Legalisation of e-scooters in the UK: the injury rate and pattern is similar to those of bicycles in an inner city metropolitan area.

INTRODUCTION: Rental electric scooters (e-scooters) have become more available to the UK public following amendments to legislation in 2020 affecting rideshare schemes. Existing literature from outside the UK demonstrates a worrying trend of increasing injuries related to their use and non-compliance with suggested safety precautions. An e-scooter rideshare scheme trial began in Liverpool in October 2020. We intended to identify the musculoskeletal injury rate and describe the injuries sustained during this pilot. METHODS: Data were collected retrospectively from electronic patient records on all patients at a major trauma centre covering the whole of the Liverpool rideshare trial site presenting with e-scooter and bicycle musculoskeletal injuries between the trial start on 6th October 2020 and 5th May 2021 and between 6th March 2020 and 5th October 2020. Data on rental e-scooter use were obtained from the rideshare operator. RESULTS: Fifty-one patients sustained musculoskeletal injuries involving e-scooters during the trial period and six injuries before the trial. Two-thirds of injuries were on rental e-scooters. We calculate an orthopaedic injury rate of 26.1 injuries per million km on e-scooters and 24.1 injuries per million km on bicycles. Over 70% of e-scooter patients had upper limb injuries, over 50% had lower limb injuries and 15.7% of patients required surgery. CONCLUSIONS: We observed an increase in musculoskeletal injuries presenting to hospital during the e-scooter pilot. Rates of musculoskeletal injuries were comparable to rates of injuries sustained on bicycles. E-scooters should be regulated closely and further safety measures introduced to minimise the rate of injuries.

Securing intraoral skin grafts to the floor of the mouth: case report and technique desription.

In this report, we describe an innovative bolstering technique that resulted in successful skin graft take to the floor of the mouth when the teeth and alveolus were unavailable for anchorage.

Whole-eye transplantation: a look into the past and vision for the future.

Blindness afflicts ~39 million people worldwide. Retinal ganglion cells are unable to regenerate, making this condition irreversible in many cases. Whole-eye transplantation (WET) provides the opportunity to replace diseased retinal ganglion cells, as well as the entire optical system and surrounding facial tissue, if necessary. Recent success in face transplantation demonstrates that this may be a promising treatment for what has been to this time an incurable condition. An animal model for WET must be established to further enhance our knowledge of nerve regeneration, immunosuppression, and technical aspects of surgery. A systematic review of the literature was performed to evaluate studies describing animal models for WET. Only articles in which the eye was completely enucleated and reimplanted were included. Study methods and results were compared. In the majority of published literature, WET can result in recovery of vision in cold-blooded vertebrates. There are a few instances in which mammalian WET models demonstrate survival of the transplanted tissue following neurovascular anastomosis and the ability to maintain brief electroretinogram activity in the new host. In this study we review in cold-blooded vertebrates and mammalian animal models for WET and discuss prospects for future research for translation to human eye transplantation.

Evaluation of Right Ventricular Function in the Management of Patients Referred for Left Ventricular Assist Device Therapy.

BACKGROUND: Speckle tracking echocardiography analysis (STE) has recently allowed an in-depth analysis of right ventricular (RV) performance. The aim of the study was to observe RV function by STE in patients with advanced heart failure before and after left ventricular assist device (LVAD) implantation. METHODS: A transthoracic echocardiogram was performed in 19 patients referred for LVAD implant at baseline and with serial echocardiograms after LVAD implantation (Jarvik 2000). All echocardiographic images were analyzed off line by an independent operator to calculate with STE the RV free wall longitudinal strain (RVLS). RESULTS: All the patients, except 4, showed a progressive increase of RVLS after LVAD implant. However, 4 patients, who presented the lowest RVLS values at baseline, presented a further RV failure in the postoperative. The value of -11% represented the empirical preoperative cutoff able to identify patients at greater risk of postimplant RV failure. CONCLUSIONS: RV myocardial deformation may have important clinical implications for the selection and management of LVAD patients. It can be used to evaluate RV function before LVAD implantation, to drive decisional strategy regarding the management of this type of patients, and after LVAD implant for the follow-up.

