Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 252
Filtrar
1.
MMWR Morb Mortal Wkly Rep ; 69(9): 225-230, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32134910

RESUMO

One in 10 U.S. residents aged ≥18 years reports falling each year (1). Among all age groups, falls can cause serious injury and are the second leading cause of traumatic brain injury (TBI)-related deaths (2). TBI is a head injury caused by a bump, blow, or jolt to the head or body or a penetrating head injury that results in disruption of normal brain function.* CDC estimated national and state-specific rates and trends for TBI-related deaths (TBI deaths) caused by unintentional falls (fall-related TBI deaths) among U.S. residents during 2008-2017, by selected decedent characteristics. The national age-adjusted rate of fall-related TBI deaths increased by 17% from 2008 to 2017. Rate trends at the national level increased significantly for nearly all decedent characteristics, with the most notable increases observed among persons living in noncore (i.e., most rural), nonmetropolitan counties and those aged ≥75 years. Analysis of state-specific rate trends determined that rates of fall-related TBI deaths increased significantly in 29 states over the 10-year study period. A fall can happen to anyone of any age, but falls are preventable. Health care providers and the public need to be aware of evidence-based strategies to prevent falls, given that rates of fall-related TBI deaths are increasing. Health care providers can educate patients on fall and TBI prevention, assess their risk for falls, and when needed, encourage participation in appropriate evidence-based fall prevention programs.†.


Assuntos
Acidentes por Quedas/mortalidade , Lesões Encefálicas Traumáticas/mortalidade , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Lesões Encefálicas Traumáticas/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
2.
J Trauma Acute Care Surg ; 88(2): 207-218, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31804413

RESUMO

BACKGROUND: Administration of human mesenchymal stem cell (MSC)-derived exosomes can enhance neurorestoration in models of traumatic brain injury (TBI) and hemorrhagic shock (HS). The impact of early treatment with MSC-derived exosomes on brain injury in a large animal model remains unknown. We sought to evaluate the impact of early single-dose exosome treatment on brain swelling and lesion size, blood-based cerebral biomarkers, and blood-brain barrier (BBB) integrity. METHODS: Female Yorkshire swine were subjected to a severe TBI (12-mm cortical impact) and HS (40% estimated total blood volume). One hour into shock, animals were randomized (n = 5/cohort) to receive either lactated Ringer's (LR; 5 mL) or LR + exosomes (1 × 10 exosome particles in 5 mL LR). Animals then underwent additional shock (1 hour) followed by normal saline resuscitation. After 6 hours of observation, brain swelling (% increase compared with the uninjured side) and lesion size (mm) were assessed. Cerebral hemodynamics and blood-based biomarkers of brain injury were compared. Immunofluorescence and RNA sequencing with differential gene expression and pathway analysis were used to assess the integrity of the perilesion BBB. RESULTS: Exosome-treated animals had significantly less (p < 0.05) brain swelling and smaller lesion size. They also had significantly decreased (p < 0.05) intracranial pressures and increased cerebral perfusion pressures. Exosome-treated animals had significantly decreased (p < 0.05) albumin extravasation and significantly higher (p < 0.05) laminin, claudin-5, and zonula occludens 1 levels. Differential gene expression and pathway analysis confirmed these findings. Serum glial fibrillary acidic protein levels were also significantly lower (p < 0.05) in the exosome-treated cohort at the end of the experiment. CONCLUSION: In a large animal model of TBI and HS, early treatment with a single dose of MSC-derived exosomes significantly attenuates brain swelling and lesion size, decreases levels of blood-based cerebral biomarkers, and improves BBB integrity.


Assuntos
Barreira Hematoencefálica/patologia , Lesões Encefálicas Traumáticas/terapia , Exossomos/transplante , Células-Tronco Mesenquimais/citologia , Choque Hemorrágico/terapia , Animais , Lesões Encefálicas Traumáticas/etiologia , Lesões Encefálicas Traumáticas/patologia , Modelos Animais de Doenças , Feminino , Humanos , Ressuscitação/métodos , Choque Hemorrágico/etiologia , Choque Hemorrágico/patologia , Sus scrofa , Fatores de Tempo , Resultado do Tratamento
3.
J Safety Res ; 71: 315-318, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31862042

