Search Results (212)

Chainsaws are widely used in various occupational settings, including forestry, landscaping, farming, and by homeowners for tasks like tree felling, brush clearing, and firewood cutting. However, the use of chainsaws poses significant risks to operators and bystanders. This research quantified and compared occupational and nonoccupational injuries caused by contact with chainsaws and related objects during the period from 2018 to 2022. The emergency department and OSHA (Occupational Safety and Health Administration) data were used to characterize the cause and nature of the injuries. Results suggest that for this five-year period an estimated 127,944 people were treated in U.S. emergency departments for chainsaw-related injuries. More than 200 non-fatal and 57 fatal occupational chainsaw-involved injuries were found during the same period. Landscaping and forestry were the two industries where most of the occupational victims were employed. Upper and lower extremities were the most likely injured body parts, with open wounds from cuts being the most common injury type. The majority of fatal injuries were caused by falling objects such as trees and tree limbs while using a chainsaw. Our suggestions to reduce injuries include proper training and wearing personal protective equipment, as well as making sure any bystanders are kept in a safety zone away from trees being cut. Full article

Lung transplantation remains the standard of care for end-stage lung disease, yet a persistent gap exists between donor lung availability and growing clinical demand. Expanding the donor pool and optimising donor lung management are therefore critical priorities. However, no universally accepted management protocols are currently in place. This narrative review examines evidence-based strategies to improve lung utilisation across three donor categories: donors after brain death (DBD), controlled donors after circulatory death (cDCD), and uncontrolled donors after circulatory death (uDCD). A systematic literature search was conducted to identify interventions targeting lung preservation and function, including protective ventilation, recruitment manoeuvres, fluid and hormonal management, and ex vivo lung perfusion (EVLP). Distinct pathophysiological mechanisms—sympathetic storm and systemic inflammation in DBD, ischaemia–reperfusion injury in cDCD, and prolonged warm ischaemia in uDCD—necessitate tailored approaches to lung preservation. In DBD donors, early application of protective ventilation, bronchoscopy, and infection surveillance is essential. cDCD donors benefit from optimised pre- and post-withdrawal management to mitigate lung injury. uDCD donor lungs, uniquely vulnerable to ischaemia, require meticulous post-mortem evaluation and preservation using EVLP. Implementing structured, evidence-based lung management strategies can significantly enhance donor lung utilisation and expand the transplantable organ pool. The integration of such practices into clinical protocols is vital to addressing the global shortage of suitable lungs for transplantation. Full article

Introduction: Leptospirosis is an under-recognized zoonosis that affects both tropical and temperate regions. While it is often associated with exposure to contaminated water or infected animals, its presentation and epidemiology in Mediterranean countries remain incompletely understood. This retrospective cohort study investigates the clinical and epidemiological profile of leptospirosis in Crete, Greece, a region where data are scarce. Methods: All adult patients with laboratory-confirmed leptospirosis admitted to three major public hospitals in Crete, Greece, between January 2019 and December 2023 were included in the analysis. Diagnosis was made through serologic testing along with compatible clinical symptoms. Results: A total of 17 patients were included. Their median age was 48 years, with a predominance of males (70.6%). Notably, more than half of the patients had no documented exposure to classic risk factors such as rodents or standing water. Clinical presentations were varied but commonly included fever, fatigue, acute kidney injury, and jaundice. Of the patients who underwent imaging, most showed hepatomegaly. The median delay from symptom onset to diagnosis was 11 days, underscoring the diagnostic challenge in non-endemic areas. Ceftriaxone was the most frequently administered antibiotic (76.5%), often in combination with tetracyclines or quinolones. Despite treatment, three patients (17.6%) died, all presenting with severe manifestations such as ARDS, liver failure, or shock. A concerning increase in cases was noted in 2023. Conclusions: Leptospirosis can present with severe and potentially fatal outcomes even in previously healthy individuals and in regions not traditionally considered endemic. The relatively high mortality and disease frequency noted emphasize the importance of maintaining a high index of suspicion. Timely diagnosis and appropriate antimicrobial therapy are essential to improving patient outcomes. Additionally, the need for enhanced public health awareness, diagnostic capacity, and possibly environmental surveillance to control this neglected but impactful disease better, should be emphasized. Full article