Composite tissue vasculopathy and degeneration following multiple episodes of acute rejection in reconstructive transplantation.

Transplant vasculopathy has not been systematically investigated in composite tissue allotransplantation (CTA). The impact of multiple acute rejections (ARs) on long-term graft outcomes in reconstructive transplantation remains unknown. This study in a rat hind-limb allotransplantation model systematically analyzes vasculopathy and tissue-specific pathological changes secondary to multiple AR episodes. LEW rats were transplanted with BN rat hind limbs and treated as follows: Group 1 (Iso): isografts. Group 2 (CsA): Cyclosporine (CsA) qd; Group 3 (mult AR): CsA and dexamethasone only when AR was observed. No AR was observed in Groups 1 and 2. Multiple AR were observed in Group 3, and each episode was completely reversed (clinically) with pulsed CsA + dexamethasone treatment. Group 3 animals demonstrated significant vascular lesions along with skin and muscle atrophy, upregulation of profibrotic gene expression and fibrosis when compared to Groups 1 and 2. In addition, allograft bone was sclerotic, weak and prone to malunion and nonunion. Interestingly, vasculopathy was a late finding, whereas muscle atrophy with macrophage infiltration was seen early, after only a few AR episodes. Taken together, multiple AR episodes lead to vasculopathy and tissue-specific pathology in CTA. This is the first evidence of 'composite tissue vasculopathy and degeneration (CTVD)' in CTA.

Dendritic cell therapy in composite tissue allotransplantation.

Dendritic cells (DCs) are bone marrow-derived, professional antigen-presenting cells, with inherent tolerogenic function. The ability of immature or maturation-resistant DCs to regulate alloantigen-specific T-cell responses and to promote tolerance induction has been well demonstrated in organ and bone marrow transplantation. Recent data suggest that DCs can also promote long-term survival of composite tissue allografts in the absence of continued immunosuppressive drug therapy.

Investigation of antibody-mediated rejection in composite tissue allotransplantation in a rat limb transplant model.

BACKGROUND: Despite the widely accepted implication of antidonor antibodies and complement in solid organ transplantation, their role in reconstructive allotransplantation is not clear. The aim of this study was to analyze the humoral immune response using a rat orthotopic limb transplantation model. METHODS: We used the Brown Norway to Lewis rat orthotopic hind-limb transplant model: Group 1, isografts; group 2, allografts with daily continuous cyclosporine treatment to prevent acute rejection; and group 3, allografts undergoing multiple episodes of acute rejection. Samples were taken at 30, 60, and 90 days. Serum was analyzed by FACS for antidonor antibodies. Tissue deposition of antibodies and complement was investigated by immunofluorescence. RESULTS: By day 90, animals in group 3 had undergone 19 (+/-3.2) acute rejection episodes. There was no difference in the occurrence of serum antidonor antibodies between the three groups at any time point. However, at 90 days, anti-third-party antibodies were significantly greater among group 3. There was no difference in antibody or complement deposition in muscles between the 3 groups. CONCLUSION: Despite the increased antibody against a third party after multiple rejection episodes in this animal model, there was no clear evidence of an antibody-mediated alloresponse in limb transplantation.

Population dynamics of horn fly, Haematobia irritans irritans (L.) (Diptera: Muscidae), on Hereford cattle in Uruguay.

Abundance of adult horn flies, Haematobia irritans irritans (L.), was monitored on 25 untreated Hereford cows in Tacuarembó Department, Uruguay, during three consecutive grazing seasons, from October 1999 to May 2002. The population showed a variable pattern of abundance during three years, with peaks in late summer-early fall of each year. Adult flies were continuously present, although in very low numbers in intervening winters. Numbers of flies per cow rarely exceeded a reference level of 200 flies per animal during the grazing season. Degree-day calculations indicated that approximately 12 generations were possible each year. Time series analysis of mean densities among consecutive generations indicated that population growth was governed by simple, direct density-dependence, with additional effects of seasonally varying weather. Response surface regressions confirmed that intergenerational growth was inversely related to mean density, and directly related to temperature. Stochastic simulations with the response surface model suggested that within the range of temperatures observed in our study, horn fly populations on Hereford cattle will tend toward densities of approximately 150 flies per animal in summer, and exceed a nominal level of 200 flies per cow one or more times in about 65 of every 100 grazing seasons.

PCR-based detection of the transovarial transmission of Uruguayan Babesia bovis and Babesia bigemina vaccine strains.

Bovine babesiosis is responsible for serious economic losses in Uruguay. Haemovaccines play an important role in disease prevention, but concern has been raised about their use. It is feared that the attenuated Babesia bovis and Babesia bigemina vaccine strains may be transmitted by the local tick vector Boophilus microplus, and that reversion to virulence could occur. We therefore investigated the possibility that these strains could be transmitted via the transovarial route in ticks using a Babesia species-specific polymerase chain reaction (PCR) assay. DNA was extracted from the developmental stages of the tick vector that had fed on calves immunized with the haemovaccine. It was possible to detect Babesia DNA not only in adult ticks, but also in their eggs and larvae. In addition, it was shown that calves infested with larvae derived from eggs laid by ticks fed on acutely infected calves, were positive for Babesia using PCR. Caution should therefore be shown with the distribution of the haemovaccine in marginal areas. It is still advisable that suitable tick control measures be used to prevent transovarial transmission and the potential risk of attenuated Babesia reverting to virulence.

Babesiosis (Babesia bovis) stability in unstable environments.

Enzootic stability (herd immunity) in bovine babesiosis occurs when the rate of transmission (inoculation rate) of Babesia spp by the tick vector is sufficient to immunize a majority of susceptible calves before the loss of calfhood resistance. The effect of three tick (Boophilus microplus) control strategies (none, threshold, and strategic) on enzootic stability and the likelihood of babesiosis (Babesia bovis) outbreaks was studied using a spreadsheet age-class computer simulation model. The model was driven by weekly bovine tick counts from Brazil and Uruguay. The Eldorado do Sul, RS, Brazil bovine population (30 degrees 05' South latitude) was found to be in a naturally occurring state of enzootic stability, corresponding to an inoculation rate exceeding 0.005 throughout the year. Threshold dipping strategies should not increase the risk of babesiosis in cattle so managed. Strategic dipping resulted in an extended period of enzootic instability lasting 30 weeks, which requires protection of the herd through immunization. Because of the more prolonged low winter temperature conditions, the Tacuarembó, Uruguay bovine population (31 degrees 40' South latitude) was found to be in a naturally occurring state of enzootic instability, characterized by a 28 week period in which the inoculation rate was below 0.005. Strategic dipping should lead to eradication of the babesial parasite from tick and bovine populations, but would not result in eradication of the tick vector. This could lead to subsequent outbreaks if Babesia carrier animals were to be introduced into the herd. In both populations, strategic tick control could be accompanied by concurrent babesiosis vaccination.

Prenatal diagnosis of bowel obstruction initially manifested as isolated hyperechoic bowel.

Fetal bowel obstruction has a prevalence of 1 in 3000 to 5000 live births. Ultrasonographic diagnosis is made by demonstrating distended loops of bowel. Echogenic bowel, defined as small bowel more echogenic than liver or bone, has been associated with congenital infections, cystic fibrosis, chromosomal abnormalities, and bowel obstruction. Fetal ascites, defined as fluid in the peritoneal cavity partly surrounding the liver and bladder, also has been associated with bowel obstruction. We present a case of jejunal atresia whose presenting appearance consists of echogenic bowel, transient ascites, and massive dilatation of intestinal loops.

A finite-element model predicts thermal damage in cutaneous contact burns.

Thermal injury results from exposure of skin elements to an externally applied heat source. Finite-element analysis of heat transfer in cutaneous burns allows for an accurate prediction of tissue time-temperature relationships throughout the exposed tissue. A two-dimensional, axisymmetric, finite-element model of a contact burn was constructed, and damage integrals were calculated by applying the Arrhenius equation to the time-temperature profiles at each point. The epidermis, dermis, and subcutaneous fat were modeled as uniform elements with distinct thermal properties. Heated aluminum blocks were applied to Yorkshire pigs for 10 to 80 seconds to produce contact burns. Wound biopsies taken at 1, 24, and 48 hours were examined histologically and measured for the depth of burn. A significant deepening of the gelatinized tissue was observed in tissue taken from 1 hour to 24 hours. The finite-element prediction of cutaneous contact burn damage correlated well with histologic observations in this porcine model.