RESUMO

INTRODUCTION: Despite progress, injury remains the leading cause of preventable death for American Indian and Alaska Natives (AI/AN), aged 1 to 44. There are few publications on injuries among the AI/AN population, especially those on traumatic brain injury (TBI). A TBI can cause short- or long-term changes in cognition, communication, and/or emotion. METHODS: To describe changes over time in TBI incidence by mechanism of injury, injury intent, and age group among AI/ANs, the CDC analyzed hospitalization and death data from the 2008-2014 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and the National Vital Statistics System (NVSS), respectively. RESULTS: From 2008-2014, the incidence of TBI-related hospitalizations increased by 32% (1,477 in 2008 to 1,945 in 2014) and resulted in a 21% increase in age-adjusted rates of people hospitalized with TBI. TBI-related deaths increased in number (569 in 2008 to 644 in 2014) and age-adjusted rate (22.7 in 2008 to 25.4 in 2014) by approximately 13% and 12%, respectively. Motor-vehicle crashes were the leading cause of TBI-related deaths among AI/ANs aged 0-54 years. Practical application: Prevention efforts should focus on increasing motor-vehicle safety and advancing prevention strategies for other leading causes of TBI, including: falls, intentional self-harm, and assaults.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Lesões Encefálicas Traumáticas/epidemiologia , Hospitalização/estatística & dados numéricos , Índios Norte-Americanos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/etiologia , Criança , Pré-Escolar , Humanos , Incidência , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
4.
J Safety Res ; 70: 127-133, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31847987

RESUMO

INTRODUCTION: Falls are the leading cause of traumatic brain injury (TBI) for children in the 0-4 year age group. There is limited literature pertaining to fall-related TBIs in children age 4 and under and the circumstances surrounding these TBIs. This study provides a national estimate and describes actions and products associated with fall-related TBI in this age group. METHOD: Data analyzed were from the 2001-2013 National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), a nationally representative sample of emergency departments (ED). Case narratives were coded for actions associated with the fall, and product codes were abstracted to determine fall location and product type. All estimates were weighted. RESULTS: An estimated 139,001 children younger than 5 years were treated annually in EDs for nonfatal, unintentional fall-related TBI injuries (total = 1,807,019 during 2001-2013). Overall, child actions (e.g., running) accounted for the greatest proportion of injuries and actions by others (e.g., carrying) was highest for children younger than 1 year. The majority of falls occurred in the home, and involved surfaces, fixtures, furniture, and baby products. CONCLUSIONS: Fall-related TBI in young children represents a significant public health burden. The majority of children seen for TBI assessment in EDs were released to home. Prevention efforts that target parent supervision practices and the home environment are indicated. Practical applications: Professionals in contact with parents of young children can remind them to establish a safe home and be attentive to the environment when carrying young children to prevent falls.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/etiologia , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estados Unidos/epidemiologia
5.
MMWR Morb Mortal Wkly Rep ; 68(46): 1050-1056, 2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31751321

RESUMO

Traumatic brain injury (TBI) affects the lives of millions of Americans each year (1). To describe the trends in TBI-related deaths among different racial/ethnic groups and by sex, CDC analyzed death data from the National Vital Statistics System (NVSS) over an 18-year period (2000-2017). Injuries were also categorized by intent, and unintentional injuries were further categorized by mechanism of injury. In 2017, TBI contributed to 61,131 deaths in the United States, representing 2.2% of approximately 2.8 million deaths that year. From 2015 to 2017, 44% of TBI-related deaths were categorized as intentional injuries (i.e., homicides or suicides). The leading category of TBI-related death varied over time and by race/ethnicity. For example, during the last 10 years of the study period, suicide surpassed unintentional motor vehicle crashes as the leading category of TBI-related death. This shift was in part driven by a 32% increase in TBI-related suicide deaths among non-Hispanic whites. Firearm injury was the underlying mechanism of injury in nearly all (97%) TBI-related suicides among all groups. An analysis of TBI-related death rates by sex and race/ethnicity found that TBI-related deaths were significantly higher among males and persons who were American Indians/Alaska Natives (AI/ANs) than among all other groups across all years. Other leading categories of TBI-related deaths included unintentional motor vehicle crashes, unintentional falls, and homicide. Understanding the leading contributors to TBI-related death and identifying groups at increased risk is important in preventing this injury. Broader implementation of evidence-based TBI prevention efforts for the leading categories of injury, such as those aimed at stemming the significant increase in TBI-related deaths from suicide, are warranted.