Background/objectives: Falls are a leading cause of traumatic injury and hospitalization for adults over the age of 65. While common, bed-related falls are relatively understudied when compared to ambulatory falls. The aim of this study is to characterize the risk factors for the hospitalization of older adults presenting to U.S. emergency departments (EDs) after a fall from bed. Methods: This was a cross-sectional study using publicly available data from the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) from 2014 to 2023, including all adults over the age of 65 presenting to the NEISS’s participating EDs with bed-related fall injuries. We identified fall injuries using a keyword search of the NEISS narratives and determined how the fall occurred by manually reviewing a randomized 3% sample of the narratives. We summarized demographics and injury patterns with descriptive statistics. We constructed a multivariable logistic regression model to identify risk factors for hospitalization and used Poisson regression to assess temporal trends in fall incidence and hospital admissions. Results: An estimated average of 320,751 bed-related fall injuries presented to EDs annually from 2014 to 2023. ED visits increased by 2.85% per year, while hospital admissions rose by 5.67% per year (p < 0.001). The most common injury patterns were superficial injuries (contusions, abrasions, lacerations, avulsions, and punctures) (28.6%), fractures (21.7%), and internal injuries (including concussions) (21.6%). Most of the falls occurred while transitioning into or out of bed (34.4%) or falling out of bed (56.8%). Hospitalization was required in 34.1% of cases and was associated with male sex, medication use at time of injury, and fracture injuries. Conclusions: Bed-related falls and associated hospitalizations are increasing among older adults. ED providers should understand risk factors for hospitalization in these common injuries such as male sex, medication use at time of injury, and high-risk injury patterns. Additionally, prevention efforts should focus on helping older adults remain safely in bed and then assisting with transitions into or out of bed. Full article

Background: Trauma-related injuries are among the most common reasons for paediatric hospital presentations and represent a substantial component of orthopaedic care. Their management poses unique challenges due to ongoing skeletal development in children. While most reported fractures occur at home or during sports, prior studies have primarily used data from urban European populations, limiting the relevance of their findings for rural and regional settings. Urban-centred research often informs public healthcare guidelines, treatment algorithms, and infrastructure planning, introducing a bias when findings are generalised outside of metropolitan populations. This study addresses that gap by analysing fracture data from two rural trauma centres in New South Wales, Australia. This study assesses paediatric fractures resulting from severe injury mechanisms in rural areas, identifying common fracture types, underlying mechanisms, and treatment approaches to highlight differences in demographics. These findings aim to cast a light on healthcare challenges that regional areas face and to improve the overall cultural safety of children who live and grow up outside of the metropolitan trauma networks. Methods: We analysed data from two major rural referral hospitals in New South Wales (NSW) for paediatric injuries presenting between 1 January 2018 and 31 December 2022. This study included 150 patients presenting with fractures following severe mechanisms of injury, triaged into Australasian Triage Scale (ATS) categories 1 and 2 upon initial presentation. Results: A total of 150 severe fractures were identified, primarily affecting the upper and lower limbs. Males presented more frequently than females, and children aged 10–14 years old were most commonly affected. High-energy trauma from motorcycle (dirt bike) accidents was the leading mechanism of injury among all patients, and accounted for >50% of injuries among 10–14-year-old patients. The most common fractures sustained in these events were upper limb fractures, notably of the clavicle (n = 26, 17.3%) and combined radius/ulna fractures (n = 26, 17.3%). Conclusions: Paediatric trauma in regional Australia presents a unique and under-reported challenge, with high-energy injuries frequently linked to unregulated underage dirt bike use. Unlike urban centres where low-energy mechanisms dominate, rural areas require targeted prevention strategies. While most cases were appropriately managed locally, some were transferred to tertiary centres. These findings lay the groundwork for multi-centre research, and support the need for region-specific policy reform in the form of improved formal injury surveillance, injury prevention initiatives, and the regulation of under-aged off-road vehicular usage. Full article

