures are a common cause of pediatric hospital admissions and surgeries, with a significant prevalence in the United Kingdom across all injury categories. Among psychiatric conditions in children, attention deficit hyperactivity disorder (ADHD) stands out as frequently associated with fractures, particularly those involving extremities. ADHD, with diagnoses prevalent among a significant proportion of school-age children and adolescents, has witnessed a growing global incidence. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist for our systematic literature search, using various databases and specific search terms related to ADHD and fractures. We considered articles from 2018 to 2023, focusing on English language papers with free full-text access. Our selection process used the PRISMA flowchart. We began with 1,890 articles and, after deduplication, title screening, abstract assessment, and quality evaluation included nine research papers in our review. Our primary focus was on examining fracture-related outcomes in individuals with ADHD compared to those without, considering medication status. These studies encompassed various designs, with a focus on the ADHD-fracture relationship and methylphenidate's (MPH) impact. Our study confirms that ADHD increases fracture risk and suggests that MPH may help mitigate this risk. Early ADHD detection is vital for nonpharmacological interventions. Orthopedic surgeons should proactively identify ADHD, while healthcare professionals should offer injury prevention guidance, particularly for at-risk groups.
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Affiliation(s)
- Gourav Garg
- Orthopaedics, King's Mill Hospital, Sutton-in-Ashfield, GBR
- Internal Medicine, Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lotanna Umeano
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sadaf Iftikhar
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sarah F Alhaddad
- Pediatric, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Christian N Paulsingh
- Pathology, St. George's University School of Medicine, St. Georges, GRD
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Safeera Khan
- Neuropsychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Cusack SE, Ridings LE, Davidson TM, Espeleta HC, Wilson DA, Ruggiero KJ. Social support in relation to posttraumatic stress disorder symptoms among patients with violent versus nonviolent injury. Psychol Trauma 2024; 16:504-512. [PMID: 37166922 PMCID: PMC10921927 DOI: 10.1037/tra0001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Violent injuries have become increasingly more common in the United States. Individuals experiencing violent injury are at increased risk for the development of posttraumatic stress disorder (PTSD) as compared to those experiencing nonviolent injury. Social support is touted as a protective factor against various psychiatric symptoms (i.e., PTSD), though little is known about the relation between PTSD symptoms and social support in traumatic injury populations. The aims of the present paper were twofold: (1) examine the prevalence of PTSD as a function of injury type (2) explore differences in levels of social support as a function of injury type and (3) explore the association between injury type and later PTSD symptoms as moderated by baseline social support. METHOD Participants were 553 adults from a level-one trauma center in the Southeast United States who experienced a violent injury or nonviolent injury and completed measures of social support at baseline as well as PTSD symptoms at the 30-day follow-up timepoint. The study utilized data from both the baseline timepoint (i.e., upon admission to the trauma surgery unit), as well as a 30-day follow-up timepoint. RESULTS Results demonstrated that those endorsing nonviolent injury reported lower levels of social support and PTSD symptoms. Social support predicted later PTSD symptoms until injury type was included as a covariate in the model. Social support did not moderate the relationship between injury type and later PTSD symptoms. CONCLUSIONS Findings highlight the interrelatedness of key risk variables (i.e., injury type) with protective factors in influencing the trajectory of psychopathology postinjury. Violence intervention and interruption programs may have the capacity to fill patient needs when social support networks are insufficient. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Shannon E. Cusack
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University
- Department of Psychiatry & Behavioral Sciences, College of Medicine, Medical University of South Carolina
| | - Leigh E. Ridings
- Department of Nursing, College of Nursing, Medical University of South Carolina
| | - Tatiana M. Davidson
- Department of Nursing, College of Nursing, Medical University of South Carolina
| | - Hannah C. Espeleta
- Department of Nursing, College of Nursing, Medical University of South Carolina
| | - Dulaney A. Wilson
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina
| | - Kenneth J. Ruggiero
- Department of Nursing, College of Nursing, Medical University of South Carolina
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Jarman MP, Jin G, Chen A, Losina E, Weissman JS, Berry SD, Salim A. Short-term outcomes of prehospital opioid pain management for older adults with fall-related injury. J Am Geriatr Soc 2024. [PMID: 38418369 DOI: 10.1111/jgs.18830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Opioids are recommended for pain management in patients being cared for and transported by emergency medical services, but no specific guidelines exist for older adults with fall-related injury. Prior research suggests prehospital opioid administration can effectively manage pain in older adults, but less is known about safety in this population. We compared short-term safety outcomes, including delirium, disposition, and length of stay, among older adults with fall-related injury according to whether they received prehospital opioid analgesia. METHODS We linked Medicare claims data with prehospital patient care reports for older adults (≥65) with fall-related injury in Illinois between January 1, 2014 and December 31, 2015. We used weighted regression models (logistic, multinomial logistic, and Poisson) to assess the association between prehospital opioid analgesia and incidence of inpatient delirium, hospital disposition, and length of stay. RESULTS Of 28,150 included older adults, 3% received prehospital opioids. Patients receiving prehospital opioids (vs. no prehospital opioids) were less likely to be discharged home from the emergency department (adjusted probability = 0.30 [95% CI: 0.25, 0.34] vs. 0.47 [95% CI: 0.46, 0.48]), more likely to be discharged to a non-home setting after an inpatient admission (adjusted probability = 0.43 [95% CI: 0.39, 0.48] vs. 0.30 [95% CI: 0.30, 0.31]), had inpatient length of stay 0.4 days shorter (p < 0.001) and ICU length of stay 0.7 days shorter (p = 0.045). Incidence of delirium did not vary between treatment and control groups. CONCLUSIONS Few older adults receive opioid analgesia in the prehospital setting. Prehospital opioid analgesia may be associated with hospital disposition and length of stay for older adults with fall-related injury. However, our findings do not provide evidence of an association with inpatient delirium. These findings should be considered when developing guidelines for prehospital pain management specific to the older adult population.
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Affiliation(s)
- Molly P Jarman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Ginger Jin
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Annie Chen
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elena Losina
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Salim
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Trauma, Burn, and Surgical Critical Care, Brigham and Woemn's Hospital, Boston, Massachusetts, United States
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Sinha P, Chauhan VS, Wani AM. Closed Degloving Injury of the Foot Caused by a High Impact Force: A Case Report. Cureus 2024; 16:e54182. [PMID: 38496199 PMCID: PMC10940966 DOI: 10.7759/cureus.54182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
An 18-year-old male subject was referred to our MRI scanning center, by an orthopedic surgeon, for a swelling over the plantar region of the foot. He had been in a motor vehicle accident a few weeks back, with no evidence of fracture at the time of injury. In subsequent weeks, he developed a swelling over his foot. MRI showed the presence of a fluid intensity lesion in the subdermal and dermal layers of his foot. Unguarded motor vehicle accidents often tend to cause severe injuries. Sometimes, they even need operative management since a motor vehicle collision is a high-impact accident. One of the pathologies caused by a high impact force is the Morel-Lavallée lesion or a closed type of degloving injury. A Morel-Lavallee lesion also needs operative intervention if major vascular channels are involved in the degloving. However, if the major vessels supplying the region of degloving are intact, open surgery may not be needed. In such cases, incision and drainage along with serial wound dressing may be attempted. The primary risk in closed degloving is recurrent or subsequent tissue necrosis. Close and watchful monitoring is needed to anticipate and prevent these. Closed degloving injuries or Morel-Lavallée lesions have been commonly described in the thigh and pelvis region. Here, we describe a case that developed in the dermal and fascial layers of the foot and was managed conservatively. The epidermal layer showed regeneration, and the patient did not need subsequent amputation.
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Affiliation(s)
- Pragya Sinha
- Radiodiagnosis, Rama Medical College Hospital & Research Centre, Hapur, IND
| | | | - Asif M Wani
- Radiology, Government Medical College, Srinagar, Srinagar, IND
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Xia W, Wang Y, Wu X, Yang X. Development of a Questionnaire for Measuring Trauma-Informed Care of Nurses Working with Traumatically Injured Patients. J Multidiscip Healthc 2024; 17:367-378. [PMID: 38287968 PMCID: PMC10823872 DOI: 10.2147/jmdh.s437341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/11/2024] [Indexed: 01/31/2024] Open
Abstract
Purpose To develop a new questionnaire for assessing nurses' current situation of knowledge, attitude and practice related to trauma-informed care (TIC) for patients with traumatic injury. Methods By literature review, qualitative interview and Delphi consultation, the 46 preliminary items about trauma-informed care of nurses working with traumatically injured patients were selected. After that, the preliminary questionnaire was distributed to 293 Chinese nurses in relevant departments. The collected data were analyzed by internal reliability, split-half reliability, structural validity and content validity. Results The questionnaire was developed with a total of 30 items in 3 dimensions: 8 items in the TIC knowledge dimension, 10 items in the TIC attitude dimension and 12 items in the TIC practice dimension. The Cronbach's alpha coefficient was 0.939, and the content validity was 0.971. Conclusion This designed questionnaire shews receptable reliability and validity, which could be used to assess the knowledge, attitude and practice of nurses in application of trauma-informed care for traumatically injured patients.
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Affiliation(s)
- Weiping Xia
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
- Department of Surgical Inpatient, United Family Hospital, Shanghai, 200335, People’s Republic of China
| | - Yanbo Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Xiaoning Wu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Xiaojie Yang
- Department of Orthopedics, Jiangyin Hospital Affiliated to Nantong University, Jiang Yin, 214400, People’s Republic of China
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Prater L, Bulger E, Maier RV, Goldstein E, Thomas P, Russo J, Wang J, Engstrom A, Abu K, Whiteside L, Knutzen T, Iles-Shih M, Heagerty P, Zatzick D. Emergency Department and Inpatient Utilization Reductions and Cost Savings Associated With Trauma Center Mental Health Intervention: Results From a 5-year Longitudinal Randomized Clinical Trial Analysis. Ann Surg 2024; 279:17-23. [PMID: 37747970 PMCID: PMC10843150 DOI: 10.1097/sla.0000000000006102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVE To identify and refer patients at high risk for the psychological sequelae of traumatic injury, the American College of Surgeons Committee on Trauma now requires that trauma centers have in-place protocols. No investigations have documented reductions in utilization and associated potential cost savings associated with trauma center mental health interventions. BACKGROUND The investigation was a randomized clinical trial analysis that incorporated novel 5-year emergency department (ED)/inpatient health service utilization follow-up data. METHODS Patients were randomized to a mental health intervention, targeting the psychological sequelae of traumatic injury (n = 85) versus enhanced usual care control (n = 86) conditions. The intervention included case management that coordinated trauma center-to-community care linkages, psychotropic medication consultation, and psychotherapy elements. Mixed model regression was used to assess intervention and control group utilization differences over time. An economic analysis was also conducted. RESULTS Over the course of the 5-year intervention, patients demonstrated significant reductions in ED/inpatient utilization when compared with control patients [ F (19,3210) = 2.23, P = 0.009]. Intervention utilization reductions were greatest at 3 to 6 months (intervention 15.5% vs control 26.7%, relative risk = 0.58, 95% CI: 0.34, 1.00) and 12 to 15 months (intervention 16.5% vs control 30.6%, relative risk = 0.54, 95% CI: 0.32, 0.91) postinjury time points. The economic analysis suggested potential intervention cost savings. CONCLUSIONS Mental health intervention is associated with significant reductions in ED and inpatient utilization, as well as potential cost savings. These findings could be productively integrated into future American College of Surgeons Committee on Trauma policy discussions.
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Affiliation(s)
- Laura Prater
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Firearm Injury and Policy Research Program, University of Washington, Seattle, WA
| | - Eileen Bulger
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Surgery, University of Washington, Seattle, WA
| | - Ronald V. Maier
- Department of Surgery, University of Washington, Seattle, WA
| | - Evan Goldstein
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | | | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | | | - Khadija Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Lauren Whiteside
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Tanya Knutzen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Matt Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Doug Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
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Knowlton LM, Logan DS, Arnow K, Hendricks WD, Gibson AB, Tran LD, Wagner TH, Morris AM. Do hospital-based emergency Medicaid programs benefit trauma centers? A mixed-methods analysis. J Trauma Acute Care Surg 2024; 96:44-53. [PMID: 37828656 PMCID: PMC10841404 DOI: 10.1097/ta.0000000000004162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Hospital Presumptive Eligibility (HPE) is a temporary Medicaid insurance at hospitalization, which can offset patient costs of care, increase access to postdischarge resources, and provide a path to sustain coverage through Medicaid. Less is known about the implications of HPE programs on trauma centers (TCs). We aimed to describe the association with HPE and hospital Medicaid reimbursement and characterize incentives for HPE participation among hospitals and TCs. We hypothesized that there would be financial, operational, and mission-based incentives. METHODS We performed a convergent mixed methods study of HPE hospitals in California (including all verified TCs). We analyzed Annual Financial Disclosure Reports from California's Department of Health Care Access and Information (2005-2021). Our primary outcome was Medicaid net revenue. We also conducted thematic analysis of semistructured interviews with hospital stakeholders to understand incentives for HPE participation (n = 8). RESULTS Among 367 California hospitals analyzed, 285 (77.7%) participate in HPE, 77 (21%) of which are TCs. As of early 2015, 100% of TCs had elected to enroll in HPE. There is a significant positive association between HPE participation and net Medicaid revenue. The highest Medicaid revenues are in HPE level I and level II TCs. Controlling for changes associated with the Affordable Care Act, HPE enrollment is associated with increased net patient Medicaid revenue ( b = 6.74, p < 0.001) and decreased uncompensated care costs ( b = -2.22, p < 0.05). Stakeholder interviewees' explanatory incentives for HPE participation included reduction of hospital bad debt, improved patient satisfaction, and community benefit in access to care. CONCLUSION Hospital Presumptive Eligibility programs not only are a promising pathway for long-term insurance coverage for trauma patients but also play a role in TC viability. Future interventions will target streamlining the HPE Medicaid enrollment process to reduce resource burden on participating hospitals and ensure ongoing patient engagement in the program. LEVEL OF EVIDENCE Economic And Value Based Evaluations; Level II.