Assuntos
Lesões Encefálicas Traumáticas/mortalidade , Acidentes de Trânsito/estatística & dados numéricos , Lesões Encefálicas Traumáticas/etnologia , Lesões Encefálicas Traumáticas/etiologia , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Armas de Fogo/estatística & dados numéricos , Humanos , Intenção , Masculino , Fatores de Risco , Distribuição por Sexo , Suicídio/etnologia , Suicídio/estatística & dados numéricos , Estados Unidos/epidemiologia
6.
J Clin Neurosci ; 70: 27-32, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31537459

RESUMO

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children with a broad injury spectrum and associated continuum in the level of care required. A dearth of data exists regarding children requiring inpatient neurosurgical admission following TBI. A retrospective study of children 0-16 years-old admitted to the neurosurgical unit of a level-1 paediatric trauma hospital in Queensland, Australia following TBI was conducted focusing on the demographics, clinical characteristics, and management of these patients to guide those involved in their management, and identify areas for improvement in injury prevention and trauma system management. Over 48 months, 671 patients were identified (62.6% male) with median age 5.0 years, the majority transferred from peripheral centres. Falls (47.2%) and traffic accidents (21.5%) were the most common mechanisms. Non-displaced skull fracture was the most common injury. Moderate or severe TBI (GCS 3-12) was seen in 14.8% of whom were more likely to require surgery, intensive care, or suffer polytrauma. Clinically significant TBI, defined as moderate/severe TBI, polytrauma, death, requiring neurosurgery, intensive care admission, intubation, or admission three or more nights was detected in 57.97% with higher rates in transferred patients (62.9%) versus primary presentations (50.6%). Mechanisms involving low kinetic forces especially low-height falls and children with non-surgical pathology were less likely to meet criteria for clinically significant TBI. Opportunity exists to optimise triage and transfer practices within the trauma network to minimise the economic and social implications of over-triage with many children requiring only brief observation.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Acidentes por Quedas , Acidentes de Trânsito , Adolescente , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Neurocirurgia/estatística & dados numéricos , Prevalência , Queensland/epidemiologia , Estudos Retrospectivos , Triagem/métodos
8.
Chin J Traumatol ; 22(5): 286-289, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31521457

RESUMO

PURPOSE: A head injury (HI) may cause a skull fracture, which may or may not be associated with injury to the brain. In essence, a skull base fracture (SBF) is a linear fracture at the base of the skull. Loss of consciousness and Glasgow coma score (GCS) may vary depending on an associated intracranial pathology. The pathomechanism is believed to be caused by high energy impact directly to the mastoid and supraorbital bone or indirectly from the cranial vault. Aim of this study is to define the correlation between SBF and intracranial hemorrhage (ICH) in patients with HI. METHODS: Analysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to diagnostic criteria of SBF patients based only on clinical symptoms associated with ICH caused by HI treated in the Department of Neurosurgery at Dr. Hasan Sadikin Hospital, Bandung, Indonesia from January 1, 2012 to December 31, 2017. The exclusion criteria included age less than 15 years and no head computed tomography (CT) scan examination provided. RESULTS: A total of 9006 patients were included into this study in which they were divided into 3 groups: group 1, HI with no ICH; group 2, HI with single ICH and group 3, HI with multiple ICH. In all the SBF cases, SBF at anterior fossa accounted for 69.40% of them, which were mostly accompanied with mild HI (64.70%). Severity of HI and site of SBF correlated with the existence of traumatic brain lesions on CT scan, thus these factors were able to predict whether there were traumatic brain lesions or not. Most of the patients with epidural hemorrhage (EDH) has single traumatic lesion on CT scan, whereas most of the patients with cerebral contusion (CC) has multiple traumatic lesions on CT scan. On patients with both traumatic brain injury and SBF, most of the patients with anterior fossa SBF has EDH; whereas most of the patients with middle fossa SBF were accompanied with CC. Surgery was not required for most of the patients with SBF. CONCLUSION: SBFs were strongly correlated with traumatic ICH lesions patients with anterior fossa SBF were more likely to suffer EDH whereas with middle fossa SBF were more likely to suffer CC.