Human induced pluripotent stem cells (iPSCs) offer immense potential as a source for cell therapy in spinal cord injury (SCI) and other diseases. The development of hypoimmunogenic, universal cells that could be transplanted to any recipient without requiring a matching donor could significantly enhance their therapeutic potential and accelerate clinical translation. To create off-the-shelf hypoimmunogenic cells, we used CRISPR-Cas9 to delete B2M (HLA class I) and CIITA (master regulator of HLA class II). Double-knockout (DKO) iPSC-derived neural progenitor cells (NPCs) evaded T-cell-mediated immune rejection in vitro and after grafting into the injured spinal cord of athymic rats and humanized mice. However, loss of HLA class I heightened susceptibility to host natural killer (NK) cell attack, limiting graft survival. To counter this negative effect, we engineered DKO NPCs to overexpress macrophage migration inhibitory factor (MIF), an NK cell checkpoint ligand. MIF expression markedly reduced NK cell-mediated cytotoxicity and improved long-term engraftment and integration of NPCs in the animal models for spinal cord injury. These findings demonstrate that MIF overexpression, combined with concurrent B2M and CIITA deletion, generates hiPSC neural derivatives that escape both T- and NK-cell surveillance. This strategy provides a scalable route to universal donor cells for regenerative therapies in SCI and potentially other disorders. Full article

Background/Objectives: Equestrian activities can result in spine injuries. Most studies are from single centers, and none use a national database. It was the purpose of this study to describe the demographics, injury mechanisms, and types of equestrian-associated spinal injuries using a US national ED database. Methods: The National Electronic Injury Surveillance System database was queried for equestrian-related spine injuries from 2000–2023. ED disposition was categorized as discharged or not discharged. Statistical analyses accounted for the weighted, stratified nature of the data to obtain national estimates. Results: There were an estimated 54,830 patients, having an average age of 42 years. Most were female (73.6%) and White (93.7%); one-half (51.1%) were not discharged from the ED. The spine level was the lumbar (49.1%), thoracic (24.4%), sacrococcygeal (15.5%), and cervical (11.0%) spine. Multiple spine fractures occurred in 4.0%. A simple fall off a horse occurred in 53.6% of the injuries, and the patient was bucked/thrown/kicked off the horse in 39.7%. Neurologic injury was rare (1.8%). Hospital admission was highest in the cervical group (74.3%) and lowest in the sacrococcygeal group (33.5%). The cervical group had the highest percentage of males (43.7%) compared to the thoracic, lumbar, and sacrococcygeal groups (22.8%, 27.3%, 16.8%, respectively). There were proportionally fewer females in those over 50 years of age, where the male percentage was 11.7%, 25.6%, and 31.6% for those <18 years, 18–50 years, and >50 years old, respectively. Conclusions: This large study can be used as baseline data to evaluate further changes in equestrian injuries, especially the impact of further prevention strategies, education protocols, and legislative/governmental regulations of public equestrian localities. Full article

