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1.
Int J Mol Sci ; 22(17)2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34502537

RESUMO

Macrophages emerge in the milieu around innervated neurons after nerve injuries. Following nerve injury, autophagy is induced in macrophages and affects the regulation of inflammatory responses. It is closely linked to neuroinflammation, while the immunosuppressive drug tacrolimus (FK506) enhances nerve regeneration following nerve crush injury and nerve allotransplantation with additional neuroprotective and neurotrophic functions. The combined use of FK506 and adipose-derived stem cells (ADSCs) was employed in cell therapy for organ transplantation and vascularized composite allotransplantation. This study aimed to investigate the topical application of exosomes secreted by ADSCs following FK506 treatment (ADSC-F-exo) to the injured nerve in a mouse model of sciatic nerve crush injury. Furthermore, isobaric tags for relative and absolute quantitation (iTRAQ) were used to profile the potential exosomal proteins involved in autophagy. Immunohistochemical analysis revealed that nerve crush injuries significantly induced autophagy in the dorsal root ganglia and dorsal horn of the spinal segments. Locally applied ADSC-F-exo significantly reduced autophagy of macrophages in the spinal segments after nerve crush injury. Proteomic analysis showed that of the 22 abundant exosomal proteins detected in ADSC-F-exo, heat shock protein family A member 8 (HSPA8) and eukaryotic translation elongation factor 1 alpha 1 (EEF1A1) are involved in exosome-mediated autophagy reduction.


Assuntos
Autofagia/efeitos dos fármacos , Lesões por Esmagamento/complicações , Exossomos/metabolismo , Macrófagos/efeitos dos fármacos , Traumatismos da Coluna Vertebral/metabolismo , Células-Tronco/efeitos dos fármacos , Tacrolimo/farmacologia , Tecido Adiposo/citologia , Tecido Adiposo/metabolismo , Animais , Células Cultivadas , Cromatografia Líquida/métodos , Exossomos/ultraestrutura , Imunossupressores/farmacologia , Macrófagos/metabolismo , Camundongos Endogâmicos C57BL , Microscopia Eletrônica de Transmissão , Mapas de Interação de Proteínas , Proteoma/metabolismo , Proteômica/métodos , Traumatismos da Coluna Vertebral/etiologia , Células-Tronco/metabolismo , Espectrometria de Massas em Tandem/métodos
2.
Emerg Med J ; 38(5): 330-337, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34449409

RESUMO

BACKGROUND: Clinical decision rules (CDRs) are commonly used to guide imaging decisions in cervical spine injury (CSI) assessment despite limited evidence for their use in paediatric populations. We set out to determine CSI incidence, imaging rates and the frequency of previously identified CSI risk factors, and thus assess the projected impact on imaging rates if CDRs were strictly applied as a rule in our population. METHODS: A single-centre prospective observational study on all aged under 16 years presenting for assessment of possible CSI to a tertiary paediatric emergency department over a year, commencing September 2015. CDR variables from the National Emergency X-Radiography Utilization Study (NEXUS) rule, Canadian C-Spine rule (CCR) and proposed Paediatric Emergency Care Applied Research Network (PECARN) rule were collected prospectively and applied post hoc. RESULTS: 1010 children were enrolled; 973 had not received prior imaging. Of these, 40.7% received cervical spine imaging; 32.4% X-rays, 13.4% CT scan and 3% MRI. All three CDRs identified the five children (0.5%) with CSI who had not received prior imaging. If CDRs were strictly applied as a rule for imaging, projected imaging rates in our setting would be as follows: NEXUS-44% (95% CI 41% to 47.4%), CCR-at least 48.4% (95% CI 45.3% to 51.7%) and PECARN-68% (95% CI 65.1% to 71.1%). CONCLUSION: CSIs were rare (0.5% of our cohort), however, 40% of children received imaging. CDRs have been designed to guide imaging decisions; if strictly applied as a rule for imaging, the CDRs assessed in this study would increase imaging rates. Projected rates differ considerably depending on the CDR applied. These findings highlight the need for a validated paediatric-specific cervical spine imaging CDR.


