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Geng XY, Wang MK, Chen JH, Xiao L, Yang JS. Marine biological injuries and their medical management: A narrative review. World J Biol Chem 2023; 14:1-12. [PMID: 36741876 PMCID: PMC9896478 DOI: 10.4331/wjbc.v14.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/29/2022] [Accepted: 12/14/2022] [Indexed: 01/20/2023] Open
Abstract
The marine environment can be extremely dangerous, and the harm caused by marine organisms when they contact the human body can be especially harmful, even deadly. Contact includes stings, bites, wounds, and consumption as food. In this article, the characteristics of the common marine biological injuries are summarized, the major marine organisms causing damage in China’s marine waters are described, and injury prevention and treatment methods are discussed.
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Affiliation(s)
- Xiao-Yu Geng
- Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ming-Ke Wang
- Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Jin-Hong Chen
- Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Liang Xiao
- Faculty of Naval Medicine, Naval Medical University, Shanghai 200433, China
| | - Ji-Shun Yang
- Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
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Evans LL, Jensen AR, Meert KL, VanBuren JM, Richards R, Alvey JS, Carcillo JA, McQuillen PS, Mourani PM, Nance ML, Holubkov R, Pollack MM, Burd RS. All body region injuries are not equal: Differences in pediatric discharge functional status based on Abbreviated Injury Scale (AIS) body regions and severity scores. J Pediatr Surg 2022; 57:739-746. [PMID: 35090715 DOI: 10.1016/j.jpedsurg.2021.09.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Functional outcomes have been proposed for assessing quality of pediatric trauma care. Outcomes assessments often rely on Abbreviated Injury Scale (AIS) severity scores to adjust for injury characteristics, but the relationship between AIS severity and functional impairment is unknown. This study's primary aim was to quantify functional impairment associated with increasing AIS severity scores within body regions. The secondary aim was to assess differences in impairment between body regions based on AIS severity. METHODS Children with serious (AIS≥ 3) isolated body region injuries enrolled in a multicenter prospective study were analyzed. The primary outcome was functional status at discharge measured using the Functional Status Scale (FSS). Discharge FSS was compared (1) within each body region across increasing AIS severity scores, and (2) between body regions for injuries with matching AIS scores. RESULTS The study included 266 children, with 16% having abnormal FSS at discharge. Worse FSS was associated with increasing AIS severity only for spine injuries. Abnormal FSS was observed in a greater proportion of head injury patients with a severely impaired initial Glasgow Coma Scale (GCS) (GCS< 9) compared to those with a higher GCS score (43% versus 9%; p < 0.01). Patients with AIS 3 extremity and severe head injuries had a higher proportion of abnormal FSS at discharge than AIS 3 abdomen or non-severe head injuries. CONCLUSIONS AIS severity does not account for variability in discharge functional impairment within or between body regions. Benchmarking based on functional status assessment requires clinical factors in addition to AIS severity for appropriate risk adjustment. LEVEL OF EVIDENCE 1 (Prognostic and Epidemiological).
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Affiliation(s)
- Lauren L Evans
- Department of Surgery, Division of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, 744 52nd Street, 4th Floor OPC2, Oakland CA 94609, United States
| | - Aaron R Jensen
- Department of Surgery, Division of Pediatric Surgery, UCSF Benioff Children's Hospital Oakland, 744 52nd Street, 4th Floor OPC2, Oakland CA 94609, United States.
| | - Kathleen L Meert
- Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI 48201, United States
| | - John M VanBuren
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Rachel Richards
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Jessica S Alvey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Joseph A Carcillo
- Department of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Patrick S McQuillen
- Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA
| | - Peter M Mourani
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO
| | - Michael L Nance
- Division of Pediatric Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Richard Holubkov
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, United States
| | - Murray M Pollack
- Department of Pediatrics, Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington DC 20010, United States
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, DC 20010, United States
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Jensen AR, Evans LL, Meert KL, VanBuren JM, Richards R, Alvey JS, Holubkov R, Pollack MM, Burd RS. Functional status impairment at six-month follow-up is independently associated with child physical abuse mechanism. Child Abuse Negl 2021; 122:105333. [PMID: 34583299 DOI: 10.1016/j.chiabu.2021.105333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Children with abusive injuries have worse mortality, length-of-stay, complications, and healthcare costs compared to those sustaining an accidental injury. Long-term functional impairment is common in children with abusive head trauma but has not been examined in a cohort with heterogeneous body region injuries. OBJECTIVE To assess for an independent association between child physical abuse and functional impairment at discharge and six-month follow-up. PARTICIPANTS AND SETTING Seriously injured children (<15 years) treated at seven pediatric trauma centers. METHODS Functional status was compared between child physical abuse and accidental injury groups at discharge and six-month follow-up. Functional impairment was defined at discharge ("new domain morbidity") as a change from pre-injury ≥2 points in any of the six domains of the Functional Status Scale (FSS), and impairment at six-month follow-up as an abnormal total FSS score. RESULTS Children with abusive injuries accounted for 10.5% (n = 45) of the cohort. New domain morbidity was present in 17.8% (n = 8) of child physical abuse patients at discharge, with 10% (n = 3) of children having an abnormal FSS at six-months. There were no differences in new domain morbidity at hospital discharge between children injured by abuse and or accidental injury. However, children injured by physical abuse were 4.09 (2.15, 7.78) times more likely to have functional impairment at six months. CONCLUSIONS Child physical abuse is an independent risk factor for functional impairment at six-month follow-up. Functional status measurement for this high-risk group of children should be routinely measured and incorporated into trauma center quality assessments.
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Affiliation(s)
- Aaron R Jensen
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, and Department of Surgery, University of California San Francisco, San Francisco, CA 94611, USA.
| | - Lauren L Evans
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, and Department of Surgery, University of California San Francisco, San Francisco, CA 94611, USA.
| | - Kathleen L Meert
- Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, 48201, USA.
| | - John M VanBuren
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
| | - Rachel Richards
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
| | - Jessica S Alvey
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
| | - Richard Holubkov
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.
| | - Murray M Pollack
- Department of Pediatrics, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA.
| | - Randall S Burd
- Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, DC 20010, USA.
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Saul D, Dresing K. [Surgical treatment of bites]. Oper Orthop Traumatol 2018; 30:321-41. [PMID: 30209521 DOI: 10.1007/s00064-018-0563-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/21/2018] [Accepted: 06/07/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Thorough and profound debridement for acute bite injuries while sparing nerves, vessels and tendons. INDICATIONS Acute traumatic and late presented bite injuries. CONTRAINDICATIONS General contraindication for anesthesia or surgery. SURGICAL TECHNIQUE Extensive flabellate local anesthesia/general anesthesia, wound irrigation using 0.9% NaCl or antiseptic solutions, removal of avital tissues, wound debridement, wound edge excision, anew extensive irrigation, drainage if necessary, wound closure where applicable (except older or punctual deep injuries), bandage, elastic wrapping and immobilization. If necessary, plastic surgery with coverage of remaining defects. POSTOPERATIVE MANAGEMENT Immobilization with initially daily wound evaluation, removal of drainage/loop on postoperative day 2; if necessary, antibiotic therapy with amoxicillin and clavulanic acid in high-risk wounds (e.g., puncture wounds, joint or bone involvement, extensive soft tissue squeezing), suture removal on day 10-12 after surgery. RESULTS Of 142 bite injuries that were treated and retrospectively evaluated, 46% were caused by dogs and 32% by cats. Patients were on average 44 years old; 55% of all dog bites affected women, but 67% of all cat bites. In 48% of the cases, general anesthesia was necessary. The postoperative infection rate was 6.3%.
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Wolyncewicz GEL, Palmer CS, Jowett HE, Hutson JM, King SK, Teague WJ. Horse-related injuries in children - unmounted injuries are more severe: A retrospective review. Injury 2018; 49:933-938. [PMID: 29224906 DOI: 10.1016/j.injury.2017.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/13/2017] [Accepted: 12/05/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Horse-related injuries account for one quarter of all paediatric sports fatalities. It is not known whether the pattern of injury spectrum and severity differ between children injured whilst mounted, compared with those injured unmounted around horses. We aimed to identify any distinctions between the demographic features, spectrum and severity of injuries for mounted versus unmounted patients. PATIENTS AND METHODS Trauma registry data were reviewed for 505 consecutive paediatric patients (aged<16years) admitted to a large paediatric trauma centre with horse-related injuries over a 16-year period. Patients were classified into mounted and unmounted groups, and demographics, injury spectrum, injury severity, and helmet usage compared using odds ratios and Wilcoxon rank-sum tests. RESULTS More patients (56%) were injured in a private setting than in a sporting or supervised context (23%). Overall, head injuries were the most common horse-related injury. Mounted patients comprised 77% of the cohort. Mounted patients were more likely to sustain upper limb fractures or spinal injuries, and more likely to wear helmets. Unmounted were more likely to be younger males, and more likely to sustain facial or abdominal injuries. Strikingly, unmounted children had significantly more severe and critical Injury Severity Scores (OR 2.6; 95% CI 1.5, 4.6) and longer hospital stay (2.0days vs 1.1days; p<0.001). Unmounted patients were twice as likely to require intensive care or surgery, and eight times more likely to sustain a severe head injury. CONCLUSIONS Horse-related injuries in children are serious. Unmounted patients are distinct from mounted patients in terms of gender, age, likelihood of personal protective equipment use, severity of injuries, and requirement for intensive or invasive care. This study highlights the importance of vigilance and other safety behaviours when unmounted and around horses, and proposes specific targets for future injury prevention campaigns, both in setting of organised and private equestrian activity.
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Affiliation(s)
- Grace E L Wolyncewicz
- Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Cameron S Palmer
- Trauma Service, The Royal Children's Hospital, Melbourne, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
| | - Helen E Jowett
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - John M Hutson
- Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Urology, The Royal Children's Hospital, Melbourne, Australia.
| | - Sebastian K King
- Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia; Department of Gastroenterology & Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia.
| | - Warwick J Teague
- Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Trauma Service, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia.