Background: Desmoid tumors (DTs) are rare, non-metastatic but locally aggressive connective tissue neoplasms. While standard treatments include surgery, radiation, and ablation, current guidelines advocate active surveillance unless tumors progress or symptoms worsen. Cryotherapy has shown promise in treating DTs; however, its application in rectus abdominis DTs has been limited due to proximity to critical intra-abdominal structures. Methods: This case series describes a novel approach involving laparoscopic-assisted cryoablation in three patients with rectus abdominis DTs. Laparoscopic visualization was employed to improve tumor localization and procedural safety during percutaneous cryoablation. Results: The average tumor size was 7.4 cm, and a mean of 14 cryoprobes were used per case. All patients experienced complete symptom resolution. One patient developed a complication—injury to the inferior epigastric artery—requiring embolization. Follow-up imaging at three months showed significant tumor shrinkage and necrosis in two patients. The third patient had increased lesion volume due to post-procedural hematoma, although radiological markers of cryoablation efficacy were present. Conclusions: Laparoscopic-assisted cryoablation appears to be a feasible and effective technique for treating rectus abdominis DTs, providing symptom relief and favorable early tumor response. Further studies are warranted to evaluate long-term outcomes and validate this approach in broader clinical settings. Full article

Early detection and the rise of targeted cancer treatment have led to increased overall survival and decreased mortality among cancer patients. As the cancer survivor population ages, there is an increased risk for cardiovascular disease due to pre-existing comorbidities, deconditioning during therapy, or the natural progression of aging. Furthermore, with emerging oncologic therapies, there is an increased recognition of their potential cardiovascular toxicities. Indeed, heart disease is the leading cause of death in cancer survivors, which may reflect upon both the success of novel oncologic therapies and their potential cardiovascular toxicities. This recognition has driven the development of cardio-oncology, a multi-disciplinary field that involves collaboration between hematologists, oncologists, and cardiologists to screen, prevent, and manage cardiovascular disease in cancer patients and cancer survivors. The field focuses on early cardiovascular detection and prevention for these patients before, during, and after their oncologic treatment. As oncologic therapies evolve and our knowledge of short- and long-term adverse cardiovascular effects grows, it is critical for physicians to identify those at risk for increased morbidity and mortality, while also balancing the importance of their oncologic treatment plan. Multimodality cardiac imaging is the crux of the diagnosis and surveillance of these patients within cardio-oncology, and includes echocardiography, nuclear, computed tomography (CT), and cardiac magnetic resonance (CMR). Cardiac imaging is essential to establish the baseline function and assess various cardiotoxicities, including left ventricular dysfunction, heart failure, atherosclerosis, vascular injury, and arrhythmias. This review will discuss common oncologic therapies and their cardiotoxic profiles, the cardiac multimodality imaging modalities used in cardio-oncology, and the various approaches for the diagnosis and surveillance of this population. Full article

Background/Objectives: In hospital settings, the wide variability of acute and complex chronic conditions—among both adult and pediatric patients—requires advanced approaches to detect early signs of clinical deterioration and the risk of transfer to the intensive care unit (ICU). Nursing diagnoses (NDs), standardized representations of patient responses to actual or potential health problems, reflect nursing complexity. However, most studies have focused on the total number of NDs rather than the individual role each diagnosis may play in relation to outcomes such as ICU transfer. This study aimed to identify and rank the specific NDs most strongly associated with ICU transfers in hospitalized adult and pediatric patients. Methods: A retrospective, monocentric observational study was conducted using electronic health records from an Italian tertiary hospital. The dataset included 42,735 patients (40,649 adults and 2086 pediatric), and sociodemographic, clinical, and nursing data were collected. A random forest model was applied to assess the predictive relevance (i.e., variable importance) of individual NDs in relation to ICU transfers. Results: Among adult patients, the NDs most strongly associated with ICU transfer were Physical mobility impairment, Injury risk, Skin integrity impairment risk, Acute pain, and Fall risk. In the pediatric population, Acute pain, Injury risk, Sleep pattern disturbance, Skin integrity impairment risk, and Airway clearance impairment emerged as the NDs most frequently linked to ICU transfer. The models showed good performance and generalizability, with stable out-of-bag and validation errors across iterations. Conclusions: A prioritized ranking of NDs appears to be associated with ICU transfers, suggesting their potential utility as early warning indicators of clinical deterioration. Patients presenting with high-risk diagnostic profiles should be prioritized for enhanced clinical surveillance and proactive intervention, as they may represent vulnerable populations. Full article

