相关论文
2023 - Concepts in Magnetic Resonance Part A
Effect of Early Nursing Intervention under Amplitude-Integrated Electroencephalography and Magnetic Resonance Images on Brain Injury in Premature Infants

To investigate the effects of early nursing intervention on brain injury among premature infants, 100 premature infants diagnosed with brain injury were included in the research and randomly divided into the control group (50 cases) and the experimental group (50 cases). The patients in the two groups were performed with the same conventional comprehensive treatment. The patients in the control group received conventional nursing while those in the experimental group underwent early nursing intervention. During follow-up, neurodevelopment, motor behavior, the incidence rate of brain injury, and nursing satisfaction of the infants in the two groups were compared. It was demonstrated that the five neurodevelopment scores of the experimental group were all higher than those of the control group. The differences showed statistical significance ( P < 0.05 ). The total effective rate of motor development of the experimental group reached 94%, while that of the control group amounted to 80%. Obviously, the total effective rate of motor development of the experimental group was higher than that of the control group. The difference was statistically significant ( P < 0.05 ). The nursing satisfaction of the experimental group reached 98%, which was apparently higher than that of the control group (74%). The difference suggested statistical significance ( P < 0.05 ). The rates of brain injury at 1 and 2 years after the birth of the experimental group were 6% and 2%, respectively. The rates of brain injury at 1 and 2 years after the birth of the control group amounted to 18% and 14%, respectively. The rates of brain injury at 1 and 2 years after the birth of the experimental group were lower than those of the control group. The difference revealed statistical significance ( P < 0.05 ). Hence, the early nursing intervention of premature infants with brain injury could promote brain development, improve neurological function, reduce the incidence of brain injury, and achieve an ideal nursing effect.

2020 - Journal of neurosurgery. Spine
Postoperative changes in spinal cord signal intensity in patients with spinal cord injury without major bone injury: comparison between preoperative and postoperative magnetic resonance images.

OBJECTIVE Although increased signal intensity (ISI) on MRI is observed in patients with cervical spinal cord injury (SCI) without major bone injury, alterations in ISI have not been evaluated. The association between postoperative ISI and surgical outcomes remains unclear. This study elucidated whether or not the postoperative classification and alterations in MRI-based ISI of the spinal cord reflected the postoperative symptom severity and surgical outcomes in patients with SCI without major bone injury. METHODS One hundred consecutive patients with SCI without major bone injury (79 male and 21 female) with a mean age of 55 years (range 20-87 years) were included. All patients were treated with laminoplasty and underwent MRI pre- and postoperatively (mean 12.5 ± 0.8 months). ISI was classified into three groups on the basis of sagittal T2-weighted MRI: grade 0, none; grade 1, light (obscure); and grade 2, intense (bright). The neurological statuses were evaluated according to the Japanese Orthopaedic Association (JOA) scoring system and the American Spinal Injury Association Impairment Scale (AIS). RESULTS Preoperatively, 8 patients had grade 0 ISI, 49 had grade 1, and 43 had grade 2; and postoperatively, 20 patients had grade 0, 24 had grade 1, and 56 had grade 2. The postoperative JOA scores and recovery rate (RR) decreased significantly with increasing postoperative ISI grade. The postoperative ISI grade tended to increase with the postoperative AIS grade. Postoperative grade 2 ISI was observed in severely paralyzed patients. The postoperative ISI grade improved in 23 patients (23%), worsened in 25 (25%), and remained unchanged in 52 (52%). Patients with an improved ISI grade had a better RR than those with a worsened ISI grade. CONCLUSIONS Postoperative ISI reflected postoperative symptom severity and surgical outcomes. Alterations in ISI were seen postoperatively in 48 patients (48%) and were associated with surgical outcomes.

2018 - Journal of Hypertension
A3561 Association of depression with mortality in an elderly treated hypertensive population

Objectives: Both elevated blood pressure (BP) and/or depression increase the risk of cardiovascular disease and mortality. This study among treated elderly hypertensive patients explored the incidence of depression, its association (pre-existing and incident) with mortality and predictors of incident depression including any effect of ACE Inhibitor- or diuretic-based antihypertensive treatment. Methods: Data from 6083 hypertensive patients aged ≥65yrs enrolled in the Second Australian National Blood Pressure study were used. Participants were followed for a median of 10.8 years (including 4.1yrs in-trial) and classified into: ‘no depression’, ‘pre-existing’ and ‘incident’ depression groups based on either being diagnosed with depressive disorders and/or treated with an anti-depressant drug at baseline or during the in-trial period. For the current study, end-points were all-cause and any cardiovascular mortality. Results: 313 (5%) participants had pre-existing depression and a further 916 (15%) participants developed depression during the trial period (an incidence of 4% per annum). Increased all-cause mortality was observed among those with either pre-existing or incident depression compared to those without. For cardiovascular mortality, a 24% increased risk was observed among those with incident depression. Incident depression was associated with being female, aged ≥75 years, being an active smoker at study entry, and developing new diabetes during the study period. There was no difference in incident depression between those randomised to either thiazide diuretic-based or ACE inhibitor-based therapy. Conclusion: This elderly cohort had a high incidence of depression irrespective of their randomised antihypertensive regimen. Both pre-existing and incident depression were associated with increased mortality.

2006 - Anesthesia and Analgesia
Physiological assessment and control in studies evaluating central nervous system injury: should size matter?

I n this issue of Anesthesia & Analgesia, Loepke et al. (1) examined the effect of a 1-h isoflurane exposure on extracerebral physiological variables in postnatal day (PND) 10 mice—an age suggested to mimic the brain maturation of human term infants. Studies were performed in anesthetized mice with and without controlled mechanical ventilation and in parallel groups exposed to a hypoxic-ischemic insult. Mice that were removed from the dam for an identical period of time, but not exposed to prolonged anesthesia, served as controls. Remarkably, mice anesthetized with isoflurane became hypoglycemic, as detected at the end of the 1-h anesthetic exposure. At that time, the mean blood glucose concentrations were 43 mg/dL and 38 mg/dL in spontaneously ventilating and mechanically ventilated mice, respectively. In some mice, blood glucose concentration was less than the 20 mg/dL limit of the assay used. The mean blood glucose concentration was even lower (26 mg/dL) in anesthetized, mechanically ventilated mice exposed to hypoxic-ischemic injury, and the mortality rate was 100%. The normal value for blood glucose in the control group was 108 mg/dL. Unanesthetized controls for either the anesthetic exposure alone or the hypoxic-ischemic injury did not exhibit hypoglycemia. Although the mechanism underlying the isoflurane-mediated hypoglycemia in PND 10 mice remains unclear, the findings may be important. In 2003, Jevtovic-Todovoric et al. (2) reported in the Journal of Neuroscience, that a 6-h exposure of PND 7 rats to isoflurane, either alone or combined with midazolam and nitrous oxide, resulted in neurological deterioration in the developing brain. Needless to say, the report garnered considerable notice. The possibility that exposure to general anesthetics at a critical juncture in brain development could lead to neuronal death paralleled the concept of central nervous system injury in conditions such as the fetal alcohol syndrome, in which exposure to the N-methyl-d-aspartate receptor antagonist ethanol leads to neurodegeneration and a described phenotype (3) and raised important concerns in obstetrics, perinatal medicine, neonatology, and pediatric critical care medicine. Clearly, the findings could have far-reaching implications for clinical care, including anesthesia during pregnancy or delivery, surgery in premature infants, and possibly even sedation or brain-targeted therapies, such as “barbiturate coma” in infants with severe traumatic brain injury, in pediatric intensive care units worldwide. The findings of Jevtovic-Todovoric et al. (2) merit additional investigation in light of these potential ramifications to routine clinical care, as well as possible implications for the interpretation of experimental neonatal or pediatric brain injury studies. The report by Loepke et al. in this issue of the journal (1) describing isoflurane’s effects in developing mice expands on the work of Jevtovic-Todovoric et al. (2), using the perspective of a clinical anesthesiologist who is probing the potential clinical ramifications of the findings. Monitoring and controlling physiological variables in the newborn or developing rodent is challenging. Endotracheal intubation, controlled mechanical ventilation, and the use of invasive continuous arterial blood pressure and oxygen saturation monitoring are technically demanding. Similarly, serial arterial blood gas sampling and assessment of blood chemistries are even more problematic because assay sample volumes are often a physiologically important fraction of the rodent’s total blood volume. Consequently, many experimental studies involving developing rodents may not effectively mirror the current clinical practice of invasive monitoring Accepted for publication July 26, 2005. Address correspondence and reprint requests to Patrick Kochanek, Safar Center for Resuscitation Research, Critical Care Med, Pittsburgh, PA 15260. Address e-mail to kochanekpm@ ccm.upmc.edu.

2014 - International Journal of Geographical Information Science
Space-time analyses for forecasting future incident occurrence: a case study from Yosemite National Park using the presence and background learning algorithm

To address a spatiotemporal challenge such as incident prevention, we need information about the time and place where incidents have occurred in the past. Using geographic coordinates of previous incidents in coincidence with spatial layers corresponding to environmental variables, we can produce probability maps in geographic and temporal space. Here, we evaluate spatial statistic and machine learning approaches to answer an important space-time question: where and when are wildland search and rescue (WiSAR) incidents most likely to occur within Yosemite National Park (YNP)? We produced a monthly probability map for the year 2011 based on the presence and background learning (PBL) algorithm that successfully forecasts the most likely areas of WiSAR incident occurrence based on environmental variables (distance to anthropogenic and natural features, vegetation, elevation, and slope) and the overlap with historic incidents from 2001 to 2010. This will allow decision-makers to spatially allocate resources where and when incidents are most likely to occur. In the process, we not only answered questions related to a real-world problem but also used novel space-time analyses that give us insight into machine learning principles. The GIScience findings from this applied research have major implications for best practices in future space-time research in the fields of epidemiology and ecological niche modeling.

2022 - Cardiovascular therapeutics
Curcumin Attenuates Ferroptosis-Induced Myocardial Injury in Diabetic Cardiomyopathy through the Nrf2 Pathway

Diabetes causes lipid peroxide to accumulate within cardiomyocytes. Furthermore, lipid peroxide buildup is a risk factor for ferroptosis. This study is aimed at examining whether curcumin can ameliorate ferroptosis in the treatment of diabetic cardiomyopathy. Hematoxylin and eosin and Masson sections were used to examine the morphology, arrangement, and degree of fibrosis of the myocardium of diabetic rabbit models. The expression levels of nuclear Nrf2, Gpx4, Cox1, and Acsl4 in diabetic animal and cell models were quantitatively analyzed using immunofluorescence and western blotting. Nrf2-overexpression lentivirus vectors were transfected into cardiomyocytes, and the protective effects of curcumin and Nrf2 on cardiomyocytes under high glucose stimulation were assessed using terminal deoxynucleotidyl transferase dUTP nick-end labelling and reactive oxygen species probes. Diabetes was found to disorder myocardial cell arrangement and significantly increase the degree of myocardial fibrosis and collagen expression in myocardial cells. Curcumin treatment can increase nuclear transfer of Nrf2 and the expression of Gpx4 and HO-1, reduce glucose induced myocardial cell damage, and reverse myocardial cell damage caused by the ferroptosis inducer erastin. This study confirmed that curcumin can promote the nuclear translocation of Nrf2, increase the expression of oxidative scavenging factors, such as HO-1, reduce excessive Gpx4 loss, and inhibit glucose-induced ferroptosis in cardiomyocytes. This highlights a potentially new therapeutic route for investigation for the treatment diabetic cardiomyopathy.

2014 - Medicine and science in sports and exercise
Contusion injury with chronic in vivo polyphenol supplementation: leukocyte responses.

INTRODUCTION In vivo, daily proanthocyanidolic oligomer (PCO) supplementation before and after experimental skeletal muscle contusion injury has been shown to result in a blunted neutrophil response in tissue, quicker macrophage infiltration into muscle, and faster recovery due to a left shift in time course of inflammation. The current study investigated effects of PCO on circulatory neutrophils and macrophage subpopulations as well as in vitro neutrophil migration. METHODS Primary cultured neutrophils obtained from control animals were incubated in media with 20% conditioned plasma. To obtain conditioned media, male Wistar rats were supplemented with PCO (20 mg·kg(-1)d(-1)) or placebo (PLA) for 2 wk before a mass-drop contusion injury. Conditioned plasma was prepared from blood collected at different time points after injury (12 h, 1 d, 3 d, and 5 d). Macrophage subpopulation distribution, inflammatory cytokine, and myeloperoxidase levels were assessed for all time points. RESULTS On day 1 postinjury, circulating neutrophil numbers were significantly lower in PLA than PCO, suggesting that extravasation from the blood was reduced by PCO. Concurrently, neutrophil migration in vitro was blunted in the presence of conditioned plasma from PCO supplemented rats compared with PLA supplemented rats. Plasma M1 and M2c macrophage numbers differed over time and between groups. M1 macrophage numbers peaked on day 3 with PCO supplementation, followed by a rise in M2c macrophages on day 5, when M1 macrophages numbers were still high in PLA. CONCLUSIONS We conclude that PCO supplementation limits neutrophil migration capacity in vitro despite a chemotactic gradient. Furthermore, the earlier appearance of type M2 macrophages suggests a switch to an anti-inflammatory phenotype after injury even in circulation.

2007 - The Journal of cardiovascular surgery
Management of lower extremity arterial injuries.

Past and current military experience has contributed considerably to the advances made in the treatment of extremity vascular injuries. However, the management of arterial injuries of the lower extremity is still associated with significant rates of limb loss and functional deficits. The incidence of civilian arterial limb injuries, including those related to iatrogenic vessel catheterization, has increased over time, but remains fortunately uncommon. Several related issues, such as the initial order of intervention for associated bony injuries, use of temporary intravascular shunt, repair of concomitant venous injuries, and prophylactic fasciotomy, have been debated extensively and remain controversial. The current treatment of extremity arterial injuries continues to evolve with the availability of superior imaging modalities and emerging endovascular technology. Additionally, the multi-disciplinary approach to the injured patients has produced improved limb-salvage and patient survival. In this review, we discuss the diagnostic evaluation, surgical and endovascular treatment of arterial injuries in the lower extremity.

1999 - The Journal of trauma
Biomechanical predictor of commotio cordis in high-speed chest impact.

BACKGROUND Commotio cordis is a term used to describe cases of blunt thoracic impact causing fatality without gross structural damage of the heart and internal organs. Death is attributed to ventricular fibrillation or cardiac arrhythmia aggravated by traumatic apnea. The biomechanical response related to the risk of commotio cordis has not been determined. METHODS Reanalysis of previously published experimental data was performed to determine which biomechanical parameter predicts the occurrence of commotio cordis. Logistic regression was used to determine the risk for commotio cordis with the level of chest compression, rate of chest deformation, and viscous criterion. RESULTS By using only cases without serious tissue injury (Abbreviated Injury Scale score < 4), viscous criterion was the best predictor of commotio cordis or ventricular fibrillation (chi2 = 7.69, p = 0.006). It was also the best predictor of heart rupture (chi2 = 13.19,p = 0.0003) and severe cardiac injury with Abbreviated Injury Scale score > or = 4 (chi2 = 25.03, p = 0.0001). CONCLUSION Based on this in-depth analysis, the viscous criterion is the relevant biomechanical response to assess the risk of commotio cordis and more severe thoracic injury in high-speed blunt impact.

2012 - Biomarkers
Are recently reported biomarkers helpful for early and accurate diagnosis of acute kidney injury?

Over the past few years and with the use of innovative genomic and proteomic tools, several molecules that their urinary concentration is modified during acute kidney injury have been identified and proposed as biomarkers. Among the most studied biomarkers are neutrophil gelatinase-associated lipocalin-2, kidney injury molecule-1, interleukin-18, cystatin C, N-acetyl-β-D-glucosaminidase, liver fatty-acid binding protein, and heat shock protein 72. Here, we reviewed and compared the sensitivity and specificity of each biomarker for the appropriate diagnosis of acute kidney injury, as well as its ability to stratify renal injury and to monitor a renoprotective pharmacologic strategy.

1999 - Proceedings 199 IEEE/IEEJ/JSAI International Conference on Intelligent Transportation Systems (Cat. No.99TH8383)
Road safety through video detection

Automatic incident detection has become a necessity for the ever increasing traffic density on most major roads. Effective incident management completely depends on fast incident detection and fast incident verification. While video detection handles both traffic data collection and automatic incident detection, its incident detection shows a high detection rate, a short time to detect, a fast incident control and a low false alarm rate. These characteristics make video extremely useful for reaching incident management goals such as fast and effective intervention or secondary incident prevention. Two specific applications are discussed in detail: the video and congestion monitoring system and the mobile road works monitoring system.

2015 - Accident; analysis and prevention
Mapping cyclist activity and injury risk in a network combining smartphone GPS data and bicycle counts.

In recent years, the modal share of cycling has been growing in North American cities. With the increase of cycling, the need of bicycle infrastructure and road safety concerns have also raised. Bicycle flows are an essential component in safety analysis. The main objective of this work is to propose a methodology to estimate and map bicycle volumes and cyclist injury risk throughout the entire network of road segments and intersections on the island of Montreal, achieved by combining smartphone GPS traces and count data. In recent years, methods have been proposed to estimate average annual daily bicycle (AADB) volume and injury risk estimates at both the intersection and segment levels using bicycle counts. However, these works have been limited to small samples of locations for which count data is available. In this work, a methodology is proposed to combine short- and long-term bicycle counts with GPS data to estimate AADB volumes along segments and intersections in the entire network. As part of the validation process, correlation is observed between AADB values obtained from GPS data and AADB values from count data, with R-squared values of 0.7 for signalized intersections, 0.58 for non-signalized intersections and between 0.48 and 0.76 for segments with and without bicycle infrastructure. The methodology is also validated through the calibration of safety performance functions using both sources of AADB estimates, from counts and from GPS data. Using the validated AADB estimates, the factors associated with injury risk were identified using data from the entire population of intersections and segments throughout Montreal. Bayesian injury risk maps are then generated and the concentrations of expected injuries and risk at signalized intersections are identified. Signalized intersections, which are often located at the intersection of major arterials, witness 4 times more injuries and 2.5 times greater risk than non-signalized intersections. A similar observation can be made for arterials which not only have a higher concentration of injuries but also injury rates (risk). On average, streets with cycle tracks have a greater concentration of injuries due to greater bicycle volumes, however, and in accordance with recent works, the individual risk per cyclist is lower, justifying the benefits of cycle tracks.

2010 - PLoS ONE
Burn Injury Reduces Neutrophil Directional Migration Speed in Microfluidic Devices

Thermal injury triggers a fulminant inflammatory cascade that heralds shock, end-organ failure, and ultimately sepsis and death. Emerging evidence points to a critical role for the innate immune system, and several studies had documented concurrent impairment in neutrophil chemotaxis with these post-burn inflammatory changes. While a few studies suggest that a link between neutrophil motility and patient mortality might exist, so far, cumbersome assays have prohibited exploration of the prognostic and diagnostic significance of chemotaxis after burn injury. To address this need, we developed a microfluidic device that is simple to operate and allows for precise and robust measurements of chemotaxis speed and persistence characteristics at single-cell resolution. Using this assay, we established a reference set of migration speed values for neutrophils from healthy subjects. Comparisons with samples from burn patients revealed impaired directional migration speed starting as early as 24 hours after burn injury, reaching a minimum at 72–120 hours, correlated to the size of the burn injury and potentially serving as an early indicator for concurrent infections. Further characterization of neutrophil chemotaxis using this new assay may have important diagnostic implications not only for burn patients but also for patients afflicted by other diseases that compromise neutrophil functions.

1987 - British Journal of Sports Medicine
Racquet sports--patterns of injury presenting to a sports injury clinic.

In an 8-year retrospective study, 631 injuries due to the racquet sports of squash (59%), tennis (21%) and badminton (20%) were seen in a sports injury clinic, males predominating (58 to 66%). The proportion of squash injuries was higher than expected and probably relates to higher physical stress and risk of contact in this sport. Also they occurred mainly in persons over 25 years (59%) i.e. the reverse for sport in general. Acute traumatic injuries were seen especially in squash players, a majority affecting the knee, lumbar region, muscles and ankle. Tennis injuries differed most with lateral epicondylitis, patello-femoral pain and lumbar disc prolapse being relatively common. The badminton injury pattern overlapped the others. Lower limb injuries predominated in all three. Detailed assessment of 106 cases showed many to be new, infrequent, social players. Poor warm-up was a common factor in new and established players. The importance of these findings is discussed.

1979 - The Journal of trauma
Occult cervical spine injuries in fatal traffic accidents.

Post-mortem radiographs as well as careful inspection at autopsy of 100 consecutive traffic accident victims revealed an incidence of cervical spine injury of 24%. All but four of the 24 fractures and/or dislocations were localized to the level between the occiput and the axis. One half of the cases were not clinically suspected of having spine injuries before the detailed postmortem search. Seventeen of the 24 cervical spines were resected en bloc and the pathologic anatomy of the injuries was determined. The high incidence of cervical spine injuries and the anatomic findings at dissection have clinical implications for physicians who manage multiply traumatized patients. The need for immobilization and early radiographic evaluation of patients with cervical spine injuries is emphasized.

2001 - Radiology
Focal arterial injuries of the proximal extremities: helical CT arteriography as the initial method of diagnosis.

PURPOSE To present our experience with helical computed tomographic (CT) arteriography as the initial diagnostic examination in patients suspected to have focal arterial injuries of the proximal extremities. MATERIALS AND METHODS During 19 months, 142 arterial segments in the proximal portions of the extremities of 139 patients with trauma were evaluated with helical CT arteriography. CT arteriograms were interpreted on site by the radiologist in charge of emergency procedures and retrospectively with consensus interpretation between two radiologists. CT study quality and the presence of arterial injuries were noted. CT arteriographic findings were compared with those of surgery, conventional arteriography, and/or clinical follow-up. RESULTS Five (3.6%) patients had nondiagnostic studies and underwent conventional arteriography. In the remaining 137 arterial segments in 134 patients, helical CT arteriography demonstrated arterial injuries in 61 segments and normal arteries in 76 segments. These segments were treated initially with surgery (55 segments) or endovascular intervention (four segments) or were observed (78 segments); 77 of the 78 observed segments remained stable at 3-18 months (mean follow-up, 5.2 months). There were no differences between the on-site and consensus interpretations (kappa = 1.0). The sensitivity of CT arteriography was 95.1%, and the specificity was 98.7%. CONCLUSION Helical CT arteriography can be performed as the initial diagnostic method in most patients suspected to have focal arterial injuries of the proximal portions of the extremities.

2003 - Journal of the American Society of Nephrology : JASN
Induction of renoprotective gene expression by cobalt ameliorates ischemic injury of the kidney in rats.

Hypoxia in the tubulointerstitium has been thought to play pivotal roles in the pathophysiology of acute renal failure and the progression of chronic kidney disease. Pre-induction of hypoxia-inducible and renoprotective gene expression may protect subsequent ischemic injury. This study evaluated the efficacy of cobalt, which inhibits HIF-1 degradation and increases the expression level of hypoxia-related genes, in an acute ischemic tubulointerstitial injury model of rats. Ischemic renal injury was induced by 45-min clamping of renal pedicles with contralateral nephrectomy. Elevation of serum creatinine and morphologic injury after the ischemic insult was observed. Administration of cobalt chloride afforded striking functional improvement (mean +/- SEM creatinine in mg/dl: Co treatment group, 2.14 +/- 1.21; control, 3.69 +/- 1.43; P < 0.05) associated with amelioration of tubulointerstitial damage. Cobalt treatment also reduced macrophage infiltration significantly. In the kidney of rats treated with cobalt, mRNA levels of several genes that serve for tissue protection, such as HO-1, EPO, Glut-1, and VEGF, were increased before ischemic injury. Upregulation of HO-1 by cobalt was confirmed at the protein level. Subcutaneous injection of cobalt also ameliorated ischemic injury, which was associated with upregulation of renal HIF-1alpha protein expression. These results suggest that protection against hypoxic tubulointerstitial injury by cobalt administration is mediated by induction of renoprotective gene expression. HIF induction is one possible and attractive explanation for the observed effects.

1993 - The Journal of emergency medicine
Mechanisms of brain injury.

Head injuries vary widely in their etiology, pathophysiology, clinical presentation, and optimal treatment strategies. Broadly speaking, there are two categories of brain injury: focal injuries and diffuse injuries. Focal brain injuries, which are usually caused by direct blows to the head, comprise contusions, brain lacerations, and hemorrhage leading to the formation of hematoma in the extradural, subarachnoid, subdural, or intracerebral compartments within the head. Diffuse brain injuries, which are usually caused by a sudden movement of the head, comprise classical brief cerebral concussion and more prolonged posttraumatic coma, also known as diffuse axonal injury. Primary traumatic effects involve neural or vascular elements of the brain, which can be affected by delayed effects such as deafferentation or secondary events such as ischemia, swelling, cerebral edema, and increased intracranial pressure. Axonal damage at the node of Ranvier results in a traumatic defect in the axonal membrane that causes the excessive accumulation of calcium ions within the intracellular compartment of the axon. Brain ischemia can result in a similar effect, further increasing the accumulation of calcium ions, which can lead to axonal degeneration. Injury-specific treatments are now being designed to alter the various pathophysiological mechanisms of brain injury.