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Penn-Barwell JG, Bennett PM, Mortiboy DE, Fries CA, Groom AFG, Sargeant ID. Factors influencing infection in 10 years of battlefield open tibia fractures. Strategies Trauma Limb Reconstr 2016; 11:13-8. [PMID: 26993111 PMCID: PMC4814384 DOI: 10.1007/s11751-016-0250-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/01/2016] [Indexed: 11/27/2022] Open
Abstract
The aim of this study was to characterise severe open tibial shaft fractures sustained by the UK military personnel over 10 years of combat in Iraq and Afghanistan. The UK military Joint Theatre Trauma Registry was searched for all such injuries, and clinical records were reviewed for all patients. One hundred Gustilo-Anderson III tibia fractures in 89 patients were identified in the 10 year study period; the majority sustained injuries through explosive weapons (63, 68 %) with the remainder being injured from gunshot wounds. Three fractures were not followed up for 12 months and were therefore excluded. Twenty-two (23 %) of the remaining 97 tibial fractures were complicated by infection, with S. aureus being the causative agent in 13/22 infected fractures (59 %). Neither injury severity, mechanism, the use of an external fixator, the need for vascularised tissue transfer nor smoking status was associated with subsequent infection. Bone loss was significantly associated with subsequent infection (p < 0.0001, Fisher's exact test). This study presents 10 years of open tibial fractures sustained in Iraq and Afghanistan. Most infection in combat open tibia fractures is caused by familiar organisms, i.e. S. aureus. While the overall severity of a casualty's injuries was not associated with infection, the degree of bone loss from the fracture was.
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Affiliation(s)
- J G Penn-Barwell
- National Institute of Health Research, Surgical Reconstruction and Microbiology Research Centre (NIHR SRMRC), Birmingham, UK. .,Institute of Naval Medicine, Crescent Drive, Gosport, PO12 2DL, UK.
| | - P M Bennett
- Institute of Naval Medicine, Crescent Drive, Gosport, PO12 2DL, UK
| | | | - C A Fries
- Institute of Naval Medicine, Crescent Drive, Gosport, PO12 2DL, UK
| | - A F G Groom
- Limb Reconstruction Unit, King's College Hospital, London, UK
| | - I D Sargeant
- Institute of Naval Medicine, Crescent Drive, Gosport, PO12 2DL, UK.,University Hospital Birmingham, Birmingham, UK
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Penn-Barwell JG, Myatt RW, Bennett PM, Sargeant ID, Bennett P, Fries C, Myatt R, Kendrew J, Midwinter M, Rickard R, Sargeant I, Porter K, Rowlands T, Mountain A, Foster M, Stapley S, Mortiboy D, Bishop J. Medium-term outcomes following limb salvage for severe open tibia fracture are similar to trans-tibial amputation. Injury 2015; 46:288-91. [PMID: 25548111 DOI: 10.1016/j.injury.2014.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 10/19/2014] [Accepted: 12/04/2014] [Indexed: 02/02/2023]
Abstract
Extremity injuries define the surgical burden of recent conflicts. Current literature is inconclusive when assessing the merits of limb salvage over amputation. The aim of this study was to determine medium term functional outcomes in military casualties undergoing limb salvage for severe open tibia fractures, and compare them to equivalent outcomes for unilateral trans-tibial amputees. Cases of severe open diaphyseal tibia fractures sustained in combat between 2006 and 2010, as described in a previously published series, were contacted. Consenting individuals conducted a brief telephone interview and were asked to complete a SF-36 questionnaire. These results were compared to a similar cohort of 18 military patients who sustained a unilateral trans-tibial amputation between 2004 and 2010. Forty-nine patients with 57 severe open tibia fractures met the inclusion criteria. Telephone follow-up and SF-36 questionnaire data was available for 30 patients (61%). The median follow-up was 4 years (49 months, IQR 39-63). Ten of the 30 patients required revision surgery, three of which involved conversion from initial fixation to a circular frame for non- or mal-union. Twenty-two of the 30 patients (73%) recovered sufficiently to complete an age-standardised basic military fitness test. The median physical component score of SF-36 in the limb salvage group was 46 (IQR 35-54) which was similar to the trans-tibial amputation cohort (p=0.3057, Mann-Whitney). Similarly there was no difference in mental component scores between the limb salvage and amputation groups (p=0.1595, Mann-Whitney). There was no significant difference in the proportion of patients in either the amputation or limb salvage group reporting pain (p=0.1157, Fisher's exact test) or with respect to SF-36 physical pain scores (p=0.5258, Mann-Whitney). This study demonstrates that medium term outcomes for military patients are similar following trans-tibial amputation or limb salvage following combat trauma.
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Affiliation(s)
- J G Penn-Barwell
- National Institute of Health Research, Surgical Reconstruction and Microbiology Research Centre (NIHR SRMRC), Birmingham, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (RCDM), Birmingham, UK.
| | - R W Myatt
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (RCDM), Birmingham, UK
| | - P M Bennett
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (RCDM), Birmingham, UK
| | - I D Sargeant
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine (RCDM), Birmingham, UK; Queen Elizabeth's Hospital, Birmingham, UK
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