Assuntos
Lesões Encefálicas Traumáticas/etiologia , Traumatismos Craniocerebrais/complicações , Hemorragias Intracranianas/etiologia , Base do Crânio/lesões , Fraturas Cranianas/etiologia , Adulto , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Feminino , Humanos , Incidência , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/epidemiologia , Masculino , Estudos Retrospectivos , Base do Crânio/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem
10.
J Surg Res ; 244: 63-68, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31279265

RESUMO

BACKGROUND: Several serum biomarkers have been studied to diagnose incidence and severity of traumatic brain injury (TBI), but a reliable biomarker in TBI has yet to be identified. Ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) has been proposed as a biomarker in clinical and preclinical studies, largely in the setting of isolated TBI or concussion. The aim of this study was to evaluate the performance of UCH-L1 as a serum biomarker in the setting of polytrauma and TBI. METHODS: Multiple variations of murine TBI and polytrauma models were used to evaluate serum biomarkers. The different models included TBI with and without hemorrhagic shock and resuscitation, isolated extremity vascular ligation, extremity ischemia/reperfusion, and blunt tail injury. Blood was drawn at intervals after injury, and serum levels of neuron-specific enolase, UCH-L1, creatine kinase, and syndecan-1 were evaluated by enzyme-linked immunosorbent assay. RESULTS: UCH-L1 levels were not significantly different between TBI, tail injury, and sham TBI. By contrast, neuron-specific enolase levels were increased in TBI mice compared with tail injury and sham TBI mice. UCH-L1 levels increased regardless of TBI status at 30 min and 4 h after hemorrhagic shock and resuscitation. In mice that underwent femoral artery cannulation followed by hemorrhagic shock/resuscitation, UCH-L1 levels were significantly elevated compared with shock sham mice at 4 h (3158 ± 2168 pg/mL, 4 h shock versus 0 ± 0 pg/mL, 4 h shock sham; P < 0.01) and at 24 h (3253 ± 2954 pg/mL, 24 h shock versus 324 ± 482 pg/mL, 24 h shock sham; P = 0.03). No differences were observed in UCH-L1 levels between the sham shock and the arterial ligation, vein ligation, or extremity ischemia/reperfusion groups at any time point. Similar to UCH-L1, creatine kinase was elevated only after shock compared with sham mice at 4, 24, and 72 h after injury. CONCLUSIONS: Our study demonstrates that UCH-L1 is not a specific marker for TBI but is elevated in models that induce central and peripheral nerve ischemia. Given the increase in UCH-L1 levels observed after hemorrhagic shock, we propose that UCH-L1 may be a useful adjunct in quantifying severity of shock or global ischemia rather than as a specific marker of TBI.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Traumatismo Múltiplo/complicações , Choque Hemorrágico/diagnóstico , Ubiquitina Tiolesterase/sangue , Animais , Biomarcadores/sangue , Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/etiologia , Modelos Animais de Doenças , Escala de Coma de Glasgow , Humanos , Masculino , Camundongos , Traumatismo Múltiplo/sangue , Índice de Gravidade de Doença , Choque Hemorrágico/sangue , Choque Hemorrágico/etiologia
11.
Pediatr Int ; 61(9): 904-912, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31287612

RESUMO

BACKGROUND: The aim of this study was to investigate the epidemiological characteristics of pediatric traumatic brain injury (TBI) requiring hospitalization in Chinese children ≤17 years of age according to sex and age group. METHODS: This study retrospectively analyzed pediatric TBI inpatient data obtained via electronic health records from one children's hospital in China. Patients aged ≤17 years admitted to the hospital due to TBI between 1 January 2013 and 31 December 2015 were identified using International Classification of Diseases (ICD) -9 and ICD-10 codes. The demographic, injury, and hospitalization characteristics were analyzed by sex and age groups. RESULTS: The subject consisted of 1,087 pediatric TBI patients admitted to the hospital (61.5% boys). The highest proportion of hospitalization was observed in the 1-3 years age group. For both boys and girls, the most common diagnosis was "traumatic epidural hematoma" and the leading mechanism of TBI was "fall". The median length of hospital stay was 8.5 days and the median hospitalization cost was 7,977.4 Chinese yuan (approximately $US 1,140). CONCLUSIONS: Boys and children aged 1-3 years incurred more pediatric TBI requiring hospitalization than their counterparts. Prevention of falls, the most common injury mechanism in both boys and girls, is an important strategy to reduce pediatric TBI and related hospitalizations.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Adolescente , Distribuição por Idade , Fatores Etários , Lesões Encefálicas Traumáticas/etiologia , Lesões Encefálicas Traumáticas/terapia , Criança , Pré-Escolar , China/epidemiologia , Feminino , Hospitalização , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Distribuição por Sexo , Fatores Sexuais
12.
World Neurosurg ; 130: 454-458, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31252079