[High frequency ventilation strategies with neonatal conventional ventilator. Assessment of gas exchange, hemodynamic status and lung injury]. / Estrategias ventilatorias de alta frecuencia con respirador neonatal convencional. Evaluación del intercambio gaseoso, estado hemodinamico y lesion pulmonar.

Experiments were performed to consider the use of conventional neonatal ventilators with assisted expiratory mechanism using ventilatory high frequency strategies. Gas exchange, hemodynamic state, and lung injury were also assessed. Twenty Albino Wistar rats, undergoing and acute lung lesion through physiological solution wash of the lungs were studied. Afterward, they were distributed into four groups according to the different ventilator strategies, based on the different pressure changes and the tidal volume, the baseline lung volume and the respiratory frequency. Group I, High Frequency Ventilation, with high baseline lung volumes (HFVh); group II, Conventional Mechanical Ventilation, with high baseline lung volume (CMVh), group III, High Frequency Ventilation, with low baseline lung volume (HFV1) and group IV Conventional Mechanical Ventilation, with low baseline lung volume (CMV1). Significant differences were found between group I (HFVh) and groups II (CMVh), III (HFV1) and IV (CMV1) as regards pO2, Artery/Alveolar relation to O2 (a/A), pCO2, arterial blood pressure and histopathologic lung lesion. The hypothesis concerning the decisive role of the baseline lung volume maintainence to minimize progressive damage caused by mechanical ventilation on a previously injured lung while attending ventilatory strategies that generate little pressure and volume cyclical changes was confirmed. We conclude that, high frequency mechanical ventilation is possible through conventional neonatal respirators with assisted expiratory mechanism.

Ventilación con presión positiva no invasiva en la insuficiencia respiratoria aguda / Non invasive positive pressure ventilation in acute respiratory failure

Trabajos recientes sugieren que la ventilación con presión positiva no invasiva (VPPNI) puede ser útil en el tratamiento de la insuficiencia respiratoria aguda (IRA). Sin embargo, no está definida su eficacia ni qué parámetros son útiles para predecir su éxito-fracaso. Con estos objetivos se estudiaron 14 pacientes con IRA (PaO2 61,2 ñ 3,2 con MFL) de causa diversa, tratados con VPPNI (equipo BIPAP-Respironics) (IPAP:9,9 ñ 0,6 cmH20, EPAP: 5 cmH20) Se midió frecuencia respiratoria (FR), frecuencia cardíaca y gases respiratorios en: 1) situación basal (BL); 2) a la hora de VPPNI (T1) y 3) a las 20 horas de VPPNI (T2). Durante la VPPNI se observó incremento de la Pa02 (BL, 61,2ñ 3,2 mmHg; T1, 87ñ 8 mmHg [p<0,05] ; y T2 104 ñ 11 mmHg [p

Epidemiology of bovine anaplasmosis and babesiosis in Latin America and the Caribbean.

The various parameters which interact in the epizootiology of babesiosis and anaplasmosis and which it is necessary to obtain in a survey are analysed and the two diseases compared. Where no data are available from Latin America and the Caribbean, the references from Australia and the United States of America are discussed. The two principal objectives of a study on the epidemiology of babesiosis and anaplasmosis are: to determine the risk of occurrence to understand the relevant factors leading to outbreaks. The first objective is relatively simple to achieve for both diseases by calculating the animal inoculation rate (h) at a determined age and the critical value of h for enzootic stability. The second objective requires exhaustive and complex studies. For babesiosis epidemiology, studies of the tick infection rate, cattle infestation rate, genetic composition of cattle, acaricides, stocking rate, climatic data and other factors are necessary. Anaplasmosis epidemiology cannot be satisfactorily explained by considering it purely as a tick-borne disease. Difficulties to be overcome include the great diversity of haematophagous Diptera in Latin America, and the scarcity of data on the capacity of these insects as anaplasmosis vectors and their feed preferences on cattle.