Assuntos
Vértebras Cervicais/lesões , Regras de Decisão Clínica , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/epidemiologia , Adolescente , Austrália/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/fisiopatologia
3.
Sci Rep ; 11(1): 11989, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099849

RESUMO

Concomitant maxillofacial and cervical spine injuries occur in 0.8-12% of the cases. We examined the relation of injury localization and the probability of cervical spine fracture. A retrospective study was conducted on patients that have been treated at Dortmund General Hospital for injuries both to the maxillofacial region and to the cervical spine between January 1st, 2007 and December 31th, 2017. Descriptive statistical methods were used to describe the correlation of cervical spine injuries with gender, age as well as maxillofacial injury localization. 7708 patients were hospitalized with maxillofacial injury, among them 173 were identified with cervical spine injury. The average ages for both genders lie remarkably above the average of all maxillofacial trauma patients (36.2 y.o. in male and 50.9 y.o. in female). In the group of men, most injuries were found between the ages of 50 and 65. Whereas most injuries among women occurred after the age of 80. The relative ratio of cervical spine injuries (CSI) varies between 1.1 and 5.26% of the maxillofacial injuries (MFI), being highest in the soft tissue injury group, patients with forehead fractures (3.12%) and patients with panfacial fractures (2.52%). Further, nasal, Le Fort I and II, zygomatic complex and mandibular condyle fractures are often associated with CSI. Fractures next to the Frankfurt horizontal plane represent 87.7% of all MFI with concomitant CSI. Patients in critical age groups with a high-energy injury are more likely to suffer both, MFI and CSI injuries. Our findings help to avoid missing the diagnosis of cervical spine injury in maxillofacial trauma patients.


Assuntos
Vértebras Cervicais/lesões , Fraturas Cranianas/etiologia , Crânio/lesões , Traumatismos da Coluna Vertebral/etiologia , Acidentes de Trânsito , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Face , Ossos Faciais/lesões , Feminino , Temperatura Alta , Humanos , Masculino , Fraturas Mandibulares/etiologia , Traumatismos Maxilofaciais/etiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Lesões dos Tecidos Moles/etiologia , Ferimentos e Lesões
4.
Am J Emerg Med ; 47: 74-79, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33780736

RESUMO

BACKGROUND: Pediatric cervical spine (CSI) and blunt cerebrovascular injuries (BCVI) are challenging to evaluate as they are rare but carry high morbidity and mortality. CT scans are the traditional imaging modality to evaluate for CSI/BCVI, but involve radiation exposure and potential future increased risk of malignancy. Therefore, we present results from the implementation of a combined CSI/BCVI pediatric trauma clinical pathway to aid clinicians in their decision-making. METHODS: We conducted a 2-year retrospective cohort study analyzing data pre and post implementation of the combined CSI/BCVI pathway. Data was obtained from a level 1 pediatric trauma center and included blunt trauma patients under the age of 14. We evaluated the use of cervical spine computed tomography (CT), CT angiography, and plain radiographs, as well as missed injuries and provider pathway adherence. RESULTS: We included 358 patients: 209 pre-pathway and 149 post-pathway implementation. Patient mean age was 8.9 years and 61% were male (61% males). There were no significant differences in GCS, AIS, and ISS between pre and post pathway groups. Post pathway implementation saw reduced use of cervical spine CT, although this was not clinically significant (33% vs 31%, p = 0.74). However, cervical spine radiography use increased (9% vs 16%, p = 0.03), and there was also an increase in screening for BCVI injuries with higher use of CTA (5% vs 7%, p = 0.52). A total of 12 CSI and 3 BCVI were identified with no missed injuries. Provider adherence to the pathway was modest (54%). Conclusion Implementation of a combined CSI/BCVI clinical pathway for pediatric trauma patients increased screening radiography and did not miss any injuries. However, CT use did not significantly decrease and provider adherence was modest, supporting the need for further implementation analysis and larger studies to validate the pathway's sensitivity and specificity for CSI/BCVI.


Assuntos
Traumatismo Cerebrovascular/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ferimentos não Penetrantes/diagnóstico por imagem , Traumatismo Cerebrovascular/etiologia , Criança , Pré-Escolar , Procedimentos Clínicos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/etiologia , Tomografia Computadorizada por Raios X/efeitos adversos , Centros de Traumatologia/estatística & dados numéricos , Índices de Gravidade do Trauma , Ferimentos não Penetrantes/complicações
5.
World Neurosurg ; 149: e116-e127, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33631390

RESUMO

OBJECTIVE: No previous large population-based studies of traumatic spinal injury (TSI) rates, trends, and patterns exist. We aimed to fill this knowledge gap on TSI epidemiology using a population-based study of 13 million people. METHODS: This is a descriptive cross-sectional cohort study that analyzes a national, mandatory reporting database for all emergency departments and ambulatory care centers in Ontario over 15 years. Demographics of TSI, trends in the TSI rate, etiology, transfer, disposition, comorbidities, and associated traumatic brain injury or spinal cord injury were analyzed. RESULTS: There were 167,357 TSI-related emergency department visits resulting in 70,684 hospitalizations and 376 deaths. The overall rate of TSI significantly increased from 66.94 to 118.61 per 100,000. Female patients had greater rates of TSI. Older patients had greater rates of TSI, especially related to falls. Fall was found to be the commonest mechanism of TSI, whereas motor vehicle collisions scaled down to the third commonest mechanism of TSI. Sport-related TSI had the greatest percentage of increase in the rate over all mechanisms (221%, P < 0.001). TSI with associated traumatic brain injury comprised 6% of the cohort but had the greatest percentage increase (91%) in the rate compared to all other TSI forms. CONCLUSIONS: The rate of TSI continues to rise in Ontario as the population ages. The rise is primarily attributed to a shift in the epidemiology and etiology of TSI from a younger male population toward an older female population, with falls as the primary injury mechanism. Establishing preventive measures to address this shift is essential.