RESUMO

INTRODUCTION: Alcohol intoxication is often present concurrently with traumatic brain injury (TBI). Recent studies have looked at the effect alcohol has on TBI and on coagulopathy. Typically, cases reviewed in the current literature report only on the effects of modest alcohol intoxication. CASE DESCRIPTION: A 43-year-old male presented to the trauma center after a fall, with rapidly deteriorating mental status. Computed tomography of the head demonstrated a 1.9-cm acute subdural hematoma. Of note, classical coagulation studies were normal, but blood ethanol level was high, 436 mg/dL. Postoperatively, the patient suffered an intracerebral hemorrhage requiring emergent return to the operating room, where a large volume of unclotted blood and clinical coagulopathy was encountered. DISCUSSION: We review the literature pertaining to coagulopathy in the context of TBI and ethanol intoxication. This case is a cautionary tale of a phenomenon of unmeasured coagulopathy in the face of severe alcohol intoxication manifested by intraoperative coagulopathy with new postoperative hemorrhage. Although routine preoperative testing indicated normal clotting function, a thromboelastogram demonstrated delayed clot formation. The protective effects of alcohol are well described; however, we believe that there is a population of patients with severe acute intoxication who have coagulopathy that may go undetected by routine preoperative screening. CONCLUSIONS: Caution should be exercised when taking care of patients with very high levels of alcohol because physiologic derangements may be unpredictable. Additional research is needed for patients with very high levels of alcohol intoxication and the effect it may have on coagulation.


Assuntos
Acidentes por Quedas , Intoxicação Alcoólica/complicações , Lesões Encefálicas Traumáticas/etiologia , Hemorragia Cerebral Traumática/etiologia , Hematoma Subdural Agudo/etiologia , Adulto , Concentração Alcoólica no Sangue , Transtornos da Coagulação Sanguínea , Lesões Encefálicas Traumáticas/sangue , Hemorragia Cerebral Traumática/sangue , Etanol/sangue , Evolução Fatal , Hematoma Subdural Agudo/sangue , Humanos , Masculino
13.
Occup Environ Med ; 76(7): 471-478, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31126965

RESUMO

INTRODUCTION: Workplace violence carries a substantial economic loss burden. Up to 10% of all traumatic brain injury (TBI) admissions result from physical assault. There remains a paucity of research on assault as a mechanism of injury, taking into account sex, and its association with work re-entry. OBJECTIVES: The aim of this study was to characterise, by sex, the sample of workers who had sustained a work-related mild TBI (wr-mTBI) and to assess the independent influence of assault, as a mechanism of injury, on time away from work. METHODS: A population-based retrospective cohort of workers' compensation claimants in Australia (n=3129) who had sustained a wr-mTBI was used for this study. A multivariable logistic regression analysis assessed whether workers who had sustained wr-mTBI as a result of assault (wr-mTBI-assault) were more likely to claim time off work compared with workers who had sustained a wr-mTBI due to other mechanisms. RESULTS: Among claimants who sustained a wr-mTBI, 9% were as a result of assault. The distribution of demographic and vocational variables differed between the wr-mTBI-assault, and not due to assault, both in the full sample, and separately for men and women. After controlling for potential confounding factors, workers who sustained wr-mTBI-assault, compared with other mechanisms, were more likely to take days off work (OR 2.14, 95% CI 1.53 to 2.99) within a 3-month timeframe. CONCLUSION: The results have policy-related implications. Sex-specific and workplace-specific prevention strategies need to be considered and provisions to support return-to-work and well-being within this vulnerable cohort should be examined.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Indenização aos Trabalhadores/estatística & dados numéricos , Violência no Trabalho , Adolescente , Adulto , Austrália/epidemiologia , Lesões Encefálicas Traumáticas/etiologia , Estudos de Coortes , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Ocupacionais/etiologia , Estudos Retrospectivos , Retorno ao Trabalho/estatística & dados numéricos , Fatores Sexuais
14.
J Trauma Acute Care Surg ; 87(1): 205-213, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31033888