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Affiliation(s)
- Lisa Marie Knowlton
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE)
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Daniel S. Logan
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE)
| | - Katherine Arnow
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE)
| | | | | | - Linda D. Tran
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE)
| | - Todd H. Wagner
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE)
| | - Arden M. Morris
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE)
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
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Bulzan M, Cavalu S, Voita-Mekeres F. Relevant Predictors in the Association Between Patients' Functional Status and Scar Outcomes After Total Hip Arthroplasty. Cureus 2023; 15:e50702. [PMID: 38111816 PMCID: PMC10726146 DOI: 10.7759/cureus.50702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND We aimed to investigate the relevant predictors in the association between the functional status and the consequences of the persistence of scars in patients with traumatic versus non-traumatic coxarthrosis after total hip arthroplasty (THA). METHODS A total of 203 patients undergoing THA after traumatic or non-traumatic coxarthrosis were asked to complete the Mekeres' Psychosocial Internalization Scale (MPIS), in which they self-evaluated on a Likert scale (between one and five) by selecting the rating that corresponded to their personal opinion and the activities of daily living (ADL) form at six months postoperative. The statistical data were processed using the IBM SPSS Statistics software version 22.0 (IBM Corp., Armonk, NY). A combined assessment of the internalization of scars using MPIS and ADL forms after THA allowed for the identification of relevant predictors of the quality of life six months post-surgery in patients with traumatic or non-traumatic coxarthrosis. RESULTS Depending on the coxarthrosis etiology (traumatic or non-traumatic), the results were further processed by a univariate ANOVA, considering the independent variables represented by symptoms, the number of surgical procedures, and the postoperative evolution, which are acting on the outcomes of physical functioning (the dependent variable) in the postoperative phase. In the case of the traumatic group, our results suggest that the number of surgical interventions, the ability to internalize scars, and autonomy in terms of body care are predictors of the quality of life. In patients with non-traumatic coxarthrosis, an important role in predicting quality of life is played by the administered treatment and the ability to maintain their autonomy regarding self-hygiene six months post-surgery. CONCLUSIONS The predictive regression equation suggests that the quality of life in patients with traumatic coxarthrosis can be predicted by the number of surgical interventions, the administered treatment, the ability to internalize scars, and the autonomy regarding body care activities. On the other hand, for patients with non-traumatic coxarthrosis, an important role in predicting the quality of life is played by the treatment and the ability to maintain autonomy in terms of body hygiene activities.
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Affiliation(s)
- Madalin Bulzan
- Orthopedics and Traumatology, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, ROU
| | - Simona Cavalu
- Therapeutics, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, ROU
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14
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Kantawala B, Khattab M, Elawad SO, Assker M, Cherri B, Nazir A, Wojtara M, Uwishema O. Addressing hydrocephalus in Africa: Challenges and way forward. Health Sci Rep 2023; 6:e1759. [PMID: 38111744 PMCID: PMC10726764 DOI: 10.1002/hsr2.1759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/04/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
Hydrocephalus occurs when the cerebrospinal fluid (CSF) accumulates in the cerebral ventricles. This is due to either obstruction in the CSF flow, decreasing its absorption by the arachnoid villus to the Dural venous sinuses, or increasing production of the CSF. The most disproportionately and severely affected by the disease consequences are African children. This is because of the high incidence of postinfectious hydrocephalus and spinal dysraphism compared with other world children. The health care system in Africa has access to 488 neurosurgeons which represents less than 1% of the global neurosurgeons, thus pediatric hydrocephalus is considered an emerging public health problem in Africa because of the difficulty of the patient's access to proper care. Numerous studies conducted in Africa have revealed a significant imbalance in the distribution of neurosurgical resources across the continent. Specifically, South Africa and North Africa collectively account for 86% of the total practicing neurosurgeons, indicating a pronounced concentration of these specialized medical professionals in these regions. Having an abundance of case studies regarding hydrocephalus is vital to increase our awareness and understanding. Hydrocephalus should gain more priority by current policymakers as an important health concern. This may be achieved by proper resource allocation to ensure better quality means of diagnosis, intervention, and rehabilitation.
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Affiliation(s)
- Burhan Kantawala
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of Medicine, Faculty of General MedicineYerevan State Medical UniversityYerevanArmenia
| | - Maha Khattab
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineHorus UniversityEgypt
| | - Shaima O. Elawad
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineUniversity of KhartoumKhartoumSudan
| | - Mohamad Assker
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineUniversity of SharjahSharjahUnited Arab Emirates
| | - Batoul Cherri
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of Medicine, Faculty of MedicineLebanese UniversityBeirutLebanon
| | - Abubakar Nazir
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of MedicineKing Edward Medical UniversityLahorePakistan
| | - Magda Wojtara
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- University of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Olivier Uwishema
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
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Larrea A, Elexpe A, Díez-Martín E, Torrecilla M, Astigarraga E, Barreda-Gómez G. Neuroinflammation in the Evolution of Motor Function in Stroke and Trauma Patients: Treatment and Potential Biomarkers. Curr Issues Mol Biol 2023; 45:8552-8585. [PMID: 37998716 PMCID: PMC10670324 DOI: 10.3390/cimb45110539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
Neuroinflammation has a significant impact on different pathologies, such as stroke or spinal cord injury, intervening in their pathophysiology: expansion, progression, and resolution. Neuroinflammation involves oxidative stress, damage, and cell death, playing an important role in neuroplasticity and motor dysfunction by affecting the neuronal connection responsible for motor control. The diagnosis of this pathology is performed using neuroimaging techniques and molecular diagnostics based on identifying and measuring signaling molecules or specific markers. In parallel, new therapeutic targets are being investigated via the use of bionanomaterials and electrostimulation to modulate the neuroinflammatory response. These novel diagnostic and therapeutic strategies have the potential to facilitate the development of anticipatory patterns and deliver the most beneficial treatment to improve patients' quality of life and directly impact their motor skills. However, important challenges remain to be solved. Hence, the goal of this study was to review the implication of neuroinflammation in the evolution of motor function in stroke and trauma patients, with a particular focus on novel methods and potential biomarkers to aid clinicians in diagnosis, treatment, and therapy. A specific analysis of the strengths, weaknesses, threats, and opportunities was conducted, highlighting the key challenges to be faced in the coming years.
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Affiliation(s)
- Ane Larrea
- Research and Development Division, IMG Pharma Biotech, 48170 Zamudio, Spain; (A.L.); (A.E.); (E.D.-M.); (E.A.)
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain;
| | - Ane Elexpe
- Research and Development Division, IMG Pharma Biotech, 48170 Zamudio, Spain; (A.L.); (A.E.); (E.D.-M.); (E.A.)
| | - Eguzkiñe Díez-Martín
- Research and Development Division, IMG Pharma Biotech, 48170 Zamudio, Spain; (A.L.); (A.E.); (E.D.-M.); (E.A.)
- Department of Immunology, Microbiology and Parasitology, Faculty of Science and Technology, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - María Torrecilla
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain;
| | - Egoitz Astigarraga
- Research and Development Division, IMG Pharma Biotech, 48170 Zamudio, Spain; (A.L.); (A.E.); (E.D.-M.); (E.A.)
| | - Gabriel Barreda-Gómez
- Research and Development Division, IMG Pharma Biotech, 48170 Zamudio, Spain; (A.L.); (A.E.); (E.D.-M.); (E.A.)
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16
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Goncharov EN, Koval OA, Bezuglov EN, Vetoshkin AA, Goncharov NG, Ramirez MDJE, Khachaturovich OS, Montemurro N. A Comparative Analysis Between Conservative Treatment, Arthroscopic Repair, and Biceps Tenodesis in Superior Labral Anterior-Posterior (SLAP) Lesions. Cureus 2023; 15:e47512. [PMID: 38022173 PMCID: PMC10663969 DOI: 10.7759/cureus.47512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Background "Throwing shoulder" hinders athletes' shoulder functions, causing pain, weakness, and performance reduction due to anatomical, physiological, and biomechanical factors. Anatomical issues include superior labral anterior-posterior (SLAP) injuries, rotator cuff injuries, and glenohumeral instability. Methods This study compared arthroscopic labral repairs in patients under 40 years old with shoulder injuries between 2015 and 2017. Sixty eligible patients were divided into three groups: conservative treatment, arthroscopic repair, and tenodesis. Measures included pain, functional scores, and the range of motion pre-/post-operation. Results At the last follow-up, pain relief and functional improvement were most significant with tenodesis (97% pain relief, 95% functional improvement), followed by repair (85% pain relief, 70% functional improvement), and least in conservative treatment (45% pain relief, 40% functional improvement). While all treatments significantly reduced pain and improved function (p<0.001), tenodesis demonstrated the highest effectiveness, suggesting it as a potentially preferred method. Significant improvements in pain relief and function were observed across all methods; however, surgical options suggested improved outcomes. Conclusion Our study compares conservative treatment, arthroscopic labral repair, and biceps tenodesis (BT) for SLAP lesions, highlighting significant pain relief and functional improvement across all. Conservative treatment suits patients with milder symptoms, while arthroscopic repair addresses larger tears. As the effectiveness of arthroscopic treatment is not inferior to conservative one, BT excels in cases of substantial bicep involvement.
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Affiliation(s)
| | | | | | | | | | | | | | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, ITA
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17
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Collins RA, Dang M, McReynolds S, Puckett Y, Ronaghan CA. Use of a dynamic tissue system and biological xenograft in complex traumatic wound closure. J Wound Care 2023; 32:S12-S15. [PMID: 37682802 DOI: 10.12968/jowc.2023.32.sup9.s12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
OBJECTIVE Asymmetrical dimensions and nonlinear margins of a multilayered traumatic wound often preclude healing via primary intention. We present the case of an otherwise healthy 21-year-old male who sustained trauma following a boating accident. METHOD The patient sustained three lacerations to the posterior thighs from the boat propeller. The most extensive wound measured 25×10×6cm of muscle extrusion with a divot fracture involving the posterior femur. RESULTS Primary closure and restoration of muscle biomechanics was achieved using a combination of a dynamic tissue system (DTS) and porcine urinary bladder matrix (PUBM) xenograft. After 24 days of treatment in hospital, the patient was discharged without the need for home health, outpatient wound care, or ongoing negative pressure wound therapy. The patient recovered full function of the legs and was cleared for participation in all activities. CONCLUSION This complex traumatic boat propeller injury presented many challenges, including a transverse orientation on the extremity, degree of muscle injury/extrusion, and significant soft tissue loss. The combined application of a DTS with PUBM biological xenograft achieved a primary myocutaneous closure without the need for skin graft or flap reconstruction by plastic surgery.
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Affiliation(s)
- Reagan A Collins
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, US
| | - Michael Dang
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, US
| | - Shirley McReynolds
- Texas Tech University Health Sciences Center, Department of Surgery, Lubbock, TX, US
| | - Yana Puckett
- West Virginia University School of Medicine, Department of Surgery, Charleston, WV, US
| | - Catherine A Ronaghan
- Texas Tech University Health Sciences Center, Department of Surgery, Lubbock, TX, US
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18
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Mugisa R, Kironde EL, Mwaka ES. Quality of life of patients with traumatic spinal cord injuries: a cross-sectional study at a tertiary hospital in Uganda. Afr Health Sci 2023; 23:521-533. [PMID: 38357147 PMCID: PMC10862569 DOI: 10.4314/ahs.v23i3.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background The study aimed to assess the perceived quality of life of patients with traumatic spinal cord injuries. Methodology This was a cross sectional study conducted in the Spine Unit of a tertiary hospital in Uganda. The study population comprised of patients with spinal cord injuries. Data were collected using the WHO Quality of Life Brief questionnaire and Functional Independence Measure tool. Results 103 patients participated in the study, most were male (73.8%), and had a mean age of 37.7 years. Most participants were married (57.3%), unemployed (72.8%) and had no steady source of income (62.1%). Road traffic accidents accounted for most injuries (59.2%). The mean duration since injury was 20.5 months. Most participants (58.3%) had incomplete spinal cord injuries and 84.5% had complications. The perceived overall quality of life was poor in 87.4% of patients. Being employed (p= 0.02), the presence of complications (p= 0.03), and injury severity (p= 0.003) significantly affected quality of life. Functional independent measure scores were significantly better in individuals less severe injuries and those with lumbar level of injury with mean scores of 113.1±8.9 and 99.9±15.3 respectively. Conclusion The overall self-reported quality of life among patients with traumatic spinal cord injury was generally poor.
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Affiliation(s)
- Rogers Mugisa
- Department of Orthopaedics, College of Health Sciences Makerere University, Kampala
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Huang GS, Dunham CM, Chance EA. Occurrence of Numerous Cerebral White Matter Hyperintensities in Trauma Patients With Cerebral Fat Embolism: A Systematic Review and Report of Two Cases. Cureus 2023; 15:e45450. [PMID: 37859880 PMCID: PMC10583483 DOI: 10.7759/cureus.45450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/21/2023] Open
Abstract
There has been little effort to identify an overall occurrence of numerous cerebral white matter hyperintensities (NCWMH) on relevant brain magnetic resonance imaging (MRI) sequences in postinjury cerebral fat embolism syndrome (CFES) patients. Also, quantification of pre-CFES cognitive status, degree of neurologic deterioration, and presence of a skeletal fracture with CFES is nominal. The authors performed a PubMed search and identified 24 relevant manuscripts. Two case reports from the authors' institution were also used. The presence of NCWMH was assessed by reviewing T2-weighted image (T2WI), diffusion-weighted image (DWI), fluid-attenuated inversion recovery (FLAIR) figures and captions, and by evaluating manuscript descriptions. When pre-CFES cognitive status was described, it was categorized as Glasgow Coma Scale (GCS) score = 14-15 (yes or no). When the degree of neurologic deterioration was noted with CFES, it was classified as coma or GCS ≤ 8 (yes or no). When skeletal fractures were itemized, they were categorized as yes or no. The total number of CFES patients was 133 (literature search was 131 and two author-described case reports). Of the 131 patients with manuscript MRI figures or descriptive statements, 120 (91. 6%) had NCWMH. Of 63 patients with a delineation of the MRI sequence, NCWMH appeared on DWI in 24, on T2WI in 57, and on FLAIR in 10 patients. Pre-CFES cognitive status was GCS 14-15 in 93.5% (58/62) of the patients. The CFES neurologic deterioration was coma or GCS ≤ 8 in 52.5% (62/118) of the patients. A skeletal fracture was present in 99.0% (101/102) of the CFES patients. The presence of NCWMH in trauma patients with hospital-acquired neurologic deterioration and the presence of a skeletal fracture is consistent with CFES.
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Affiliation(s)
- Gregory S Huang
- Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, Youngstown, USA
| | - C Michael Dunham
- Trauma, Critical Care, and General Surgery Services, St. Elizabeth Youngstown Hospital, Youngstown, USA
| | - Elisha A Chance
- Trauma and Neuroscience Research Department, St. Elizabeth Youngstown Hospital, Youngstown, USA
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O'Brien B, Farrell A, Janeczko P, Shah P. Progression and Resolution of a Post-traumatic Pleurocutaneous Fistula. Cureus 2023; 15:e44944. [PMID: 37818514 PMCID: PMC10561587 DOI: 10.7759/cureus.44944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/12/2023] Open
Abstract
Pleurocutaneous fistula (PCF) is a pathological communication between the pleural space and subcutaneous tissue. This rare condition occurs as a complication of infection, malignancy, and therapeutic procedures such as tube thoracostomies. PCF is typically confirmed with computed tomography (CT) imaging. There is no current literature describing the post-traumatic causes of PCF. We describe a PCF related to multiple rib fractures and its rapid improvement following the placement of a chest tube. This case emphasizes the importance of prompt CT imaging in trauma patients and radiographically illustrates the progression and resolution of a post-traumatic PCF.
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Affiliation(s)
| | - Aidan Farrell
- Radiology, Hackensack Meridian School of Medicine, Nutley, USA
| | | | - Pranav Shah
- Vascular and Interventional Radiology, Jersey Shore University Medical Center, Neptune, USA
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Kelly-Hedrick M, Ugiliweneza B, Toups EG, Jimsheleishvili G, Kurpad SN, Aarabi B, Harrop JS, Foster N, Goodwin RC, Shaffrey CI, Fehlings MG, Tator CH, Guest JD, Neal CJ, Abd-El-Barr MM, Williamson T. Interhospital Transfer Delays Care for Spinal Cord Injury Patients: A Report from the North American Clinical Trials Network for Spinal Cord Injury. J Neurotrauma 2023; 40:1928-1937. [PMID: 37014079 DOI: 10.1089/neu.2022.0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Abstract The North America Clinical Trials Network (NACTN) for Spinal Cord Injury (SCI) is a consortium of tertiary medical centers that has maintained a prospective SCI registry since 2004, and it has espoused that early surgical intervention is associated with improved outcome. It has previously been shown that initial presentation to a lower acuity center and necessity of transfer to a higher acuity center reduce rates of early surgery. The NACTN database was evaluated to examine the association between interhospital transfer (IHT), early surgery, and outcome, taking into account distance traveled and site of origin for the patient. Data from a 15-year period of the NACTN SCI Registry were analyzed (years 2005-2019). Patients were stratified into transfers directly from the scene to a Level 1 trauma center (NACTN site) versus IHT from a Level 2 or 3 trauma facility. The main outcome was surgery within 24 hours of injury (yes/no), whereas secondary outcomes were length of stay, death, discharge disposition, and 6-month American Spinal Injury Association Impairment Scale (AIS) grade conversion. For the IHT patients, distance traveled for transfer was calculated by measuring the shortest distance between origin and NACTN hospital. Analysis was performed with Brown-Mood test and chi-square tests. Of 724 patients with transfer data, 295 (40%) underwent IHT and 429 (60%) were admitted directly from the scene of injury. Patients who underwent IHT were more likely to have a less severe SCI (AIS D; p = 0.002), have a central cord injury (p = 0.004), and have a fall as their mechanism of injury (p < 0.0001) than those directly admitted to an NACTN center. Of the 634 patients who had surgery, direct admission to an NACTN site was more likely to result in surgery within 24 hours compared with IHT patients (52% vs. 38%) (p < 0.0003). Median IHT distance was 28 miles (interquartile range [IQR] = 13-62 miles). There was no significant difference in death, length of stay, discharge to a rehab facility versus home, or 6-month AIS grade conversion rates between the two groups. Patients who underwent IHT to an NACTN site were less likely to have surgery within 24 hours of injury, compared with those directly admitted to the Level 1 trauma facility. Although there was no difference in mortality rates, length of stay, or 6-month AIS conversion between groups, patients with IHT were more likely be older with a less severe level of injury (AIS D). This study suggests there are barriers to timely recognition of SCI in the field, appropriate admission to a higher level of care after recognition, and challenges related to the management of individuals with less severe SCI.
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Affiliation(s)
- Margot Kelly-Hedrick
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Elizabeth G Toups
- Department of Neurosurgery, Houston Methodist Hospital, Houston TX, USA
| | | | - Shekar N Kurpad
- Department of Neurosurgery, The Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bizhan Aarabi
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James S Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Norah Foster
- Department of Orthopedics, Miami Valley Hospital, Centerville, Ohio, USA
| | - Rory C Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Charles H Tator
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James D Guest
- The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Chris J Neal
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Muhammad M Abd-El-Barr
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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22
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Fuenteslópez CV, Thompson MS, Ye H. Development and Optimisation of Hydrogel Scaffolds for Microvascular Network Formation. Bioengineering (Basel) 2023; 10:964. [PMID: 37627849 PMCID: PMC10451297 DOI: 10.3390/bioengineering10080964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Traumatic injuries are a major cause of morbidity and mortality worldwide; however, there is limited research on microvascular traumatic injuries. To address this gap, this research aims to develop and optimise an in vitro construct for traumatic injury research at the microvascular level. Tissue engineering constructs were created using a range of polymers (collagen, fibrin, and gelatine), solvents (PBS, serum-free endothelial media, and MES/NaCl buffer), and concentrations (1-5% w/v). Constructs created from these hydrogels and HUVECs were evaluated to identify the optimal composition in terms of cell proliferation, adhesion, migration rate, viability, hydrogel consistency and shape retention, and tube formation. Gelatine hydrogels were associated with a lower cell adhesion, whereas fibrin and collagen ones displayed similar or better results than the control, and collagen hydrogels exhibited poor shape retention; fibrin scaffolds, particularly at high concentrations, displayed good hydrogel consistency. Based on the multipronged evaluation, fibrin hydrogels in serum-free media at 3 and 5% w/v were selected for further experimental work and enabled the formation of interconnected capillary-like networks. The networks formed in both hydrogels displayed a similar architecture in terms of the number of segments (10.3 ± 3.21 vs. 9.6 ± 3.51) and diameter (8.6446 ± 3.0792 μm vs. 7.8599 ± 2.3794 μm).
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Affiliation(s)
| | | | - Hua Ye
- Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, UK; (C.V.F.); (M.S.T.)
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Moksnes HØ, Schäfer C, Rasmussen MS, Soberg HL, Røise O, Anke A, Røe C, Næss PA, Gaarder C, Helseth E, Dahl HM, Hestnes M, Brunborg C, Andelic N, Hellstrøm T. Functional Outcomes at 6 and 12 Months Post-Injury in a Trauma Centre Population with Moderate-to-Severe Traumatic Injuries. J Clin Med 2023; 12:5300. [PMID: 37629342 PMCID: PMC10455533 DOI: 10.3390/jcm12165300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
This study aims to evaluate the global functional outcomes after moderate-to-severe traumatic injury at 6 and 12 months and to examine the sociodemographic and injury-related factors that predict these outcomes. A prospective cohort study was conducted in which trauma patients of all ages with a New Injury Severity Score > 9 who were discharged alive from two regional trauma centres in Norway over a one-year period (2020) were included. The Glasgow Outcome Scale Extended (GOSE) score was used to analyse the functional outcomes. Regression analyses were performed to investigate the predictors of the GOSE score. Follow-up assessments were obtained from approximately 85% of the 601 included patients at both time points. The mean (SD) GOSE score was 6.1 (1.6) at 6 months and 6.4 (1.6) at 12 months, which corresponds to an upper-moderate disability. One-half of the patients had a persistent disability at 12 months post-injury. The statistically significant predictors of a low GOSE score at both time points were more pre-injury comorbidity, a higher number of injuries, and higher estimated rehabilitation needs, whereas a thorax injury with an Abbreviated Injury Scale ≥ 3 predicted higher GOSE scores. A high Glasgow Coma Scale score at admission predicted a higher GOSE score at 6 months. This study strengthens the evidence base for the functional outcomes and predictors in this population.
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Affiliation(s)
- Håkon Øgreid Moksnes
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
| | - Christoph Schäfer
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, P.O. Box 6050 Langnes, N-9037 Tromsø, Norway
- Department of Rehabilitation, University Hospital of North Norway, P.O. Box 100, N-9038 Tromsø, Norway
| | - Mari Storli Rasmussen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
- Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, N-0130 Oslo, Norway
| | - Helene Lundgaard Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, N-0130 Oslo, Norway
| | - Olav Røise
- Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway;
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
| | - Audny Anke
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, P.O. Box 6050 Langnes, N-9037 Tromsø, Norway
- Department of Rehabilitation, University Hospital of North Norway, P.O. Box 100, N-9038 Tromsø, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
| | - Pål Aksel Næss
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
- Department of Traumatology, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Christine Gaarder
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
- Department of Traumatology, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
- Department of Neurosurgery, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Hilde Margrete Dahl
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway; (P.A.N.); (C.G.); (E.H.); (H.M.D.)
- Department of Child Neurology, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Morten Hestnes
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway;
- Oslo University Hospital Trauma Registry, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway;
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, N-0316 Oslo, Norway;
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway; (C.S.); (M.S.R.); (H.L.S.); (C.R.); (N.A.); (T.H.)
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Wang YC, Wang SP. [Resuscitative Endovascular Balloon Occlusion of the Aorta: Implementation and Nursing Care]. Hu Li Za Zhi 2023; 70:87-94. [PMID: 37469323 DOI: 10.6224/jn.202308_70(4).11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Uncontrolled hemorrhagic shock is the main cause of death in patients with traumatic injuries. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a rapidly performed and less-invasive treatment to stop bleeding. The REBOA balloon may be placed at the location of bleeding to achieve hemostasis. Prior to balloon placement, the indications for placement must be evaluated, including non-thoracic aortic trauma and non-traumatic patients with postpartum hemorrhage, and the appropriate sheath size (from 5 to 8 French) must be selected based on the bleeding site. As vascular injury of aortic dissection, rupture, or perforation may occur during the procedure, changes in hemodynamic parameters should be monitored. After balloon placement, ischemic complications due to blood flow occlusion such as lower extremity ischemia and acute renal failure should be tracked. After balloon removal, reperfusion injuries may occur, which can result in multiple organ failure, and should be observed closely. When caring for patients receiving REBOA, physicians should explain the procedure to their families to obtain informed consent. Also, nurses should prepare supplies and closely monitor changes in critical life signs to minimize the risks of hypotension, arrhythmia, and changes in consciousness during the procedure. After placement, the neurovascular and peripheral limbs "5P" (pain, pallor, paresthesia, pulselessness and paralysis) condition should be evaluated and recorded in detail. This treatment approach requires further study and research to assess the long-term impacts of placement and improve quality of care in these patients.
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Affiliation(s)
- Yen-Chi Wang
- MSN, RN, Department of Nursing, National Taiwan University Hospital, Taiwan, ROC
| | - Shiao-Pei Wang
- PhD, RN, Head Nurse, Department of Nursing, National Taiwan University Hospital, Taiwan, ROC.
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25
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Gemci Ç, Imerci A, Aydogan NH. Lower Extremity Injuries Due to Chainsaw During Four-Year Periods. Cureus 2023; 15:e44058. [PMID: 37746398 PMCID: PMC10517730 DOI: 10.7759/cureus.44058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Background Chainsaws cause injuries mostly on the upper extremities, then on the face and lower extremities. In the literature, there are many studies about hand and face injuries; however, articles about lower extremity injuries are limited. The aim of the study is to define injury patterns, treatments, and results of the cases that we have encountered in our hospital and to evaluate precautions after reviewing the literature. Methods Patients admitted to our hospital's Emergency Department with chainsaw-related lower extremity injuries between 2016 and 2021 are evaluated. Patients' demographic data, pathologies, treatments, length of stay in hospital, return to work time, and functional scores are calculated retrospectively. Results There were 39 male and two female patients, with a minimum follow-up of 12 months. Their mean age was 42.6 ± SD (16-62). Thirty-two patients (78.04%) had injuries on the left lower extremity, and nine patients (21.9%) had injuries on the right lower extremity. 93.75% (30/32) of the patients with left lower extremity injuries had the right hand as the dominant extremity. The most frequently observed injury pattern was extensor hallucis longus (EHL) tendon disruption, with a percentage of 58.5% (24/41). 29.2% (13/41) of the cases had bone pathologies present as well. Patients' average AOFAS score was 97.4 ± 4.4 (74-100) at the end of one year. The average hospitalization length of stay was 2.95 ± 2.7 (0-15) days, and the time interval of return to work was 6.17 ± 1.4 (2-15) weeks, excluding one patient who had to change his workplace. Conclusion Saw-related injuries of the lower extremities are the injuries that can be seen mostly in male patients. Among the right dominant-handed patients, left foot dorsum injuries were the most common EHL tendon disruptions observed. We have seen that the reason for this is foot injuries remaining in the projection of the saw due to incorrect positioning of the foot. Protective gear and shoes must be used as precautions. More preventive measures could be taken while using chainsaws and similar tools, as they may cause serious injuries. Requirements for the use and sale of this tool should be introduced, and training should be given as it can be easily purchased by the public.
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Affiliation(s)
- Çağatay Gemci
- Department of Orthopaedics and Traumatology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, TUR
| | - Ahmet Imerci
- Department of Orthopaedics and Traumatology, Mugla Sitki Kocman University Hospital, Mugla, TUR
| | - Nevres Hurriyet Aydogan
- Department of Orthopaedics and Traumatology, Mugla Sitki Kocman University Hospital, Mugla, TUR
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26
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Collier S, Bryce I. A Systematic Literature Review of the Teaching Considerations and Practices Provided to Children in an Education Setting with Comorbid Disability and Developmental Trauma. Children (Basel) 2023; 10:1289. [PMID: 37628288 PMCID: PMC10453141 DOI: 10.3390/children10081289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/08/2023] [Accepted: 07/18/2023] [Indexed: 08/27/2023]
Abstract
Developmental trauma and disability are frequently co-occurring lived experiences for children and young people. The present research explores the considerations and practices for pedagogy provided to children with a disability and who have experienced developmental trauma in an educational setting. A systematic literature review was conducted to explore and synthesise the current evidence base that exists relating to the considerations for quality teaching practice for this cohort of students within schools. Findings revealed five key themes, which contribute to an understanding of considerations and practices for teaching students with childhood trauma experiences whilst considering an additional dimension intersecting with disabilities including mental ill-health. The findings of this study broaden the understanding of the complexities facing the education sector in ensuring inclusion principles are enacted to increase impact and improve outcomes for these students with multiple and complex needs.
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Affiliation(s)
- Simone Collier
- School of Education, University of Southern Queensland, Toowoomba, QLD 4300, Australia;
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27
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Tenorio A, Brandel MG, Produturi GR, McCann CP, Wali AR, Bravo Quintana J, Doucet JJ, Costantini TW, Ciacci JD. Novel association of blunt cerebrovascular injuries with the San Diego-Mexico border wall height extension. World Neurosurg 2023:S1878-8750(23)00908-7. [PMID: 37419313 DOI: 10.1016/j.wneu.2023.06.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The San Diego-Mexico border wall height extension is associated with increased traumatic injuries and related costs after wall falls. We report previous trends and a neurological injury type not previously associated with border falls: blunt cerebrovascular injuries (BCVIs). METHODS In this retrospective cohort study, patients who presented to the UC San Diego Health Trauma Center for injuries from border wall falls from 2016-2021 were considered. Patients were included if they were admitted in the pre-height extension period (January 2016-May 2018) or post-height extension period (June 2018-December 2021). Demographics, clinical data, and hospital stay data were compared. RESULTS We identified 383 patients, 51 (68.6% male; mean age 33.5 years) in the pre-height extension cohort and 332 (77.1% male; mean age 31.5 years) in the post-height extension cohort. There were 0 and 5 BCVIs in the pre-height and post-height extension groups respectively. BCVIs were associated with increased injury severity scores (9.16 vs 31.33; p<0.001), median ICU length of stay (0 [IQR 0-3] vs 5 [IQR 2-21]; p=0.022), and total hospital charges ($163,490 [IQR $86,578, $282,036] vs $835,260 [IQR $171,049, $1,933,996]; p=0.048). Poisson modeling found BCVI admissions were 0.21 (95%CI 0.07-0.41; p=0.042) per month higher post-height extension. CONCLUSIONS We review the injuries correlated with the border wall extension and reveal an association with rare, potentially devastating BCVIs that were not seen before the border wall modifications. These BCVIs and associated morbidity shed light on the trauma increasingly found at the southern US border, which may be informative for future infrastructure policy decisions.
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Affiliation(s)
- Alexander Tenorio
- Department of Neurosurgery, University of California, San Diego, San Diego, CA.
| | - Michael G Brandel
- Department of Neurosurgery, University of California, San Diego, San Diego, CA
| | | | - Carson P McCann
- School of Medicine, University of California, San Diego, San Diego, CA
| | - Arvin R Wali
- Department of Neurosurgery, University of California, San Diego, San Diego, CA
| | - Javier Bravo Quintana
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego, San Diego, CA
| | - Jay J Doucet
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego, San Diego, CA
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego, San Diego, CA
| | - Joseph D Ciacci
- Department of Neurosurgery, University of California, San Diego, San Diego, CA
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28
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Eldore LW, Borries T, Malick H, Mason K, DePrisco G. Testicular Rupture Following Motorcycle Accident. Cureus 2023; 15:e41609. [PMID: 37565108 PMCID: PMC10409644 DOI: 10.7759/cureus.41609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/12/2023] Open
Abstract
Testicular rupture is a surgical emergency necessitating prompt diagnosis and intervention to prevent irreversible damage. Blunt trauma, including motorcycle collisions, is a common cause of testicular rupture. In the case of multi-trauma, the diagnosis of testicular rupture may be missed in the rush to surgical intervention of more grossly obvious injuries. We present a case of a 24-year-old male who suffered a motorcycle accident and subsequently presented with diffuse abdominal and hip pain. Physical exam and imaging at the emergency department showed multiple pelvic bone fractures, along with a small scrotal injury which was triaged below his pelvic injuries. His pelvic fractures were immediately operated on. Nearly 18 hours after his initial presentation, the patient received a scrotal ultrasound which demonstrated a rupture of the right testicle. Due to this long delay in diagnosis, his urological team opted for non-surgical management and instead employed a more conservative treatment regimen involving pain control, scrotal support, rest, and serial scrotal ultrasounds. This case highlights the importance of timely ultrasound examination for testicular pathology in the setting of multi-trauma and known scrotal injury. Another highlight of this case is the showcase of an uncommon treatment regimen utilizing conservative tactics as opposed to opting for surgical intervention.
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Affiliation(s)
- Luke W Eldore
- Medical School, Texas A&M College of Medicine, Dallas, USA
| | - Trevor Borries
- Diagnostic Radiology, Baylor University Medical Center, Dallas, USA
| | - Hamza Malick
- Medical School, Texas A&M College of Medicine, Dallas, USA
| | - Kiera Mason
- Diagnostic Radiology, Baylor University Medical Center, Dallas, USA
| | - Gregory DePrisco
- Diagnostic Radiology, Baylor University Medical Center, Dallas, USA
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Nhu NT, Kang JH, Yeh TS, Wu CC, Tsai CY, Piravej K, Lam C. Prediction of posttraumatic functional recovery in middle-aged and older patients through dynamic ensemble selection modeling. Front Public Health 2023; 11:1164820. [PMID: 37408743 PMCID: PMC10319009 DOI: 10.3389/fpubh.2023.1164820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/17/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Age-specific risk factors may delay posttraumatic functional recovery; complex interactions exist between these factors. In this study, we investigated the prediction ability of machine learning models for posttraumatic (6 months) functional recovery in middle-aged and older patients on the basis of their preexisting health conditions. Methods Data obtained from injured patients aged ≥45 years were divided into training-validation (n = 368) and test (n = 159) data sets. The input features were the sociodemographic characteristics and baseline health conditions of the patients. The output feature was functional status 6 months after injury; this was assessed using the Barthel Index (BI). On the basis of their BI scores, the patients were categorized into functionally independent (BI >60) and functionally dependent (BI ≤60) groups. The permutation feature importance method was used for feature selection. Six algorithms were validated through cross-validation with hyperparameter optimization. The algorithms exhibiting satisfactory performance were subjected to bagging to construct stacking, voting, and dynamic ensemble selection models. The best model was evaluated on the test data set. Partial dependence (PD) and individual conditional expectation (ICE) plots were created. Results In total, nineteen of twenty-seven features were selected. Logistic regression, linear discrimination analysis, and Gaussian Naive Bayes algorithms exhibited satisfactory performances and were, therefore, used to construct ensemble models. The k-Nearest Oracle Elimination model outperformed the other models when evaluated on the training-validation data set (sensitivity: 0.732, 95% CI: 0.702-0.761; specificity: 0.813, 95% CI: 0.805-0.822); it exhibited compatible performance on the test data set (sensitivity: 0.779, 95% CI: 0.559-0.950; specificity: 0.859, 95% CI: 0.799-0.912). The PD and ICE plots showed consistent patterns with practical tendencies. Conclusion Preexisting health conditions can predict long-term functional outcomes in injured middle-aged and older patients, thus predicting prognosis and facilitating clinical decision-making.
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Affiliation(s)
- Nguyen Thanh Nhu
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Jiunn-Horng Kang
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tian-Shin Yeh
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Epidemiology and Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, United States
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Chia-Chieh Wu
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Yu Tsai
- Centre for Transport Studies, Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
| | - Krisna Piravej
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Carlos Lam
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Gál E, Bartosiewicz L. Integrating New Prehistoric Palaeopathological Finds from Hungary. Animals (Basel) 2023; 13:1994. [PMID: 37370504 DOI: 10.3390/ani13121994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Eight newly identified pathological animal remains identified in two Middle Neolithic assemblages (ca 5330-4940 calBC) in northern and western Hungary were placed within the broader context of relevant prehistoric finds. The aim was to understand the underrepresented Middle Neolithic finds in light of the better-known cases from other prehistoric periods. The newly reported cases include arthritic and inflammatory lesions, as well as dental disorders, such as linear enamel hypoplasia, recognized for the first time in the Hungarian Neolithic. Identifications were based on bone macromorphology. When large samples are available, the frequencies of pathological bone specimens reflect the taxonomic composition. Along with the increasing number of cases, longevity related to exploitation for secondary products also became manifest. Therefore, the effects of assemblage size, disease classification and differences between authors (related to training and the time of publication) need to be considered before pathological lesions can be interpreted in terms of diachronic changes in animal husbandry.
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Affiliation(s)
- Erika Gál
- Institute of Archaeology, Research Centre for the Humanities, Tóth Kálmán u. 4, 1097 Budapest, Hungary
| | - László Bartosiewicz
- Osteoarchaeological Research Laboratory, Stockholm University, Lilla Frescativägen 7, 106 91 Stockholm, Sweden
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Candib A, Lee N, Sam N, Cho E, Rojas J, Hastings R, DeAlva K, Khon D, Gonzalez A, Molina B, Torabzadeh G, Vu J, Hasenstab K, Sant K, Phillips JA, Finley K. The Influence of Cannabinoids on Drosophila Behaviors, Longevity, and Traumatic Injury Responses of the Adult Nervous System. Cannabis Cannabinoid Res 2023. [PMID: 37158809 DOI: 10.1089/can.2022.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Introduction: The legalization of cannabis products has increased their usage in the United States. Among the ∼500 active compounds, this is especially true for cannabidiol (CBD)-based products, which are being used to treat a range of ailments. Research is ongoing regarding the safety, therapeutic potential, and molecular mechanism of cannabinoids. Drosophila (fruit flies) are widely used to model a range of factors that impact neural aging, stress responses, and longevity. Materials and Methods: Adult wild-type Drosophila melanogaster cohorts (w1118/+) were treated with different Δ9-tetrahydrocannabinol (THC) and CBD dosages and examined for neural protective properties using established neural aging and trauma models. The therapeutic potential of each compound was assessed using circadian and locomotor behavioral assays and longevity profiles. Changes to NF-κB pathway activation were assessed by measuring expression levels of downstream targets using quantitative real-time polymerase chain reaction analysis of neural cDNAs. Results: Flies exposed to different CBD or THC dosages showed minimal effects to sleep and circadian-based behaviors or the age-dependent decline in locomotion. The 2-week CBD (3 μM) treatment did significantly enhance longevity. Flies exposed to different CBD and THC dosages were also examined under stress conditions, using the Drosophila mild traumatic brain injury (mTBI) model (10×). Pretreatment with either compound did not alter baseline expression of key inflammatory markers (NF-κB targets), but did reduce neural mRNA profiles at a key 4-h time point following mTBI exposure. Locomotor responses were also significantly improved 1 and 2 weeks following mTBI. After mTBI (10×) exposure, the 48-h mortality rate improved for CBD (3 μM)-treated flies, as were global average longevity profiles for other CBD doses tested. While not significant, THC (0.1 μM)-treated flies show a net positive impact on acute mortality and longevity profiles following mTBI (10×) exposure. Conclusions: This study shows that the CBD and THC dosages examined had at most a modest impact on basal neural function, while demonstrating that CBD treatments had significant neural protective properties for flies following exposure to traumatic injury.
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Affiliation(s)
- Alec Candib
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Nicholas Lee
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Natasha Sam
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Eddie Cho
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Jesse Rojas
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Reina Hastings
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Kyle DeAlva
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Diana Khon
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Andrea Gonzalez
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Brandon Molina
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Gina Torabzadeh
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Josephine Vu
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Kyle Hasenstab
- Department of Mathematics and Statistics, San Diego State University, San Diego, California, USA
| | - Karylin Sant
- Division of Environmental Health, San Diego State University, San Diego, California, USA
| | - Joy A Phillips
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
| | - Kim Finley
- Shiley Bioscience Center, San Diego State University, San Diego, California, USA
- Biology Department, San Diego State University, San Diego, California, USA
- Division of Environmental Health, San Diego State University, San Diego, California, USA
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Meena K, Gautam S, Kyizom T, Meena RK, Nayak AP, Prakash S. Effect of 3% Hypertonic Saline Resuscitation on Lactate Clearance and Its Comparison With 0.9% Normal Saline in Traumatic Injury Patients: A Prospective Randomized Control Trial. Cureus 2023; 15:e38836. [PMID: 37303339 PMCID: PMC10254090 DOI: 10.7759/cureus.38836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Fluid resuscitation with normal saline (NS) can aggravate lactate production. The objective of this study was to evaluate the efficacy of small-volume resuscitation using 3% hypertonic sodium chloride (HS) and its comparison with NS in trauma patients. The primary endpoint was an increase in lactate clearance after 1 hr of fluid resuscitation. The secondary endpoint was the incidence of hemodynamic stability, the volume of transfusion, correction of metabolic acidosis, and complications such as fluid overload and abnormal serum sodium levels. MATERIALS AND METHODS It was a prospective, randomized, single-blind study. The study was conducted on 60 patients who arrived at the trauma center for emergency operative intervention. Inclusion criteria for patient selection were trauma victims of age more than 18 years and the requirement of emergency operative intervention for trauma except for traumatic brain injury. Patients were divided into two groups: Group HS (hypertonic saline) and Group NS (normal saline). Patients were resuscitated with either 3% HS (4ml/kg) or 0.9% NS (20ml/kg). RESULTS The HS group had higher lactate clearance at 1 hour compared to the NS group, and this difference was statistically significant with a p-value of <0.001. When hemodynamic parameters were compared at 30 and 60 minutes after resuscitation, the HS group had a significantly lower heart rate (p<0.05 at 30 minutes and <0.001 at 60 minutes, respectively), a higher mean arterial pressure at 60 minutes (p<0.001), a higher pH at 60 minutes (p< 0.05), and a higher bicarbonate concentration at 60 minutes (p<0.05). The HS and NS groups had significant differences in serum sodium levels at 60 minutes (p<0.001). CONCLUSIONS Resuscitation with 3% hypertonic saline improved lactate clearance. Lower volumes of fluid infusion for resuscitation achieved better hemodynamic stability and correction of metabolic acidosis in the hypertonic saline group. Our study shows that hypertonic saline can be a promising fluid for small-volume resuscitation in trauma patients with compensated mild to moderate shock.
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Affiliation(s)
- Kavita Meena
- Anaesthesiology, Banaras Hindu University, Varanasi, IND
| | | | - Tenzin Kyizom
- Anaesthesiology, Sh. Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, IND
| | - Rajesh K Meena
- Anaesthesiology, Banaras Hindu University, Varanasi, IND
| | - Aditya P Nayak
- Anaesthesiology, Banaras Hindu University, Varanasi, IND
| | - Shashi Prakash
- Anaesthesiology, Banaras Hindu University, Varanasi, IND
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Vidaurre MDPH, Osborn BK, Lowak KD, McDonald MM, Wang YWW, Pa V, Richter JR, Xu Y, Arnold K, Liu J, Cardenas JC. A 3- O-sulfated heparan sulfate dodecasaccharide (12-mer) suppresses thromboinflammation and attenuates early organ injury following trauma and hemorrhagic shock. Front Immunol 2023; 14:1158457. [PMID: 37122735 PMCID: PMC10140401 DOI: 10.3389/fimmu.2023.1158457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Dysregulated inflammation and coagulation are underlying mechanisms driving organ injury after trauma and hemorrhagic shock. Heparan sulfates, cell surface glycosaminoglycans abundantly expressed on the endothelial surface, regulate a variety of cellular processes. Endothelial heparan sulfate containing a rare 3-O-sulfate modification on a glucosamine residue is anticoagulant and anti-inflammatory through high-affinity antithrombin binding and sequestering of circulating damage-associated molecular pattern molecules. Our goal was to evaluate therapeutic potential of a synthetic 3-O-sulfated heparan sulfate dodecasaccharide (12-mer, or dekaparin) to attenuate thromboinflammation and prevent organ injury. Methods Male Sprague-Dawley rats were pre-treated subcutaneously with vehicle (saline) or dekaparin (2 mg/kg) and subjected to a trauma/hemorrhagic shock model through laparotomy, gut distention, and fixed-pressure hemorrhage. Vehicle and dekaparin-treated rats were resuscitated with Lactated Ringer's solution (LR) and compared to vehicle-treated fresh-frozen-plasma-(FFP)-resuscitated rats. Serial blood samples were collected at baseline, after induction of shock, and 3 hours after fluid resuscitation to measure hemodynamic and metabolic shock indicators, inflammatory mediators, and thrombin-antithrombin complex formation. Lungs and kidneys were processed for organ injury scoring and immunohistochemical analysis to quantify presence of neutrophils. Results Induction of trauma and hemorrhagic shock resulted in significant increases in thrombin-antithrombin complex, inflammatory markers, and lung and kidney injury scores. Compared to vehicle, dekaparin treatment did not affect induction, severity, or recovery of shock as indicated by hemodynamics, metabolic indicators of shock (lactate and base excess), or metrics of bleeding, including overall blood loss, resuscitation volume, or hematocrit. While LR-vehicle-resuscitated rodents exhibited increased lung and kidney injury, administration of dekaparin significantly reduced organ injury scores and was similar to organ protection conferred by FFP resuscitation. This was associated with a significant reduction in neutrophil infiltration in lungs and kidneys and reduced lung fibrin deposition among dekaparin-treated rats compared to vehicle. No differences in organ injury, neutrophil infiltrates, or fibrin staining between dekaparin and FFP groups were observed. Finally, dekaparin treatment attenuated induction of thrombin-antithrombin complex and inflammatory mediators in plasma following trauma and hemorrhagic shock. Conclusion Anti-thromboinflammatory properties of a synthetic 3-O-sulfated heparan sulfate 12-mer, dekaparin, could provide therapeutic benefit for mitigating organ injury following major trauma and hemorrhagic shock.
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Affiliation(s)
- Maria del Pilar Huby Vidaurre
- Center for Translational Injury Research, Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Baron K. Osborn
- Center for Translational Injury Research, Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Kaylie D. Lowak
- Center for Translational Injury Research, Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Michelle M. McDonald
- Department of Pathology and Laboratory Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yao-Wei W. Wang
- Center for Translational Injury Research, Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Veda Pa
- Center for Translational Injury Research, Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jillian R. Richter
- Department of Surgery, Division of Trauma and Acute Care Surgery, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yongmei Xu
- Eshelman School of Pharmacy, Division of Chemical Biology and Medicinal Chemistry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Katelyn Arnold
- Eshelman School of Pharmacy, Division of Chemical Biology and Medicinal Chemistry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jian Liu
- Eshelman School of Pharmacy, Division of Chemical Biology and Medicinal Chemistry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jessica C. Cardenas
- Center for Translational Injury Research, Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
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Barki MT, Filza F, Khattak AF, Khalid OB, Qazi M, Gilani H, Ayub S, Farooq M. A Survey of Traumatic Brain Injuries from Road Traffic Collisions in a Lower Middle-Income Country. Cureus 2023; 15:e36892. [PMID: 37128537 PMCID: PMC10147992 DOI: 10.7759/cureus.36892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/03/2023] Open
Abstract
The burden of traumatic brain injury (TBI) from road traffic collisions (RTCs) is great in low-and middle-income countries (LMICs) due to shortfalls in preventative measures, and the lack of relevant, accurate data collection. To address this gap, we sought to study the epidemiology of TBI from RTCs in two LMIC neurosurgical centres in order to identify factors amenable to preventative strategies. A prospective survey of all adult and paediatric cases of TBI from RTCs admitted to Northwest General Hospital (NWGH) and Hayatabad Medical Complex (HMC) over a four-week period was carried out. Data on patient demographics, risk factors, injury details, pre-hospitalisation details, admission details and post-acute care was collected and analysed. A total of 68 patients were included in the study. 18 (26%) of the patients were male and in the 30 to 39 age group. Fifty-two percent were two-wheeler riders and/or passengers. 51 (75%) of the RTCs occurred between 12 noon and 12 midnight and in rural areas (66.2%). The most commonly documented risk factor that led to the RTC was speeding (35.3%). Pre-hospital care was either absent or undocumented. Up to two-thirds of patients were not direct transfers, and most were transported in private vehicles (48.5%) arriving later than an hour after injury (94.1%). Less than half with documented disabilities were referred for rehabilitation (38.5%). There are still gaps in the prevention of TBI from RTCs and in relevant data collection. Data collection systems must be strengthened, and further exploratory research carried out in order to improve the prevention of TBI from RTCs.
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Affiliation(s)
| | - Faiqa Filza
- Neurosurgery, Northwest General Hospital and Research Center, Peshawar, PAK
| | - Almas F Khattak
- Community Medicine and Research, Northwest School of Medicine, Peshawar, PAK
| | - Osama Bin Khalid
- Medicine and Surgery, Northwest School of Medicine, Peshawar, PAK
| | - Mustafa Qazi
- Medicine and Surgery, Northwest School of Medicine, Peshawar, PAK
| | - Humaira Gilani
- Dermatology, Northwest General Hospital and Research Center, Peshawar, PAK
| | - Shahid Ayub
- Neurosurgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
- Neurosurgery, Khyber Girls Medical College, Peshawar, PAK
| | - Muhammad Farooq
- Neurosurgery, Afridi Medical Complex and Teaching Hospital, Peshawar, PAK
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Bae K, Park SS, Kang MS. [Impact of social distancing on traumatic injury incidence during the COVID-19 pandemic: A study using nationwide data from South Korea from 2018 to 2020.]. Revue de chirurgie orthopedique et traumatologique 2023:S1877-0517(23)00052-7. [PMID: 36748024 PMCID: PMC9892316 DOI: 10.1016/j.rcot.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/03/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND COVID-19 spread rapidly in 2020. To decrease its transmission rate, governments worldwide implemented social distancing. It has transformed people's physical and social activities. Such changes, differently influenced by age, might affect the incidence of traumatic injury. HYPOTHESIS The impact of social distancing on traumatic injuries can influence differently by age. PATIENTS AND METHODS Nationwide randomized stratified sampling data (2018 to 2020, 1 million people per year) from Korean National Health Insurance Sharing Service were used. In this period, 364,690 patients with traumatic injuries were analyzed. People were grouped by age into 0 - 4, 5 - 19, 20 - 64, and ≥ 65 years. The incidence of traumatic injuries was compared between periods of social distancing and no social distancing. Social distancing levels, injured body parts, injury types, hospitalization rate, total medical cost per patient, weather, temperature, and holidays were also included for detailed analysis. RESULTS Only the 5-19 age group showed the significant interaction of social distancing and traumatic injury. In this group, as the social distancing level increased, the injury incidence decreased especially during the spring and autumn semesters. However, the proportion of injuries requiring hospitalization and total medical cost per patient increased. DISCUSSION Social distancing significantly affects the incidence of traumatic injuries for schooler (5 - 19 years). Considering that the incidence changed during these semesters, the restriction of school attendance, due to social distancing, may have caused the decrease. Reduced trauma in this group seems to be related to decrease of mild trauma, considering the hospitalization rate and total medical costs. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Kunhyung Bae
- Department of Orthopedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Soo-Sung Park
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Michael Seungcheol Kang
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Collins RA, Zhu C, Daniel H, Puckett Y, Ronaghan CA. Crush injury with significant soft tissue loss managed utilising biological and dynamic tissue systems: a case study. J Wound Care 2023; 32:S17-S19. [PMID: 36744736 DOI: 10.12968/jowc.2023.32.sup2.s17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Major traumatic crush injuries are difficult to manage, with high morbidity, requiring prolonged, complex treatment with many procedures. Free-flap reconstruction is often used yet full functionality still may not be regained. In this case study of a traumatic crush injury of the anterior distal tibia, ankle and foot of a 48-year-old male patient, we opted for an alternative management strategy using a combination of a dynamic tissue system (DTS) and biological xenografts (porcine urinary bladder matrix and a multi-tissue platform). The DTS was kept in place in an outpatient setting for four weeks postoperatively and removed after that time. At the 3-month follow-up, the wound was significantly smaller at about 15% of the original size. The wound healed completely before 6-month follow-up. Our patient's traumatic crush injury was successfully healed using an alternative management strategy, DTS and biologic xenografts.
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Affiliation(s)
- Reagan A Collins
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, US
| | - Christina Zhu
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, US
| | - Hannah Daniel
- Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, US
| | - Yana Puckett
- West Virginia University School of Medicine, Department of Surgery, Charleston, WV, US
| | - Catherine A Ronaghan
- Texas Tech University Health Sciences Center, Department of Surgery, Lubbock, TX, US
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Fakhry SM, Morse JL, Garland JM, Elkbuli A, Sheets NW, Slivinski A, Berg GM, Wyse RJ, Shen Y, Wilson NY, Miller AL, Carrick MM, Fisher C, Shillinglaw WC, Banton KL, Lieser MJ, Chipko JM, McBride KM, Biswas S, Watts DD. Low Prevalence but High Impact of COVID-19 Positive Status in Adult Trauma Patients: A Multi-institutional Analysis of 28 904 Patients. Am Surg 2023; 89:216-223. [PMID: 36112785 PMCID: PMC9478633 DOI: 10.1177/00031348221126963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Few large investigations have addressed the prevalence of COVID-19 infection among trauma patients and impact on providers. The purpose of this study was to quantify the prevalence of COVID-19 infection among trauma patients by timing of diagnosis, assess nosocomial exposure risk, and evaluate the impact of COVID-19 positive status on morbidity and mortality. METHODS Registry data from adults admitted 4/1/2020-10/31/2020 from 46 level I/II trauma centers were grouped by: timing of first positive status (Day 1, Day 2-6, or Day ≥ 7); overall Positive/Negative status; or Unknown if test results were unavailable. Groups were compared on outcomes (Trauma Quality Improvement Program complications) and mortality using univariate analysis and adjusted logistic regression. RESULTS There were 28 904 patients (60.7% male, mean age: 56.4, mean injury severity score: 10.5). Of 13 274 (46%) patients with known COVID-19 status, 266 (2%) were Positive Day 1, 119 (1%) Days 2-6, 33 (.2%) Day ≥ 7, and 12 856 (97%) tested Negative. COVID-19 Positive patients had significantly worse outcomes compared to Negative; unadjusted comparisons showed longer hospital length of stay (10.98 vs 7.47;P < .05), higher rates of intensive care unit (57.7% vs 45.7%; P < .05) and ventilation use (22.5% vs 16.9%; P < .05). Adjusted comparisons showed higher rates of acute respiratory distress syndrome (1.7% vs .4%; P < .05) and death (8.1% vs 3.4%; P < .05). CONCLUSIONS This multicenter study conducted during the early pandemic period revealed few trauma patients tested COVID-19 positive, suggesting relatively low exposure risk to care providers. COVID-19 positive status was associated with significantly higher mortality and specific morbidity. Further analysis is needed with consideration for care guidelines specific to COVID-19 positive trauma patients as the pandemic continues.
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Affiliation(s)
- Samir M. Fakhry
- Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, TN, USA,Samir M. Fakhry, MD, FACS, Center for Trauma and Acute Care Surgery Research, HCA Healthcare, Clinical Services Group, 2515 Park Plaza, Bldg 2-3W, Nashville, TN 37203, USA.
| | - Jennifer L. Morse
- Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, TN, USA
| | - Jeneva M. Garland
- Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, TN, USA
| | - Adel Elkbuli
- Trauma Services, Kendall Regional Medical Center, Miami, FL, USA
| | | | | | - Gina M. Berg
- Trauma Services, Wesley Medical Center, Wichita, KS, USA
| | - Ransom J. Wyse
- Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, TN, USA
| | - Yan Shen
- Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, TN, USA
| | - Nina Y. Wilson
- Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, TN, USA
| | | | | | - Chris Fisher
- Trauma Services, Sunrise Hospital and Medical Center, Las Vegas, NV, USA
| | | | - Kaysie L. Banton
- Department of Surgery, Swedish Medical Center, Englewood, CO, USA
| | - Mark J. Lieser
- Department of Trauma Surgery, Research Medical Center, Kansas City, MO, USA
| | - John M. Chipko
- Department of Trauma Surgery, Research Medical Center, Kansas City, MO, USA
| | - Katherine M. McBride
- Trauma Surgery & Surgical Critical Care, Memorial Health University Medical Center, Savannah, GA, USA
| | - Saptarshi Biswas
- Trauma Surgery, Grand Strand Medical Center, Myrtle Beach, SC, USA
| | - Dorraine D. Watts
- Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, TN, USA
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Bhasiin K, Heintz O, Colodner KJ. Optimization and Technical Considerations for the Dye-Exclusion Protocol Used to Assess Blood-Brain Barrier Integrity in Adult Drosophila melanogaster. Int J Mol Sci 2023; 24:ijms24031886. [PMID: 36768206 PMCID: PMC9916281 DOI: 10.3390/ijms24031886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
The blood-brain barrier (BBB) is a multicellular construct that regulates the diffusion and transport of metabolites, ions, toxins, and inflammatory mediators into and out of the central nervous system (CNS). Its integrity is essential for proper brain physiology, and its breakdown has been shown to contribute to neurological dysfunction. The BBB in vertebrates exists primarily through the coordination between endothelial cells, pericytes, and astrocytes, while invertebrates, which lack a vascularized circulatory system, typically have a barrier composed of glial cells that separate the CNS from humoral fluids. Notably, the invertebrate barrier is molecularly and functionally analogous to the vertebrate BBB, and the fruit fly, Drosophila melanogaster, is increasingly recognized as a useful model system in which to investigate barrier function. The most widely used technique to assess barrier function in the fly is the dye-exclusion assay, which involves monitoring the infiltration of a fluorescent-coupled dextran into the brain. In this study, we explore analytical and technical considerations of this procedure that yield a more reliable assessment of barrier function, and we validate our findings using a traumatic injury model. Together, we have identified parameters that optimize the dye-exclusion assay and provide an alternative framework for future studies examining barrier function in Drosophila.
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Carmo GP, Grigioni J, Fernandes FAO, Alves de Sousa RJ. Biomechanics of Traumatic Head and Neck Injuries on Women: A State-of-the-Art Review and Future Directions. Biology (Basel) 2023; 12:biology12010083. [PMID: 36671775 PMCID: PMC9855362 DOI: 10.3390/biology12010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023]
Abstract
The biomechanics of traumatic injuries of the human body as a consequence of road crashes, falling, contact sports, and military environments have been studied for decades. In particular, traumatic brain injury (TBI), the so-called "silent epidemic", is the traumatic insult responsible for the greatest percentage of death and disability, justifying the relevance of this research topic. Despite its great importance, only recently have research groups started to seriously consider the sex differences regarding the morphology and physiology of women, which differs from men and may result in a specific outcome for a given traumatic event. This work aims to provide a summary of the contributions given in this field so far, from clinical reports to numerical models, covering not only the direct injuries from inertial loading scenarios but also the role sex plays in the conditions that precede an accident, and post-traumatic events, with an emphasis on neuroendocrine dysfunctions and chronic traumatic encephalopathy. A review on finite element head models and finite element neck models for the study of specific traumatic events is also performed, discussing whether sex was a factor in validating them. Based on the information collected, improvement perspectives and future directions are discussed.
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Affiliation(s)
- Gustavo P. Carmo
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Jeroen Grigioni
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Fábio A. O. Fernandes
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
- LASI—Intelligent Systems Associate Laboratory, 4800-058 Guimaraes, Portugal
| | - Ricardo J. Alves de Sousa
- Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
- LASI—Intelligent Systems Associate Laboratory, 4800-058 Guimaraes, Portugal
- Correspondence: ; Tel.: +351-234-370-200
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Knowlton LM, Tran LD, Arnow K, Trickey AW, Morris AM, Spain DA, Wagner TH. Emergency Medicaid programs may be an effective means of providing sustained insurance among trauma patients: A statewide longitudinal analysis. J Trauma Acute Care Surg 2023; 94:53-60. [PMID: 36138539 PMCID: PMC9805493 DOI: 10.1097/ta.0000000000003796] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hospital Presumptive Eligibility (HPE) is a temporary Medicaid insurance at hospitalization that offsets costs of care, increases access to postdischarge resources, and provides patients with a path to sustain coverage through Medicaid. Because HPE only lasts up to 60 days, we aimed to determine Medicaid insurance status 6 months after injury among HPE-approved trauma patients and identify factors associated with successful sustainment. METHODS Using a customized longitudinal claims data set for HPE-approved patients from the California Department of Health Care Services, we analyzed adults with a primary trauma diagnosis (International Classification of Diseases version 10) who were HPE approved in 2016 and 2017. Our primary outcome was Medicaid sustainment at 6 months. Univariate and multivariate analyses were performed. RESULTS A total of 9,749 trauma patients with HPE were analyzed; 6,795 (69.7%) sustained Medicaid at 6 months. Compared with patients who did not sustain, those who sustained had higher Injury Severity Score (ISS > 15: 73.5% vs. 68.7%, p < 0.001), more frequent surgical intervention (74.8% vs. 64.5%, p < 0.001), and were more likely to be discharged to postacute services (23.9% vs. 10.4%, p < 0.001). Medicaid sustainment was high among patients who identified as White (86.7%), Hispanic (86.7%), Black (84.3%), and Asian (83.7%). Medicaid sustainment was low among the 2,505 patients (25.7%) who declined to report race, ethnicity, or preferred language (14.8% sustainment). In adjusted analyses, major injuries (ISS > 16) (vs. ISS < 15: adjusted odds ratio [aOR], 1.51; p = 0.02) and surgery (aOR, 1.85; p < 0.001) were associated with increased likelihood of Medicaid sustainment. Declining to disclose race, ethnicity, or language (aOR, 0.05; p < 0.001) decreased the likelihood of Medicaid sustainment. CONCLUSION Hospital Presumptive Eligibility programs are a promising pathway for securing long-term insurance coverage for trauma patients, particularly among the severely injured who likely require ongoing access to health care services. Patient and provider interviews would help to elucidate barriers for patients who do not sustain. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Lisa Marie Knowlton
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE)
| | - Linda D. Tran
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE)
| | - Katherine Arnow
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE)
| | - Amber W. Trickey
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE)
| | - Arden M. Morris
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE)
| | - David A. Spain
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Todd H. Wagner
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE)
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Bernard DL, O’Loughlin K, Davidson TM, Rothbaum A, Anton MT, Ridings LE, Cooley JL, Gavrilova Y, Hink AB, Ruggiero KJ. Differences in mental health engagement and follow-up among Black and White patients after traumatic injury. J Trauma Acute Care Surg 2023; 94:117-124. [PMID: 35358156 PMCID: PMC9525457 DOI: 10.1097/ta.0000000000003604] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Severe injury necessitating hospitalization is experienced by nearly three million US adults annually. Posttraumatic stress disorder and depression are prevalent clinical outcomes. The mechanisms by which programs equitably promote mental health recovery among trauma-exposed patients are understudied. We evaluated clinical outcomes and engagement among a cohort of Black and White patients enrolled in the Trauma Resilience and Recovery Program (TRRP), a stepped-care model to accelerate mental health recovery after traumatic injury. METHODS Trauma Resilience and Recovery Program is a four-step model that includes (1) bedside psychoeducation about mental health recovery following traumatic injury, (2) a text-messaging symptom tracking system, (3) a 30-day postinjury mental health screen, and (4) referrals to mental health services. Data describe 1,550 patients enrolled in TRRP within a Level I trauma center ( Mage = 40.86; SD, 17.32), 611 of whom identified as Black (74.5% male) and 939 of whom identified as White (67.7% male). RESULTS Enrollment in TRRP was nearly universal (97.9%) regardless of race or injury mechanism. Enrollment and usage of the text-message system were statistically similar between Black (35.7%) and White patients (39.5%). Trauma Resilience and Recovery Program reengaged Black and White patients at a similar rate at the 30-day postinjury follow-up. However, Black patients were more likely to report peritraumatic distress at the bedside and clinical elevations in posttraumatic stress disorder and depression on the 30-day screen. Referrals were more likely to be accepted by Black patients relative to White patients with clinically elevated symptoms. CONCLUSION Enrollment and engagement were comparable among Black and White patients served by TRRP. Data provide preliminary evidence to suggest that TRRP is feasible and acceptable and engages patients in mental health follow-up equitably. However, research that includes careful measurement of social determinants of health and long-term follow-up examining initiation, completion, and benefit from treatment is needed. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Donte L. Bernard
- Department of Psychological Sciences, University of Missouri, Columbia, MO, 65211, USA
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Kerry O’Loughlin
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Tatiana M. Davidson
- Departments of Nursing and Psychiatry and Behavioral Sciences, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Alex Rothbaum
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Leigh E. Ridings
- Departments of Nursing and Psychiatry and Behavioral Sciences, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - John L. Cooley
- Department of Psychological Sciences, Texas Tech University
| | - Yulia Gavrilova
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Ashley B. Hink
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J. Ruggiero
- Departments of Nursing and Psychiatry and Behavioral Sciences, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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Harb F, Bird CM, Webb EK, Torres L, deRoon-Cassini TA, Larson CL. Experiencing racial discrimination increases vulnerability to PTSD after trauma via peritraumatic dissociation. Eur J Psychotraumatol 2023; 14:2211486. [PMID: 37229524 DOI: 10.1080/20008066.2023.2211486] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/27/2023] Open
Abstract
Background: Racial discrimination is a traumatic stressor that increases the risk for posttraumatic stress disorder (PTSD), but mechanisms to explain this relationship remain unclear. Peritraumatic dissociation, the complex process of disorientation, depersonalization, and derealization during a trauma, has been a consistent predictor of PTSD. Experiences of frequent racial discrimination may increase the propensity for peritraumatic dissociation in the context of new traumatic experiences and contribute to PTSD symptoms. However, the role of peritraumatic dissociation in the relationship between experiences of discrimination and PTSD has not been specifically explored.Objective: The current study investigated the role of peritraumatic dissociation in the impact of racial discrimination on PTSD symptoms after a traumatic injury, and the moderating role of gender.Method: One hundred and thirteen Black/African American individuals were recruited from the Emergency Department at a Level I Trauma Center. Two weeks after the trauma, participants self-reported their experiences with racial discrimination and peritraumatic dissociation. At the six-month follow-up appointment, individuals underwent a clinical assessment of their PTSD symptoms.Results: Results of longitudinal mediation analyses showed that peritraumatic dissociation significantly mediated the effect of racial discrimination on PTSD symptoms, after controlling for age and lifetime trauma exposure. A secondary analysis was conducted to examine the moderating role of gender. Gender was not a significant moderator in the model.Conclusions: Findings show that racial discrimination functions as a stressor that impacts how individuals respond to other traumatic events. The novel results suggest a mechanism that explains the relationship between racial discrimination and PTSD symptoms. These findings highlight the need for community spaces where Black Americans can process racial trauma and reduce the propensity to detach from daily, painful realities. Results also show that clinical intervention post-trauma must consider Black Americans' experiences with racial discrimination.
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Affiliation(s)
- Farah Harb
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Claire M Bird
- Trauma Research Consortium, Baylor Scott and White Research Institute, Baylor Scott & White Health, Dallas, TX, USA
| | - E Kate Webb
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Lucas Torres
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Terri A deRoon-Cassini
- Department of Surgery, Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christine L Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Liu T, Liu X, Li Y, Wang A, Chen S, Wu S, Hou S, Fan H, Cao C. Associations of Traumatic Injury with Abnormal Glucose Metabolism: A Population-Based Prospective Cohort Study. Clin Epidemiol 2023; 15:325-336. [PMID: 36936063 PMCID: PMC10022519 DOI: 10.2147/clep.s399920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
Purpose Empirical data on the association between traumatic injury and abnormal glucose metabolism risk is limited. This study aimed to investigate the association between traumatic injury and abnormal glucose metabolism. Patients and Methods This study included 153,162 participants in the Kailuan Study from 2006 to 2013. Participants with abnormal glucose metabolism at baseline were excluded. All participants were monitored every two years until December 31, 2019. During follow-up, 1915 subjects with a first traumatic injury (defined as a physical injury caused by an external force) were identified. For each subject with traumatic injury, one control subject was randomly selected and matched for age (± 3 years) and sex. A total of 3830 subjects were included in the final analysis. Cox proportional hazards models were used to examine the association between traumatic injury and the subsequent risk of abnormal glucose metabolism. Results During a median follow-up of 6.91 (3.57-9.41) years, 990 abnormal glucose metabolism events occurred. After adjustment for demographics, lifestyle behaviors, and traditional risk factors, those who had traumatic injury compared to controls were 32% more likely to develop any abnormal glucose metabolism (hazard ratio [HR] 1.32; 95% confidence interval [CI]1.16-1.49), including impaired fasting glucose (IFG) (HR 1.29; 95% CI 1.12-1.48) and diabetes (HR 1.37; 95% CI 1.10-1.70). The risks for abnormal glucose metabolism, IFG, and diabetes in subjects with moderate-severe injury were higher than in subjects with mild injury for the 1-year follow-up period, while the association was not significantly different by injury severity for the whole follow-up period. Conclusion Traumatic injury was associated with an increased risk of abnormal glucose metabolism. However, the risks of outcome events decreased as the follow-up period extended. Improved short- and long-term prevention and management strategies for controlling glucose are needed for individuals with traumatic injury.
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Affiliation(s)
- Tao Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, People’s Republic of China
| | - Xin Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, People’s Republic of China
| | - Yue Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, People’s Republic of China
| | - Aitian Wang
- Department of Intensive Medicine, Kailuan General Hospital, Tangshan, People’s Republic of China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, People’s Republic of China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, People’s Republic of China
| | - Shike Hou
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, People’s Republic of China
| | - Haojun Fan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, People’s Republic of China
| | - Chunxia Cao
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, People’s Republic of China
- Correspondence: Chunxia Cao; Haojun Fan, Institute of Disaster and Emergency Medicine, Tianjin University, No. 92 Weijin Road, Nankai District, Tianjin, 300072, People’s Republic of China, Tel +86 02227893596, Fax +86 02227893596-307, Email ;
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Cwikla JD, Edwards TH, Giles JT, Kennedy S, Smith B, Gimeno Ruiz de Porras D, Scott LLF. Identification of Potentially Preventable Traumatic Injury Among Military Working Dogs Deployed During the Global War on Terror. J Spec Oper Med 2022; 22:122-129. [PMID: 36525025 DOI: 10.55460/th1b-vl8o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Prevention of deployment-related injury is critical for readiness of US military working dogs (MWDs). This study evaluated deployment-related injuries to determine if they were potentially preventable and identify possible abatement strategies. METHODS Data were collected on 195 MWD injury events that occurred between 11 September 2001 and 31 December 2018. Injuries were reviewed by a panel of veterinarians and categorized into groups based on panel consensus. The panel also established which interventions could have been effective for mitigating injuries. Multipurpose canine (MPC) and conventional MWD injury event characteristics were compared to identify meaningful differences. RESULTS Of the 195 injuries, 101 (52%) were classified as preventable or potentially preventable. Most (72%) of the potentially preventable injuries occurred in conventional MWDs, with penetrating injuries (64%) being the most common type of trauma. For the preventable/potentially preventable injuries, the most common preventative intervention identified was handler training (53%) followed by protective equipment (46%). There were differences between MPCs and conventional MWDs for injury prevention category, type of trauma, mechanism of injury, and preventative intervention (all p < .001). CONCLUSION The application of a preventable review process to MWD populations may be beneficial in identifying potentially preventable injuries and preventative intervention strategies.
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DeBot M, Mitra S, Lutz P, Schaid TR, Stafford P, Hadley JB, Hom P, Sauaia A, Silliman CC, Moore EE, Cohen MJ. SHOCK INDUCES ENDOTHELIAL PERMEABILITY AFTER TRAUMA THROUGH INCREASED ACTIVATION OF RHOA GTPASE. Shock 2022; 58:542-548. [PMID: 36548645 PMCID: PMC9793983 DOI: 10.1097/shk.0000000000002008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Introduction: Severely injured patients develop a dysregulated inflammatory state characterized by vascular endothelial permeability, which contributes to multiple organ failure. To date, however, the mediators of and mechanisms for this permeability are not well established. Endothelial permeability in other inflammatory states such as sepsis is driven primarily by overactivation of the RhoA GTPase. We hypothesized that tissue injury and shock drive endothelial permeability after trauma by increased RhoA activation leading to break down of endothelial tight and adherens junctions. Methods: Human umbilical vein endothelial cells (HUVECs) were grown to confluence, whereas continuous resistance was measured using electrical cell-substrate impedance sensing (ECIS) Z-Theta technology, 10% ex vivo plasma from severely injured trauma patients was added, and resistance measurements continued for 2 hours. Areas under the curve (AUCs) were calculated from resistance curves. For GTPase activity analysis, HUVECs were grown to confluence and incubated with 10% trauma plasma for 5 minutes before harvesting of cell lysates. Rho and Rac activity were determined using a G-LISA assay. Significance was determined using Mann-Whitney tests or Kruskal-Wallis test, and Spearman ρ was calculated for correlations. Results: Plasma from severely injured patients induces endothelial permeability with plasma from patients with both severe injury and shock contributing most to this increased permeability. Surprisingly, Injury Severity Score (ISS) does not correlate with in vitro trauma-induced permeability (-0.05, P > 0.05), whereas base excess (BE) does correlate with permeability (-0.47, P = 0.0001). The combined impact of shock and injury resulted in a significantly smaller AUC in the injury + shock group (ISS > 15, BE < -9) compared with the injury only (ISS > 15, BE > -9; P = 0.04) or minimally injured (ISS < 15, BE > -9; P = 0.005) groups. In addition, incubation with injury + shock plasma resulted in higher RhoA activation ( P = 0.002) and a trend toward decreased Rac1 activation ( P = 0.07) compared with minimally injured control. Conclusions: Over the past decade, improved early survival in patients with severe trauma and hemorrhagic shock has led to a renewed focus on the endotheliopathy of trauma. This study presents the largest study to date measuring endothelial permeability in vitro using plasma collected from patients after traumatic injury. Here, we demonstrate that plasma from patients who develop shock after severe traumatic injury induces endothelial permeability and increased RhoA activation in vitro . Our ECIS model of trauma-induced permeability using ex vivo plasma has potential as a high throughput screening tool to phenotype endothelial dysfunction, study mediators of trauma-induced permeability, and screen potential interventions.
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Affiliation(s)
- Margot DeBot
- University of Colorado Denver, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
| | - Sanchayita Mitra
- University of Colorado Denver, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
| | - Patrick Lutz
- University of Colorado Denver, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
| | - Terry R. Schaid
- University of Colorado Denver, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
| | - Preston Stafford
- University of Colorado Denver, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
| | - Jamie B. Hadley
- University of Colorado Denver, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
| | - Patrick Hom
- University of Colorado Denver, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
| | - Angela Sauaia
- University of Colorado Denver, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
- University of Colorado Denver, School of Public Health, Management and Policy, Department of Health Systems, Aurora, CO
| | - Christopher C. Silliman
- University of Colorado Denver, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
| | - Ernest E. Moore
- Denver Health Medical Center, Ernest E Moore Shock Trauma Center, Denver, CO
| | - Mitchell J. Cohen
- University of Colorado Denver, School of Medicine, Department of Surgery/Trauma Research Center, Aurora, CO
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Reeder S, Ameratunga S, Ponsford J, Fitzgerald M, Lyons R, Nunn A, Ekegren C, Cameron P, Gabbe B. Long-term health and mobility of older adults following traumatic injury: a qualitative longitudinal study. Disabil Rehabil 2022; 44:7818-7828. [PMID: 34751629 DOI: 10.1080/09638288.2021.1998671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this study was to explore older adults' experiences of and approaches to managing their long-term health and mobility after traumatic injury. METHODS A longitudinal qualitative study was undertaken with older adults following traumatic injury in Victoria, Australia. Fifteen participants (≥65 years) were interviewed at three years post-injury (n = 15), and re-interviewed at four (n = 14) and five years (n = 12) post-injury. Using a framework approach, a longitudinal thematic analysis was performed. RESULTS Older age at the time of injury was identified by participants as a key factor influencing their recovery. Many participants reported actively attempting to regain their strength and fitness in the first five years following injury. However, their age, injury impacts, other health conditions, and weight gain made it difficult to achieve recovery goals. Many older adults reported a decline in their physical function over time. While these experiences and persistent disability constrained or changed the quality of social relationships, community participation, and independence, several participants described adapting to their functional limitations, and managing their secondary conditions over time. CONCLUSION In our cohort, the intertwined combination of ageing, injury, and comorbid conditions negatively affected health and mobility, reinforcing the need for preventative strategies.Implications for rehabilitationOlder adults recovering from traumatic injury may benefit from specialised care pathways that offer long-term and tailored therapies, with programs and services specific to their needs and goals.An integrated service approach by injury insurers, health care, primary care, disability, and aged care could more clearly identify and effectively address the individual needs and goals of older adults with complex conditions.Health and social services that work with people with injuries to develop personalised coping strategies can reduce anxiety related to uncertainty about the future, promote well-being, and support participation in valued activities.