Assuntos
Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/etiologia , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Adulto Jovem
6.
Childs Nerv Syst ; 37(6): 1949-1956, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33515056

RESUMO

PURPOSE: Paediatric spine trauma is uncommon and is managed differently from adults due to the anatomical differences of the paediatric spine. The paediatric spine is less ossified, with lax ligaments and a higher fulcrum in the c-spine which results in a different pattern of injuries. The aim of this study is to provide a contemporary audit of paediatric spinal trauma. METHODS: A retrospective review was conducted using the Trauma and Audit Research Network database at a major trauma centre (2011-2018). All patients < 18 years old with a spine injury underwent case note and radiology review. RESULTS: A total of 72 patients (37, 51.4% male with an average age of 13.3 (± 5.9) years old) were identified. The most common mechanism of injury was road traffic collisions (n = 39, 54.2%). The most common sporting cause was motocross accidents (n = 6, 8.3%), and a further 6 (8.3%) patients had a suspected inflicted injury. Eight patients (11.1%) sustained a spinal cord injury. Twenty-seven (37.5%) patients underwent surgical intervention to treat their spinal injury. CONCLUSION: This series demonstrates the profile of injury mechanisms causing paediatric spinal injuries. Paediatric spine injuries continue to have the potential for lifelong disability and require careful, specialist management. This series also highlights certain causes such as motocross accidents and suspected inflicted injury which are more frequent than expected and raise potential public health concerns.


Assuntos
Traumatismos da Medula Espinal , Traumatismos da Coluna Vertebral , Acidentes de Trânsito , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/etiologia , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/etiologia , Centros de Traumatologia , Reino Unido/epidemiologia
7.
J Emerg Med ; 60(1): 17-24, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32893065

RESUMO

BACKGROUND: Spinal injuries (SIs) can pose a significant burden to patients and family; delayed surgical intervention, associated with interhospital transfer, results in worse outcomes. OBJECTIVE: This study aimed to identify early patient-centered factors associated with risk for near-shore SIs to assist clinicians with expeditious medical decision-making. METHODS: We performed a multicenter retrospective study of all adults transported from Ocean City, Maryland to two emergency departments (EDs) and one regional trauma center for evaluation of suspected SIs from 2006 to 2017. Outcomes were any SI and any spinal cord injury (SCI). Multivariable logistic regression was performed for association of environmental and clinical factors with outcomes. RESULTS: We analyzed 278 records, 102 patients (37%) were diagnosed with any SI and 41 (15%) were diagnosed with SCIs. Compared with patients without SI, patients with SI were more likely to be older (48 vs. 39 years), male (90% vs. 70%), with pre-existing spinal condition (62% vs. 33%), and injury caused by diving (11% vs. 2%). Multivariable logistic regression showed age (odd ratio [OR] 1.07; 95% confidence interval [CI] 1.04-1.11), diving (OR 3.5; 95% CI 3-100+), and wave height (OR 4.5; 95% CI 1.35-15.2) were associated with any SI, and a chief complaint of extremity numbness or tingling (OR 5.73; 95% CI 1.2-27.9) was associated with SCI. CONCLUSIONS: We identified older age, diving, and higher wave height as risk factors for any SI and symptoms of numbness and tingling were associated with SCIs. Clinicians should consider expediting these patients' transfers to a trauma center with neurosurgical capability.