RESUMO

BACKGROUND: Aeromedical evacuation (AE) is often used as a rapid and effective way to evacuate patients. However, little is known about the possible effects of AE on patients with blast and traumatic brain injury. In the current study, we used blast overpressure (BOP) as a method to introduce traumatic brain injury in rats and investigated the effects of hypobaria during AE on histology and inflammatory response. METHODS: Animals were exposed to a 12-hour flight 2 days after BOP and euthanized 48 hours after flight. Control animals were kept at normobaria. RESULTS: Overall, BOP animals exposed to flight demonstrated higher histopathologic injury scores as compared to control animals in lungs, brain, kidney, heart, and intestine. The BOP animals exposed to normobaria exhibited a proinflammatory response compared to those that were not blasted, an observation that was not seen in BOP animals exposed to hypobaria. CONCLUSION: These data suggest that AE 48 hours post blast may lead to impairment in the inflammatory process and worsening of long-term outcomes. LEVEL OF EVIDENCE: Animal research, level II.


Assuntos
Resgate Aéreo , Pressão Atmosférica , Traumatismos por Explosões/patologia , Inflamação/etiologia , Ferimentos e Lesões/patologia , Animais , Encéfalo/patologia , Lesões Encefálicas Traumáticas/etiologia , Lesões Encefálicas Traumáticas/patologia , Intestinos/patologia , Rim/patologia , Pulmão/patologia , Masculino , Miocárdio/patologia , Ratos , Ratos Sprague-Dawley
15.
J Forensic Leg Med ; 65: 15-21, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31029002

RESUMO

In dealing with a scooter-related traffic accident with rider death, it is necessary to identify the driver responsible for the accident. This study aimed to reconstruct the kinematics of a scooter-microvan accident involving three riders and explored the differences in injury risks and characteristics of the scooter driver and passengers. We reconstructed a real accident by using MADYMO multi-body simulation software. Moreover, we designed two-variable simulation experiments to analyze how the velocity and impact angle of the microvan are related to the injuries of the three riders. When the microvan speed is set at 18 km/h and that of the scooter is set at 28.8 km/h, the simulated kinematics correlates well with real accident data, and the impact positions and injury parameters correlate well with the actual injuries. When the impact angle is smaller than 30° and the microvan impact velocity is lower than 40 km/h, the head injury of the driver is more life-threatening than the corresponding injuries of the rear passengers. When the impact angle is 15° and the microvan impact velocity is in the range of 0-20 km/h, the femur fracture risk is higher for the driver than for passengers. As the impact angle increases to 45°, passengers have a higher risk of femur fracture than the driver in the velocity range of 0-10 km/h. This impact velocity range becomes 0-30 km/h at an impact angle of 60° and then 40-70 km/h at an impact angle of 90°. Our study shows that the multibody method can reconstruct accidents and predict the different injury features and risks between the driver and passengers, which is useful in identifying the driver.


Assuntos
Acidentes de Trânsito , Automóveis , Simulação por Computador , Motocicletas , Traumatismo Múltiplo/etiologia , Medição de Risco , Fenômenos Biomecânicos , Lesões Encefálicas Traumáticas/etiologia , China , Análise de Elementos Finitos , Ciências Forenses/métodos , Humanos , Escala de Gravidade do Ferimento
16.
Mil Med ; 184(Suppl 1): 265-272, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901455

RESUMO

OBJECTIVE: Mild blast traumatic brain injury is commonly prevalent in modern combat casualty care and has been associated with the development of neurodegenerative conditions. However, whether primary lower level blast overpressure (LBOP) causes neurodegeneration and neuroinflammation remains largely unknown. The aim of our present study was to determine whether LBOP can cause neuroinflammation and neurodegeneration. METHODS: Anesthetized rats were randomly assigned to LBOP group (70 kPa, n = 5) or sham group (without blast, n = 5). Histopathological and cytokine changes in brain tissue at 5 days post-injury were evaluated by hematoxylin-eosin staining and Bioplex assay, respectively. RESULTS: Histopathological assessment revealed neuronal degeneration and increased density of inflammatory cells in frontal and parietal cortex, hippocampus and thalamus in rats exposed to LBOP. LBOP exposure significantly elevated levels of pro-inflammatory cytokines (EPO, IL-1ß, IL-6, IL-12, IL-18, and TNF-α) and chemokines (GRO and RANTES) as well as of an anti-inflammatory cytokine (IL-13) in the frontal cortex. CONCLUSIONS: This study reveals a role of neuroinflammation in neurodegeneration after mild blast traumatic brain injury. Therapies that target this process might in warfighters might function either by attenuating the development of post-traumatic stress disorder, chronic traumatic encephalopathy and Alzheimer's disease, or by slowing their progression.