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Affiliation(s)
- Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand.,Population Health Directorate, Counties Manukau Health (District Health Board), Auckland, New Zealand
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Mark Fitzgerald
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia
| | - Ronan Lyons
- Health Data Research UK, Swansea University, Swansea, UK
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Melbourne, Australia
| | - Christina Ekegren
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,School of Primary and Allied Health Care, Melbourne, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Emergency and Trauma Centre, Alfred Health, Melbourne, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Health Data Research UK, Swansea University, Swansea, UK
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Bonaroti J, Billiar I, Moheimani H, Wu J, Namas R, Li S, Kar UK, Vodovotz Y, Neal MD, Sperry JL, Billiar TR. Plasma proteomics reveals early, broad release of chemokine, cytokine, TNF, and interferon mediators following trauma with delayed increases in a subset of chemokines and cytokines in patients that remain critically ill. Front Immunol 2022; 13:1038086. [PMID: 36532045 PMCID: PMC9750757 DOI: 10.3389/fimmu.2022.1038086] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
Severe injury is known to cause a systemic cytokine storm that is associated with adverse outcomes. However, a comprehensive assessment of the time-dependent changes in circulating levels of a broad spectrum of protein immune mediators and soluble immune mediator receptors in severely injured trauma patients remains uncharacterized. To address this knowledge gap, we defined the temporal and outcome-based patterns of 184 known immune mediators and soluble cytokine receptors in the circulation of severely injured patients. Proteomics (aptamer-based assay, SomaLogic, Inc) was performed on plasma samples drawn at 0, 24, and 72 hours (h) from time of admission from 150 trauma patients, a representative subset from the Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock (PAMPer) trial. Patients were categorized into outcome groups including Early Non-Survivors (died within 72 h; ENS; n=38), Non-Resolvers (died after 72 h or required ≥7 days of intensive care; NR; n=78), and Resolvers (survivors that required < 7 days of intensive care; R; n=34), with low Injury Severity Score (ISS) patients from the Tranexamic Acid During Prehospital Transport in Patients at Risk for Hemorrhage After Injury (STAAMP) trial as controls. The major findings include an extensive release of immune mediators and cytokine receptors at time 0h that is more pronounced in ENS and NR patients. There was a selective subset of mediators elevated at 24 and 72 h to a greater degree in NR patients, including multiple cytokines and chemokines not previously described in trauma patients. These findings were validated in a quantitative fashion using mesoscale discovery immunoassays (MSD) from an external validation cohort (VC) of samples from 58 trauma patients matched for R and NR status. This comprehensive longitudinal description of immune mediator patterns associated with trauma outcomes provides a new level of characterization of the immune response that follows severe injury.
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Affiliation(s)
- Jillian Bonaroti
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Isabel Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Hamed Moheimani
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Junru Wu
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Xiangya School of Medicine, Central South University, Changsha, China
| | - Rami Namas
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shimena Li
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Upendra K. Kar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Matthew D. Neal
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jason L. Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Timothy R. Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States,Pittsburgh Trauma and Transfusion Medicine Research Center, Division of Trauma and Acute Care Surgery, University of Pittsburgh, Pittsburgh, PA, United States,*Correspondence: Timothy R. Billiar,
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Schwarzman J, Lalor A, Reeder S, Callaway L, Aburumman M, Gabbe BJ, Ekegren CL. Factors influencing care and support for older adults with traumatic injury in Australia: a qualitative study. Disabil Rehabil 2022; 44:6692-6698. [PMID: 34493139 DOI: 10.1080/09638288.2021.1970258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate factors influencing provision of care and support to older adults with traumatic injury in Australia, from a health service and policy perspective. METHODS Semi-structured interviews were undertaken with 16 clinicians, support providers, researchers, policy makers, and representatives from peak bodies in Australia, who had experience across injury, ageing, and disability sectors. A thematic analysis was performed using a framework approach. RESULTS Themes identified included prolonged injury recovery in older adults, limited accommodation options, restricted access to preventive care, escalating care needs over time, issues with siloed funding schemes and funding availability, and the need for advocacy to coordinate care across different schemes. Certain themes were specific to people who were older when injured. Others related to people who had acquired an injury at a younger age and were ageing with injury. However, most themes had relevance for both groups. CONCLUSIONS For older adults, this research has highlighted a range of cross-sector problems which impact upon the potential to recover from injury and to age well with injury. To improve the lives of older adults with injuries, Australia needs better coordinated system interfaces, shared funding models or packages of care across sectors, and improved advocacy and case management.Implications for rehabilitationTo address the lack of long-term, multi-disciplinary preventive care for age-related conditions and secondary complications in people with injuries, older adults may need more prolonged, or individualised, care following injury, episodic health checks, and a greater focus on long-term health care.Accessible and well-coordinated specialist housing and support responses, that offer timely access to health care professionals and carers trained in both ageing and disability, and enable greater support for "ageing in place", are required to manage changing care needs of people ageing with injury.There needs to be greater involvement of geriatricians, nurses, and allied health care professionals within the aged care sector in order to care for people with complex needs, including older adults with injury-related disability.To reduce gaps in care and support for injured older adults, Australia needs better coordinated system interfaces, shared funding models or packages of care across sectors.
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Affiliation(s)
- Joanna Schwarzman
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Aislinn Lalor
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,Department of Occupational Therapy, Monash University, Frankston, Australia
| | - Sandy Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Libby Callaway
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,Department of Occupational Therapy, Monash University, Frankston, Australia
| | - Mohammed Aburumman
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,Monash University Accident Research Centre (MUARC), Monash University, Clayton, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Baldock TE, Dixon JR, Koubaesh C, Johansen A, Eardley WGP. Variation of implant use in A1 and A2 trochanteric hip fractures : a study from the National Hip Fracture Database of England and Wales. Bone Jt Open 2022; 3:741-745. [PMID: 36181320 PMCID: PMC9626874 DOI: 10.1302/2633-1462.310.bjo-2022-0104.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
AIMS Patients with A1 and A2 trochanteric hip fractures represent a substantial proportion of trauma caseload, and national guidelines recommend that sliding hip screws (SHS) should be used for these injuries. Despite this, intramedullary nails (IMNs) are routinely implanted in many hospitals, at extra cost and with unproven patient outcome benefit. We have used data from the National Hip Fracture Database (NHFD) to examine the use of SHS and IMN for A1 and A2 hip fractures at a national level, and to define the cost implications of management decisions that run counter to national guidelines. METHODS We used the NHFD to identify all operations for fixation of trochanteric fractures in England and Wales between 1 January 2021 and 31 December 2021. A uniform price band from each of three hip fracture implant manufacturers was used to set cost implications alongside variation in implant use. RESULTS We identified 18,156 A1 and A2 trochanteric hip fractures in 162 centres. Of these, 13,483 (74.3%) underwent SHS fixation, 2,352 (13.0%) were managed with short IMN, and 2,321 (12.8%) were managed with long IMN. Total cost of IMN added up to £1.89 million in 2021, and the clinical justification for this is unclear since rates of IMN use varied from 0% to 97% in different centres. CONCLUSION Most trochanteric hip fractures are managed with SHS, in keeping with national guidelines. There is considerable variance between hospitals for implant choice, despite the lack of evidence for clinical benefit and cost-effectiveness of more expensive nailing systems. This suggests either a lack of awareness of national guidelines or a choice not to follow them. We encourage provider units to reassess their practice if outwith the national norm. Funding bodies should examine implant use closely in this population to prevent resource waste at a time of considerable health austerity.Cite this article: Bone Jt Open 2022;3(10):741-745.
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Affiliation(s)
- Thomas E. Baldock
- Health Education England North East, Newcastle upon Tyne, UK,South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Jan R. Dixon
- Royal Victoria Hospital, Newcastle upon Tyne, United Kingdom
| | | | - Antony Johansen
- University Hospital of Wales, Cardiff, UK,National Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London, UK
| | - William G. P. Eardley
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK,National Falls and Fragility Fracture Audit Programme (FFFAP), Royal College of Physicians, London, UK,Department of Health Sciences, University of York, York, UK,Correspondence should be sent to William G. P. Eardley. E-mail:
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McFaline-Figueroa J, Schifino AG, Nichenko AS, Lord MN, Hunda ET, Winders EA, Noble EE, Greising SM, Call JA. Pharmaceutical Agents for Contractile-Metabolic Dysfunction After Volumetric Muscle Loss. Tissue Eng Part A 2022; 28:795-806. [PMID: 35620911 PMCID: PMC9634984 DOI: 10.1089/ten.tea.2022.0036] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/21/2022] [Indexed: 11/12/2022] Open
Abstract
Volumetric muscle loss (VML) injuries represent a majority of military service member casualties and are common in civilian populations following blunt and/or penetrating traumas. Characterized as a skeletal muscle injury with permanent functional impairments, there is currently no standard for rehabilitation, leading to lifelong disability. Toward developing rehabilitative strategies, previous research demonstrates that the remaining muscle after a VML injury lacks similar levels of plasticity or adaptability as healthy, uninjured skeletal muscle. This may be due, in part, to impaired innervation and vascularization of the remaining muscle, as well as disrupted molecular signaling cascades commonly associated with muscle adaptation. The primary objective of this study was to assess the ability of four pharmacological agents with a strong record of modulating muscle contractile and metabolic function to improve functional deficits in a murine model of VML injury. Male C57BL/6 mice underwent a 15% multimuscle VML injury of the posterior hindlimb and were randomized into drug treatment groups (formoterol [FOR], 5-aminoimidazole-4-carboxamide riboside [AICAR], pioglitazone [PIO], or sildenafil [SIL]) or untreated VML group. At the end of 60 days, the injury model was first validated by comparison to age-matched injury-naive mice. Untreated VML mice had 22% less gastrocnemius muscle mass, 36% less peak-isometric torque, and 27% less maximal mitochondrial oxygen consumption rate compared to uninjured mice (p < 0.01). Experimental drug groups were, then, compared to VML untreated, and there was minimal evidence of efficacy for AICAR, PIO, or SIL in improving contractile and metabolic functional outcomes. However, FOR-treated VML mice had 18% greater peak isometric torque (p < 0.01) and permeabilized muscle fibers had 36% greater State III mitochondrial oxygen consumption rate (p < 0.01) compared to VML untreated mice, suggesting an overall improvement in muscle condition. There was minimal evidence that these benefits came from greater mitochondrial biogenesis and/or mitochondrial complex protein content, but could be due to greater enzyme activity levels for complex I and complex II. These findings suggest that FOR treatment is candidate to pair with a rehabilitative approach to maximize functional improvements in VML-injured muscle. Impact statement Volumetric muscle loss (VML) injuries result in deficiencies in strength and mobility, which have a severe impact on patient quality of life. Despite breakthroughs in tissue engineering, there are currently no treatments available that can restore function to the affected limb. Our data show that treatment of VML injuries with clinically available and FDA-approved formoterol (FOR), a beta-agonist, significantly improves strength and metabolism of VML-injured muscle. FOR is therefore a promising candidate for combined therapeutic approaches (i.e., regenerative rehabilitation) such as pairing FOR with structured rehabilitation or cell-seeded biomaterials as it may provide greater functional improvements than either strategy alone.
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Affiliation(s)
- Jennifer McFaline-Figueroa
- Department of Physiology & Pharmacology, University of Georgia, Athens, Georgia, USA
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia, USA
| | - Albino G. Schifino
- Department of Physiology & Pharmacology, University of Georgia, Athens, Georgia, USA
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia, USA
| | - Anna S. Nichenko
- Department of Physiology & Pharmacology, University of Georgia, Athens, Georgia, USA
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia, USA
| | - Magen N. Lord
- Department of Nutritional Sciences, University of Georgia, Athens, Georgia, USA
| | - Edward T. Hunda
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia, USA
| | | | - Emily E. Noble
- Department of Nutritional Sciences, University of Georgia, Athens, Georgia, USA
| | - Sarah M. Greising
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jarrod A. Call
- Department of Physiology & Pharmacology, University of Georgia, Athens, Georgia, USA
- Regenerative Bioscience Center, University of Georgia, Athens, Georgia, USA
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