Assuntos
Traumatismos da Medula Espinal , Traumatismos da Coluna Vertebral , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Maryland , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/etiologia , Centros de Traumatologia
8.
Sports Health ; 13(1): 57-64, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32649842

RESUMO

CONTEXT: Evidence concerning a systematic, comprehensive injury risk assessment in the elite swimming population is scarce. OBJECTIVE: To evaluate the quality of current literature regarding clinical assessment techniques used to evaluate the presence and/or development of pain/injury in elite swimmers and to categorize objective clinical assessment tools into relevant predictors (constructs) that should consistently be evaluated in injury risk screens of elite swimmers. DATA SOURCES: PubMed, Embase, Scopus, CINAHL, SPORTDiscus, PEDro, and the Cochrane Library Reviews were searched through September 2018. STUDY SELECTION: Studies were included for review if they assessed a correlation between clinic-based objective measures and the presence and/or development of acute or chronic pain/injury in elite swimmers. All body regions were included. Elite swimmers were defined as National Collegiate Athletic Association, collegiate, and junior-, senior-, or national-level swimmers. Only cohort and cross-sectional studies were included (both prospective and retrospective); randomized controlled trials, expert opinion, and case reports were excluded, along with studies that focused on interventions, performance, or specific swim-stroke equipment or technology. STUDY DESIGN: Systematic review and qualitative analysis. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were utilized at each phase of review by 2 reviewers; a third reviewer was utilized for tie breaking purposes. Qualitative analysis was performed using the Methodological Items for Non-Randomized Studies (MINORS) assessment tool. RESULTS: A total of 21 studies assessed the presence and/or development of injury/pain in 3 different body regions: upper extremity, lower extremity, and spine. Calculated average MINORS scores for comparative (n = 17) and noncomparative (n = 4) studies were 18.1 of 24 and 10.5 of 16, respectively. Modifiable, objectively measurable injury risk factors in elite swimmers were categorized into 4 constructs: (1) strength/endurance, (2) mobility, (3) static/dynamic posture, and (4) patient-report regardless of body region. CONCLUSION: Limited evidence exists to draw specific correlations between identified clinical objective measures and the development of pain and/or injury in elite swimmers.


Assuntos
Medição de Risco/métodos , Natação/lesões , Humanos , Extremidade Inferior/lesões , Extremidade Inferior/fisiopatologia , Força Muscular , Exame Físico , Postura , Fatores de Risco , Autorrelato , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/fisiopatologia , Extremidade Superior/lesões , Extremidade Superior/fisiopatologia
9.
Jpn J Radiol ; 39(1): 93-99, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32894410

RESUMO

PURPOSE: Fractures are known to shorten life expectancy and worsen the quality of life. The risk of fractures after radiation therapy in cervical cancer patients is known to be multifactorial. In this study, we examined risk factors for fractures in cervical cancer patients, especially by evaluating bone densities and DVH parameters for fractured bones. MATERIALS AND METHODS: For 42 patients, clinical characteristics, pretreatment CT bone densities, and radiation dose were compared between patients with and without fractures. RESULTS: Posttreatment fractures occurred in 25 bones among ten patients. Pretreatment CT bone densities were significantly lower in patients with fractures (P < 0.05-0.01 across sites, except for the ilium and the ischium). Although DVH parameters were also significantly associated with fractures in univariate analysis, only CT densities were significantly associated with fractures in multivariate analysis. CONCLUSION: Pretreatment CT densities of spinal and pelvic bones, which may reflect osteoporosis, have a significant impact on the risk for posttreatment fractures.


Assuntos
Fraturas Ósseas/epidemiologia , Ossos Pélvicos/lesões , Ossos Pélvicos/efeitos da radiação , Traumatismos da Coluna Vertebral/etiologia , Coluna Vertebral/efeitos da radiação , Neoplasias do Colo do Útero/radioterapia , Densidade Óssea , Feminino , Humanos , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Estudos Retrospectivos , Fatores de Risco , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
10.
Elife ; 92020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33259289

RESUMO

In comparative cross-species perspective, humans experience unique physical impairments with potentially large consequences. Quantifying the burden of impairment in subsistence populations is critical for understanding selection pressures underlying strategies that minimize risk of production deficits. We examine among forager-horticulturalists whether compromised bone strength (indicated by fracture and lower bone mineral density, BMD) is associated with subsistence task cessation. We also estimate the magnitude of productivity losses associated with compromised bone strength. Fracture is associated with cessation of hunting, tree chopping, and walking long distances, but not tool manufacture. Age-specific productivity losses from hunting cessation associated with fracture and lower BMD are substantial: ~397 lost kcals/day, with expected future losses of up to 1.9 million kcals (22% of expected production). Productivity loss is thus substantial for high strength and endurance tasks. Determining the extent to which impairment obstructs productivity in contemporary subsistence populations improves our ability to infer past consequences of impairment.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Eficiência , Atividades Cotidianas , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bolívia , Densidade Óssea , Dieta Paleolítica , Eficiência/fisiologia , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Humanos , Povos Indígenas/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/etiologia
11.
Am J Emerg Med ; 38(10): 2049-2054, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33142173

RESUMO

OBJECTIVE: It remains unclear whether clinicians can rely on specific symptoms and signs to detect or exclude serious head and spinal injury sustained during near-shore aquatic activities. Our study investigated patients' history of present illness (HPI) and physical examination (PE) for their utility in detecting serious head and spinal injury. METHODS: We conducted a multicenter retrospective comparative analysis of adult patients who were transported from the beach in Ocean City, Maryland, to three nearby emergency departments for possible spinal injury from 2006 through 2017. Patients suspected to have any spinal injury from beach activities were eligible. We excluded patients who could not verbalize their symptoms or with insufficient emergency department records. We compared components of each patient's HPI and PE with radiologic evidence of spinal injury. We calculated sensitivity, specificity, and negative and positive likelihood ratios (LRs). RESULTS: We analyzed 278 patients with suspected spinal injury. Midline spinal tenderness was associated with increased likelihood of thoracic (LR+ 2.6) and lumbar spinal fractures (LR+ 3.5). HPI complaints of paralysis (LR+ 13.9) and sensory loss (LR+ 5.8) had strong associations with spinal cord injuries. Weakness found through PE was also associated with spinal cord injury (LR+ 5.3). CONCLUSIONS: We identified several components of the clinical evaluation that had clinically significant association with spinal injuries from beach-related trauma. While prospective studies are needed to confirm our observations, clinicians may consider these high-risk features in patients with beach-related trauma and adjust testing and level of care appropriately.


Assuntos
Diagnóstico por Imagem/estatística & dados numéricos , Anamnese/métodos , Oceanos e Mares , Exame Físico/métodos , Ferimentos e Lesões/complicações , Adulto , Idoso , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/etiologia , Diagnóstico por Imagem/métodos , Feminino , Humanos , Masculino , Maryland/epidemiologia , Anamnese/estatística & dados numéricos , Pessoa de Meia-Idade , Exame Físico/estatística & dados numéricos , Estudos Prospectivos , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/etiologia , Estatísticas não Paramétricas , Ferimentos e Lesões/epidemiologia
12.
BMJ Open ; 10(11): e039768, 2020 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-33191261

RESUMO

OBJECTIVES: To describe the patterns and outcomes of traumatic spinal injuries (TSIs) in a tertiary care trauma centre in Riyadh, Saudi Arabia. DESIGN: Retrospective medical record review. SETTING: Level 1 trauma centre for all patients presented from 1 February 2016 to 31 December 2018. PARTICIPANTS AND DATA: Records of patients presenting with any spinal trauma were reviewed, and the data obtained included age, gender, nationality (as Saudi and non-Saudi), date of presentation, site of fracture/injury, associated injuries, mechanism of injury, presence of neurological involvement and hospital mortality. MAIN OUTCOMES: Frequencies of different types of TSI across various subgroups. RESULTS: We identified 692 patients who presented with TSI throughout the study period. The mean age was 36.9 years. Males represented 83.2% (n=576) of the sample size, and the most common mechanism of injury was motor vehicle collision (MVC), accounting for 66.8% of cases (n=462), while fall-related injuries were seen in 31.6% of cases (n=219). A total of 454 (65.6%) of all patients were Saudi, and 332 (73.1%) of the TSIs in Saudis were due to MVC. Non-Saudi cases accounted for 238 (34.4%) of all patients, and 89 (37.4%) of the non-Saudi injuries were due to falls from height, and this association was statistically significant (p<0.001). CONCLUSION: TSI was not thoroughly examined in Saudi Arabia; therefore, this study is considered the first to be done in the Kingdom using a representative sample. The fact that non-Saudi patients had a higher proportion of falls as a mechanism of injury should be taken into consideration in terms of raising awareness and taking more safety precautions, as most construction workers tend to be expatriates.


Assuntos
Traumatismos da Coluna Vertebral , Acidentes de Trânsito , Adolescente , Adulto , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/etiologia , Adulto Jovem
13.
Sci Rep ; 10(1): 16199, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004855

RESUMO

Blunt vertebral artery injury (VAI) is associated with severe cervicocephalic trauma and may have devastating consequences. This study aimed to determine the incidence and nature of VAI in polytrauma patients. The secondary objective was to assess the association of VAI with previously suggested risk factors. It was a retrospective observational study of all polytrauma patients admitted to the trauma unit between April 2018 and July 2019, who had CT neck angiography to diagnose blunt VAI according to modified Denver criteria. Out of 1084 admitted polytrauma patients, 1025 (94.6%) sustained blunt trauma. Of these, 120 (11.7%) underwent screening CT neck angiography. VAI was detected in 10 (8.3%; 95% CI 4.1-14.8) patients. There were three patients with Grade I injury, two with Grade II, and five with Grade IV injury. Among all trauma admissions, the incidence of diagnosed VAI was 0.9% (95% CI 0.5-1.8). Among patients suspected of VAI, there was no univariable association of VAI with C-Spine fracture: OR 4.2 (95% CI 0.51-34.4; p = 0.18). There were two (20%) deaths related to VAI. Traumatic VAI was uncommonly detected in this major trauma service in Saudi Arabia. High suspicion and liberal screening by CT angiography in cases where VAI is possible should be considered to avoid missed injuries.


Assuntos
Traumatismo Múltiplo/complicações , Traumatismos da Coluna Vertebral/epidemiologia , Artéria Vertebral/lesões , Adulto , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/terapia
14.
Semin Ultrasound CT MR ; 41(5): 411-420, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32980088

RESUMO

Abusive head trauma (AHT) is the leading cause of fatal head injuries in infants. The mechanism of injury usually involves vigorous shaking of the infant, impact, or a combination of the 2. There are characteristic imaging findings of which the most common are subdural hemorrhages. Parenchymal injuries to the brain are common as well, including hypoxic ischemic injury, diffuse axonal injury, and cerebral contusions. Retinal hemorrhages are common with AHT and are best evaluated by fundoscopy, however, high grade retinal hemorrhages may be detected on cross-sectional imaging. Skull fractures are not specific to AHT but are present in third of the cases and tend to be complex in association with AHT. Injuries to the spine are more common than previously thought and typically involve soft tissues rather than bones, with the most common being ligamentous injuries in the craniocervical junction. In the setting of AHT, an affected infant would typically exhibit multiple findings. While CT of the head is the first modality of choice for assessment of an infant with AHT, magnetic resonance imaging examination of the brain and spine should follow due to its higher sensitivity for detection of these findings.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Maus-Tratos Infantis/diagnóstico , Imageamento por Ressonância Magnética/métodos , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Encéfalo/diagnóstico por imagem , Lesões Encefálicas/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Traumatismos da Coluna Vertebral/etiologia , Coluna Vertebral/diagnóstico por imagem
15.
Comput Methods Programs Biomed ; 196: 105618, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32603988

RESUMO

BACKGROUND AND OBJECTIVE: Recent research and tested data suggested that spinal injuries occur more often in a frontal impact. Most of the published information is focused on the lumbar spinal injury with respect to axial compression force by varying the height of drops. Parametric studies on the lumbar spinal injury are very scanty. Therefore, the present investigation aimed to optimize the effects of drop height, torso weight and seat angle on the characterization of lumbar injury criteria METHODS: A detailed finite element model of a spine with multi-segmented spinal columns is developed and validated with the experimental or cadaveric tests using CORA evaluation. Hence, Dynamic loading studies or weight drop techniques were used to characterize the effect of drop height, seat angle and torso weight of the upper body on the lumbar spinal injury during a frontal impact. Parametric simulations were carried out using response surface methodology (RSM). Test of significance (p < 0.05) on the parameters was carried out using ANOVA. Desirability Function Approach is used to optimize the parameters for better safety design. RESULTS: The result shows that all the factors considered in the experiment are related to the risk of lumbar spinal injury during the frontal impact. All the factors selected, the drop height, torso weight and the seat angle were the most prominent element in determining the lumbar spinal injury. The injury increased with the increase in the posture angle of the seat. Optimal parameters were determined for the better safety of the occupants as seat angle of 105°, drop height 500 mm and torso weight of 25 kg in vehicle design. During vertical impact, posterior undergoes maximum impact in the portions of vertebra and confirmed with the patient case study fracture of vertical drop incident. CONCLUSIONS: This research insight gives an improved understanding of the parametric influence of design alternatives to minimize the risk of lumbar spinal injury in automotive vehicles. The optimal combination of drop height and the seat angle provides futuristic view on autonomous vehicle seat design.


Assuntos
Heurística , Traumatismos da Coluna Vertebral , Acidentes de Trânsito , Fenômenos Biomecânicos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Postura , Traumatismos da Coluna Vertebral/etiologia
16.
PLoS One ; 15(7): e0235035, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667924

RESUMO

This study aimed to clarify the cause of rugby head and spinal cord injuries through a network centrality analysis of 14-year (2004-2018) longitudinal data in Japan. The study hypothesis is that understanding the causal relationship among the occurrence of serious injuries, the quality of player experience and play situation as a network structure could be possible to obtain practical knowledge on injury prevention. In this study, bipartite graphs are used to make it easier to understand the situation of players and injuries. This would also help to elucidate more characteristic subgroup. A network bipartite graph and subgroup (cluster) analyses were performed to clarify the injured players' experience and the cause of injury. We used the algorithm of R program, IGRAPH, clustering edge betweenness. For subgroup extraction, the modularity Q value was used to determine which step to cut. The Japanese rugby population was 93,873 (2014-2018 average), and 27% were high school students. The data showed that careful attention would be particularly needed for groups of inexperienced Japanese high school players. Our study suggests that we should consider introducing rules that prohibit "head-on collisions" in youth rugby.


Assuntos
Traumatismos em Atletas/etiologia , Traumatismos Craniocerebrais/etiologia , Futebol Americano/lesões , Traumatismos da Coluna Vertebral/etiologia , Adolescente , Criança , Regras de Decisão Clínica , Gráficos por Computador , Feminino , Humanos , Japão , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Instituições Acadêmicas , Adulto Jovem
17.
Sci Rep ; 10(1): 11218, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32665555

RESUMO

Astronauts are at increased risk of spine injury. With a view to developing training approaches for the muscles of the spine in microgravity, this study examined the effects of axial loading and postural cues on the contraction of transversus abdominis and lumbar multifidus in supine lying using a novel exercise device (GravityFit). Thirty (18 males and 12 females) endurance-trained runners without a history of spinal pain aged 33-55 years were recruited. Magnetic resonance imaging (MRI) was performed under one rest and five exercise conditions, which involved variations in axial loading and postural cues. Whole volume of the abdominal and lumbar paraspinal muscles was imaged and transversus abdominis thickness and length and multifidus anteroposterior and mediolateral thickness measured. Transversus abdominis contraction was greatest in the 'stretch tall plus arm extension' (length, - 15%, P < 0.001; thickness, + 19%, P < 0.001) and 'stretch tall plus arm extension and thoracic cue' (length, - 16%, P < 0.001; thickness, + 18%, P < 0.001) conditions. The contraction of multifidus was the greatest in the 'arm extension and thoracic cue' (anteroposterior, + 3.0%, P = 0.001; mediolateral, - 4.2%, P < 0.001) and 'stretch tall plus arm extension and thoracic cue' (anteroposterior, + 6.0%, P < 0.001; mediolateral, - 2.1%, P = 0.022) conditions. This study provides proof-of-principle for an exercise approach that may be used to facilitate the automatically contraction of the transversus abdominis and multifidus muscles. Axial loading of the body, with or without arm loading, most consistently led to contraction of the transversus abdominis and lumbar multifidus muscles, and regional differences existed in the contraction within the muscles.


Assuntos
Músculos Abdominais/fisiologia , Contração Muscular , Músculos Paraespinais/fisiologia , Condicionamento Físico Humano/métodos , Postura , Traumatismos da Coluna Vertebral/prevenção & controle , Suporte de Carga , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Coluna Vertebral/etiologia , Ausência de Peso/efeitos adversos
18.
Neurosurgery ; 87(4): 647-654, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32720683

RESUMO

BACKGROUND: Previous studies have attempted to establish return-to-play (RTP) guidelines in collision sport athletes after cervical spine injury; however, recommendations have been limited by scant high-quality evidence and basic consensus survey methodologies. OBJECTIVE: To create relevant clinical statements regarding management in collision sport athletes after cervical spine injury, and establish consensus RTP recommendations. METHODS: Following the modified Delphi methodology, a 3 round survey study was conducted with spine surgeons from the Cervical Spine Research Society and National Football League team physicians in order to establish consensus guidelines and develop recommendations for cervical spine injury management in collision sport athletes. RESULTS: Our study showed strong consensus that asymptomatic athletes without increased magnetic resonance imaging (MRI) T2-signal changes following 1-/2- level anterior cervical discectomy and fusion (ACDF) may RTP, but not after 3-level ACDF (84.4%). Although allowed RTP after 1-/2-level ACDF was noted in various scenarios, the decision was contentious. No consensus RTP for collision athletes after 2-level ACDF was noted. Strong consensus was achieved for RTP in asymptomatic athletes without increased signal changes and spinal canal diameter >10 mm (90.5%), as well as those with resolved MRI signal changes and diameter >13 mm (81.3%). No consensus was achieved in RTP for cases with pseudarthrosis following ACDF. Strong consensus supported a screening MRI before sport participation in athletes with a history of cervical spine injury (78.9%). CONCLUSION: This study provides modified Delphi process consensus statements regarding cervical spine injury management in collision sport athletes from leading experts in spine surgery, sports injuries, and cervical trauma. Future research should aim to elucidate optimal timelines for RTP, as well as focus on prevention of injuries.


Assuntos
Atletas , Futebol Americano/lesões , Futebol Americano/normas , Volta ao Esporte/normas , Traumatismos da Coluna Vertebral , Vértebras Cervicais/cirurgia , Consenso , Técnica Delfos , Discotomia , Humanos , Lesões do Pescoço/etiologia , Lesões do Pescoço/cirurgia , Fusão Vertebral , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/cirurgia
19.
BMC Public Health ; 20(1): 1186, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727594

RESUMO

BACKGROUND: Fall-related injuries are important public health problem worldwide. We aimed to describe the epidemiological and clinical characteristics of fall-related injuries in a level 1 trauma center. METHOD: A retrospective analysis of Qatar Trauma Registry data was conducted on patients admitted for fall-related injuries between 2010 and 2017. Comparative analyses of data by gender, age-groups and height of falls were performed to describe the epidemiological and clinical characteristics of patients, and in-hospital outcomes. RESULTS: A total of 4040 patients with fall-related injuries were identified in the study duration which corresponds to the rate of 2.34 per 10,000 population. Although the rate of fall-related injuries decreased over the years, the average number of patients per year remained high accounting for 32% of the hospitalized patients with moderate to severe injuries. Most of the injuries affected the head (36%) followed by spines (29%) and chest (23%). Males were predominant (89%), more likely to fall at workplace, fall from a greater height and have polytrauma than females. The working age-group (20-59 years) constituted the majority of injured (73%) and were more likely to fall at workplace, and to fall from higher heights compared to the older adults who sustained more fall at home. Overall in-hospital mortality was 3%. Outcomes including longer hospital length of stay and mortality were generally correlated with the height of fall except for the fall at home. CONCLUSION: Fall-related injuries remain as significant burden even in a level 1 trauma center. Variations in the pattern of injuries by age, gender and height of fall provide important information for targeted preventive measures.


Assuntos
Acidentes por Quedas , Hospitalização , Escala de Gravidade do Ferimento , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Acidentes por Quedas/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/etiologia , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo , Catar/epidemiologia , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/epidemiologia , Traumatismos da Coluna Vertebral/etiologia , Traumatismos Torácicos/epidemiologia , Traumatismos Torácicos/etiologia , Adulto Jovem
20.
Prehosp Disaster Med ; 35(5): 524-527, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32600478

RESUMO

BACKGROUND: Cadaveric and older radiographic studies suggest that concurrent cervical spine fractures are rare in gunshot wounds (GSWs) to the head. Despite this knowledge, patients with craniofacial GSWs often arrive with spinal motion restriction (SMR) in place. This study quantifies the incidence of cervical spine injuries in GSWs to the head, identified using computerized tomography (CT). Fracture frequency is hypothesized to be lower in self-inflicted (SI) injuries. METHODS: Isolated craniofacial GSWs were queried from this Level I trauma center registry from 2013-2017 and the US National Trauma Data Bank (NTDB) from 2012-2016 (head or face abbreviated injury scale [AIS] >2). Datasets included age, gender, SI versus not, cervical spine injury, spinal surgery, and mortality. For this hospital's data, prehospital factors, SMR, and CTs performed were assessed. Statistical evaluation was done with Stata software, with P <.05 significant. RESULTS: Two-hundred forty-one patients from this hospital (mean age 39; 85% male; 66% SI) and 5,849 from the NTDB (mean age 38; 84% male; 53% SI) were included. For both cohorts, SI patients were older (P < .01) and had increased mortality (P < .01). Overall, cervical spine fractures occurred in 3.7%, with 5.4% requiring spinal surgery (0.2% of all patients). The frequency of fracture was five-fold greater in non-SI (P < .05). Locally, SMR was present in 121 (50.2%) prior to arrival with six collars (2.5%) placed in the trauma bay. Frequency of SMR was similar regardless of SI status (49.0% versus 51.0%; P = not significant) but less frequent in hypotensive patients and those receiving cardiopulmonary resuscitation (CPR). The presence of SMR was associated with an increased use of CT of the cervical spine (80.0% versus 33.0%; P < .01). CONCLUSION: Cervical spine fractures were identified in less than four percent of isolated GSWs to the head and face, more frequently in non-SI cases. Prehospital SMR should be avoided in cases consistent with SI injury, and for all others, SMR should be discontinued once CT imaging is completed with negative results.


Assuntos
Vértebras Cervicais/lesões , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/etiologia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nevada/epidemiologia , Sistema de Registros , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/mortalidade , Fraturas da Coluna Vertebral/terapia , Traumatismos da Coluna Vertebral/mortalidade , Traumatismos da Coluna Vertebral/terapia , Tentativa de Suicídio , Centros de Traumatologia , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/mortalidade , Ferimentos por Arma de Fogo/terapia
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