Assuntos
Encefalite/patologia , Explosões/estatística & dados numéricos , Degeneração Neural/patologia , Animais , Biomarcadores/análise , Lesões Encefálicas Traumáticas/etiologia , Lesões Encefálicas Traumáticas/patologia , Quimiocina CCL5/análise , Quimiocina CXCL1/análise , Quimiocinas/análise , Citocinas/análise , Modelos Animais de Doenças , Encefalite/enzimologia , Encefalite/etiologia , Interleucina-12/análise , Interleucina-18/análise , Interleucina-1beta/análise , Interleucina-6/análise , Degeneração Neural/enzimologia , Degeneração Neural/etiologia , Ratos/lesões , Fator de Necrose Tumoral alfa/análise
17.
Eur J Trauma Emerg Surg ; 45(3): 507-515, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30895338

RESUMO

BACKGROUND: Industrial high-pressure fluid injection injuries (IHPFII) are largely occupational in nature, where these injuries are most often sustained by male manual workers. Such traumatic injuries are largely sustained with water, grease, paint, gasoline or paint thinner. IHPFII are extremely serious injuries with life and limb-threatening potential carrying the risk of life-long disability. METHODS: We reviewed the Water Jetting Association© adverse incident database of advisory alerts detailing cases from around the world that have been brought to the association's attention and the English-language literature on high-pressure hydrostatic injuries from 1937 to 2018. RESULTS: Accidents involving high-pressure water jets in the industry are uncommon. The clinical impact in all of the cases reviewed and the effects of water jet impacts range from instant fatalities at scene to loss of limb function and amputation. The majority of observed fatalities are due to major hemorrhage (exsanguination) secondary to the direct dissection of great vessels or high-energy blunt soft tissue injury and traumatic brain injury. CONCLUSIONS: As with any other trauma, IHPWJI commonly result in amputation or death. Nonetheless, a lack of comprehension of the potential severity of injuries and range of infective complications appears to be largely due to the apparent benignity of the initial presentation of the wound. This in turn leads to delays (both avoidable and unavoidable) in the transfer to appropriate medical facilities and definitive care. There is an identifiable need for education (including for health care providers across multiple levels), training and the availability of personal trauma kits for the timely and effective management of IHPWJI from the initial jet impact on the scene, as well as a need for an established referral system.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Exsanguinação/terapia , Pressão Hidrostática/efeitos adversos , Traumatismos Ocupacionais/terapia , Lesões dos Tecidos Moles/terapia , Infecção dos Ferimentos/terapia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Amputação , Lesões Encefálicas Traumáticas/etiologia , Lesões Encefálicas Traumáticas/mortalidade , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/terapia , Edema/etiologia , Exsanguinação/etiologia , Exsanguinação/mortalidade , Humanos , Traumatismos Ocupacionais/etiologia , Traumatismos Ocupacionais/mortalidade , Rabdomiólise/etiologia , Rabdomiólise/terapia , Lesões dos Tecidos Moles/etiologia , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Infecção dos Ferimentos/etiologia
18.
World Neurosurg ; 126: e1023-e1034, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30857998