2007 - Wilderness & environmental medicine
Medical Incidents and Evacuations on Wilderness Expeditions

Abstract Category 1 Continuing Medical Education credit for physicians is available to Wilderness Medical Society members for this article. Go to http://wms.org/cme/cme.asp?whatarticle=1843 to access the instructions and test questions. Objective.—Expedition activities such as mountaineering, rock climbing, river running, sea kayaking, and canoeing all involve an element of risk. Organizations that provide group wilderness and adventure experiences are responsible for managing the risk of their courses. The leaders and medical providers of these trips must therefore be prepared to anticipate and manage medical problems that may arise. The aim of this study is to provide the medical community with a better understanding of the specific injuries and illnesses that occur on wilderness expeditions. Methods.—A retrospective descriptive study was done examining the medical incidents that occurred on wilderness-based courses during the 3-year period from September 1, 2002, through August 31, 2005. Participants and staff of the National Outdoor Leadership School (NOLS) served as the study population. Results.—Injuries occurred at a rate of 1.18 per 1000 program days, and illnesses at a rate of 1.08 per 1000 program days. There were no fatalities during the time period. Athletic injuries (sprains, strains) and gastrointestinal illnesses were the most common medical incidents. Hypothermia, seizures, appendicitis, heat stroke, and pregnancy occurred but with low frequency. Fractures, dental emergencies, tick fever, athletic injuries, and nonspecific body pains were the conditions most frequently requiring evacuation. Conclusions.—The rate of medical incidents on NOLS courses declined during the 1990s and has remained relatively steady apart from a slight increase in 2004 and 2005. Athletic injuries continue to be a difficulty, as they frequently result in evacuation even though their ultimate outcome is usually benign. Evacuation decisions should be made considering both the potential severity of the medical condition as well as patient comfort. Wilderness medical personnel must be familiar with a diverse range of medical conditions in order to provide optimal care.

2004 - The American Journal of Sports Medicine
An Assessment of Football Referees’ Decisions in Incidents Leading to Player Injuries

Purpose To assess whether match injuries to footballers occurred as a result of players’ noncompliance with the rules of the game, match referees could reliably identify the legality of incidents leading to injury, and the rules of football were adequate to protect players from injury. Methods Video recordings of incidents leading to injury in 12 FIFA tournaments were used to identify parameters. Team physicians reported the details of match injuries. Two panels of FIFA referees reassessed the legality of incidents from these tournaments that resulted in injuries. Results In total, 148 general injuries and 84 head/neck injuries were assessed. For the general injuries, the match referees identified 47% and the referees’ panel identified 69% as fouls. For head injuries, the match referees identified 40% and the referees’ panel identified 49% as fouls. Conclusions Decisions made on the legality of tackles leading to injury indicated that the current rules of football were adequate for the majority of tackle situations, although the reliability with which referees could identify fouls during some match conditions was low. For incidents leading to head/neck injuries, the match referees and the referees’ panel both identified a smaller proportion of injury situations as fouls.

Preventing construction worker injury incidents through the management of personal stress and organizational stressors.

Mei-yung Leung
|
Isabelle Yee Shan Chan
|
Jingyu Yu
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M. Leung
|
Jingyu Yu
|
I. Chan

Abstract:Construction workers (CWs) are positioned at the lowest level of an organization and thus have limited control over their work. For this reason, they are often deprived of their due rewards and training or sometimes are even compelled to focus on production at the expense of their own safety. These organizational stressors not only cause the CWs stress but also impair their safety behaviors. The impairment of safety behaviors is the major cause of CW injury incidents. Hence, to prevent injury incidents and enhance safety behaviors of CWs, the current study aimed to identify the impact of various organizational stressors and stress on CW safety behaviors and injury incidents. To achieve this aim, we surveyed 395 CWs. Using factor analysis, we identified five organizational stressors (unfair reward and treatment, inappropriate safety equipment, provision of training, lack of goal setting, and poor physical environment), two types of stress (emotional and physical), and safety behaviors. The results of correlation and regression analyses revealed the following: (1) injury incidents were minimized by safety behaviors but escalated by a lack of goal setting, (2) safety behaviors were maximized by moderate levels of emotional stress (i.e., an inverted U-shape relationship between these two variables) and increased in line with physical stress and inappropriate safety equipment, (3) emotional stress was positively predicted by the provision of training and inappropriate safety equipment, and (4) physical stress was predicted only by inappropriate safety equipment. Based on these results, we suggest various recommendations to construction stakeholders on how to prevent CW injury incidents.

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