Heat stress (HS), an important environmental stressor for healthy poultry farming, has been shown to have a detrimental effect on production performance and induce serious diseases through immune system damage. As the avian peripheral immune system’s primary organ, spleen is subject to complex biological processes in response to HS injury. Histopathological characterization demonstrated that HS resulted in the destruction of the splenic red and white medulla, a decrease in cell density and organ atrophy. These changes directly impaired pathogen clearance and immune surveillance. At the physiological level, the impact of HS is characterized by disrupted metabolic homeostasis through interrupting neuroendocrine function. This, in turn, results in a significant suppression of humoral immune response. The oxidative-inflammatory cascade constitutes the core pathology of this disease. Energy metabolism disorder triggered by mitochondrial dysfunction and redox imbalance form a vicious circle, which promotes apoptosis signaling cascade. Meanwhile, over-activation of intrinsic immune system triggers a series of inflammatory factors, which further amplifies effects of tissue damage. The present prevention and control strategies are centered on synergistic anti-inflammatory and antioxidant interventions with nutrient modulators and plant actives. Nevertheless, it is imperative for future studies to incorporate multi-omics technologies in order to analyze the metabolic mechanisms and patterns of stress and establish a precise intervention strategy based on immune homeostatic regulation. This review systematically investigated the multilevel regulatory mechanisms of HS-induced spleen injury, which provides a theoretical basis for the mechanistic analysis and technological innovation of the prevention and control of HS syndrome in poultry. Full article

Introduction: Para-cycling is a competitive sport governed by the World Body for Cycling, Union Cycliste Internationale (UCI), encompassing various cycling disciplines tailored to athletes with physical or visual impairments. This study aimed to prospectively monitor the incidence of injury and illness in Para cyclists during the 2024 Paralympic season. Methods: This prospective, observational study included ten professional Para cyclists (five male, five female) with impairments ranging from spinal cord-related, neuromuscular, and musculoskeletal conditions to vision impairment. The definitions of an ‘athlete health problem’, ‘injury’, and ‘illnesses’ followed the Para sport translation of the IOC consensus. Injury and illness data were collected weekly using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems V2 (OSTRC-H2), with the addition of subjective markers of well-being and training load, between February 2024 and October 2024. All medical contacts for any injury or illness were logged in line with consensus statement recommendations. Results: The OSTRC-H2 questionnaire had a response rate of 76.5% (±12.2%, range 55–88%) across the 35 weeks. Athletes reported 7.36 (95% CI: 5.41–9.46) health problems per 365 days, with a medical attention rate of 5.56 (95% CI: 3.91–7.36) per 365 days. The overall injury rate was 1.94 per 365 athlete days (95% CI: 1.23–2.93), with a higher incidence in males (2.44, 95% CI: 1.53–3.67) than in females (1.51, 95% CI: 0.68–2.95). Conversely, illness rates were higher in females (5.40, 95% CI: 3.00–8.11) than in males (1.80, 95% CI: 0.60–3.30), with an overall illness rate of 3.60 per 365 days (95% CI: 2.29–5.10). Conclusions: This is the first study to present prospective injury and illness epidemiology rates in Para cyclists in combination with subjective well-being markers. The findings underscore the importance and feasibility of longitudinal health monitoring in Para cyclists, ensuring that both physical and mental health concerns are systematically tracked and addressed. This enables a proactive, multidisciplinary support system to respond effectively to fluctuations in well-being, particularly during periods of injury or illness. Full article

Walking Football is a growing adapted sport offering a viable alternative to traditional exercise for middle-aged and older adults. While rule modifications aim to reduce injury risk, this has yet to be established. This study conducted injury surveillance in community-based Walking Football to determine injury incidence and characteristics in training and matches. A four-month observational cohort study remotely tracked injuries and exposure time across seven Walking Football clubs in England using a sub-elite injury surveillance framework. Injuries were classified as medical attention (requiring on-field attention without subsequent absence) or time-loss (≥1 day of participation absence). Injury incidence was calculated per 1000 h of play. Across 6364.55 h of exposure, 45 injuries were reported: 30 (66.7%) medical attention and 15 (33.3%) time-loss injuries. Injury incidence was 5.3 [1.5–11.5] per 1000 h in training (medical attention: 3.3 [0.8–7.3]; time-loss: 2.0 [0.5–4.5]) and 37.6 [8.7–83.9] per 1000 h in matches (medical attention: 28.9 [5.8–66.6]; time-loss: 8.7 [0–23.2]). Match injury incidence was significantly higher than training (rate ratio: 7.1 [1.3–31.4]). Findings suggest that injury incidence in community-based Walking Football is low, supporting its safety and potential as a sustainable physical activity strategy for middle-aged and older adults. Full article

Background/Objectives: Falls occurring at home and during leisure time among elderly individuals represent a serious public health issue in Portugal and worldwide. These incidents have a significant impact on healthcare systems and social support structures, as well as the personal and family lives of the victims. There is also a recognized gap in awareness among older adults regarding fall prevention, particularly regarding environmental hazards, the need for home modifications, and the adoption of safety behaviors, including necessary adjustments in their home environments. The present study was developed to enhance our understanding of the circumstances in which falling occurs in elderly people. Methods: A cross-sectional epidemiological study was carried out, analyzing data collected through the national emergency-based injury surveillance system in 2023. Results: The proportion of falls increased across age groups, with 34.9% of total falls occurring in the group aged 85 and over. These differences were statistically significant (p < 0.001). In all age groups, falls were more frequent among women, representing between 63.6% and 69.0% of episodes. Approximately 65.9% of falls occurred at home. The likelihood of falling was higher among the oldest age group (85+) and in the home. Conclusions: The results of this study confirm that falls in elderly people tend to occur more frequently with advancing age, particularly in environments where the most time is spent. This study suggests that fall-prevention campaigns should be specifically targeted towards older females in the home environment, with particular consideration given to morning routines as part of the recommended interventions. Full article

Background/Objectives: Despite the growing burden caused by pediatric trauma, the accuracy of prehospital triage remains suboptimal due to the lack of reliable pediatric-specific tools. In this study, we aimed to evaluate the predictive validity of the reverse shock index multiplied by the Glasgow Coma Scale (rSIG) for in-hospital mortality in pediatric trauma patients and to determine appropriate age-specific rSIG cutoff values for triage use. Methods: We conducted a multicenter retrospective observational study using data from the Korean Emergency Department-Based Injury In-Depth Surveillance registry; these data covered trauma patients aged ≤18 years, spanning the period from 2011 to 2022. The rSIG was calculated using the initial vital signs and Glasgow Coma Scale scores upon arrival at the emergency department. Age groups with shared rSIG cutoffs were identified using the area under the receiver operating characteristic curve (AUC) and Akaike information criterion. Cutoff values were derived using the Youden index or further optimized to align with triage goals (<5% under-triage, <35% over-triage). Results: Among 333,995 pediatric trauma patients, the in-hospital mortality rate was 0.07%. The rSIG cutoff values derived using the Youden index showed strong predictive performance, with an AUC of 0.920 (95% CI: 0.897–0.943). The cutoff values adjusted to meet triage goals—13.3 for those aged 0–9 years, 18.4 for 10–14 years, and 20.9 for 15–18 years—achieved the best balance, with 30.94% over-triage and 9.17% under-triage. Conclusions: The rSIG is a reliable predictor of in-hospital mortality in pediatric trauma cases. We recommend using cutoff values that are optimized to meet triage goals. Further research is warranted to develop standardized methods to derive triage-appropriate cutoff values. Full article