RESUMO

BACKGROUND: Electrical bicycles (E-bikes) allow people of all ages to ride at high speeds but have an inherent risk of traumatic brain injury (TBI). Their sales have increased tremendously in recent years. METHODS: We performed a retrospective cohort study to compare the incidence and severity of TBI in E-bikers and conventional bicyclists. We included patients at a Swiss level 1 trauma center admitted from 2010 to 2015. The primary outcome was the association between TBI and the bicycle type. The secondary outcome was the association between helmet use and TBI severity. RESULTS: Of 557 patients injured riding an E-bike (n = 73) or a bicycle (n = 484), 60% sustained a TBI, most of which were mild (Glasgow coma scale [GCS] score, 13-15; E-bike, 78%; bicycle, 88%). TBI was more often moderate (GCS score, 9-12) or severe (GCS score, 3-8) in E-bikers than in bicyclists (P = 0.04). Intracranial hemorrhage, traumatic subarachnoid hemorrhage, and subdural hematoma occurred significantly more often in E-bikers than in bicyclists (P < 0.05). Neurosurgical intervention was necessary for 5 E-bikers (7%) and 25 (5%) bicyclists (P = 0.15). Wearing a helmet correlated with a lower risk of neurosurgical intervention in bicyclists (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.06-0.73; P = 0.01) and a lower risk of calvarial fractures in both bicyclists (OR, 0.16; 95% CI, 0.06-0.42; P < 0.01) and E-bikers (OR, 0.21; 95% CI, 0.05-0.84; P = 0.03). CONCLUSIONS: E-bikers had a significantly greater risk of moderate to severe TBI compared with bicyclists. Helmet use was associated with decreased odds of severe TBI in bicyclists and a tendency toward a more favorable outcome for E-bikers.


Assuntos
Ciclismo/lesões , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/etiologia , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Medicine (Baltimore) ; 98(10): e14528, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855436

RESUMO

RATIONALE: Penetrating brain injury caused by a welding electrode is a rare occurrence. This type of injury requires careful preoperative assessment and timely treatment measures to avoid secondary damage. PATIENT CONCERNS: A 55-year-old male patient fell from a height of approximately 5 m during when a welding electrode in his left hand was inadvertently inserted into his brain. The patient had a GCS score of 15 and complaints of dizziness and headache. CT showed an object of metallic density penetrating the skull and entering the brain parenchyma in the frontotemporal region. DIAGNOSIS: According to the clinical findings and preoperative imaging examination, the diagnosis was open craniocerebral injury with intracranial foreign body and left orbital wall fracture. INTERVENTION: After definite diagnosis and sufficient preoperative preparation, active surgical treatment was carried out to remove intracranial foreign body. Anti-infection and other symptomatic treatment were given after operation. The signs of infection and changes of vital signs were closely observed. OUTCOMES: After treatment, no obvious adverse reactions were found and the patient was discharged. No complications such as infection occurred during the follow-up period of 6 months. LESSONS: In treating patient with a welding electrode penetrating the brain, assessments need to be made preoperatively, the welding electrode needs to be removed in a timely manner, complete hemostasis needs to be achieved during surgery with total repair of the damaged area, and anti-inflammatory treatment needs to be administered postoperatively to achieve good results.


Assuntos
Acidentes por Quedas , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Traumatismos Cranianos Penetrantes/diagnóstico , Traumatismos Cranianos Penetrantes/terapia , Soldagem , Lesões Encefálicas Traumáticas/etiologia , Corpos Estranhos , Traumatismos Cranianos Penetrantes/etiologia , Humanos , Masculino , Pessoa de Meia-Idade
20.
Comput Methods Biomech Biomed Engin ; 22(6): 605-619, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30773915

RESUMO

This article introduces a new approach for the construction of a risk model for the prediction of Traumatic Brain Injury (TBI) as a result of a car crash. The probability of TBI is assessed through the fusion of an experiment-based logistic regression risk model and a finite element (FE) simulation-based risk model. The proposed approach uses a multilevel framework which includes FE simulations of vehicle crashes with dummy and FE simulations of the human brain. The loading conditions derived from the crash simulations are transferred to the brain model thus allowing the calculation of injury metrics such as the Cumulative Strain Damage Measure (CSDM). The framework is used to propagate uncertainties and obtain probabilities of TBI based on the CSDM injury metric. The risk model from FE simulations is constructed from a support vector machine classifier, adaptive sampling, and Monte-Carlo simulations. An approach to compute the total probability of TBI, which combines the FE-based risk assessment as well as the risk prediction from the experiment-based logistic regression model is proposed. In contrast to previous published work, the proposed methodology includes the uncertainty of explicit parameters such as impact conditions (e.g., velocity, impact angle), and material properties of the brain model. This risk model can provide, for instance, the probability of TBI for a given assumed crash impact velocity.


Assuntos
Acidentes de Trânsito , Lesões Encefálicas Traumáticas/etiologia , Análise de Elementos Finitos , Medição de Risco , Aceleração , Simulação por Computador , Humanos , Modelos Logísticos , Probabilidade , Estresse Mecânico , Máquina de Vetores de Suporte
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA