Lateral Corticospinal Tract and Dorsal Column Damage: Predictive Relationships With Motor and Sensory Scores at Discharge From Acute Rehabilitation After Spinal Cord Injury

ObjectiveTo determine if lateral corticospinal tract (LCST) integrity demonstrates a significant predictive relationship with future ipsilateral lower extremity motor function (LEMS) and if dorsal column (DC) integrity demonstrates a significant predictive relationship with future light touch (LT) sensory function post spinal cord injury (SCI) at time of discharge from inpatient rehabilitation.DesignRetrospective analyses of imaging and clinical outcomes.SettingUniversity and academic hospital.ParticipantsA total of 151 participants (N=151) with SCI.InterventionsInpatient rehabilitation.Main Outcome MeasuresLEMS and LT scores at discharge from inpatient rehabilitation.ResultsIn 151 participants, right LCST spared tissue demonstrated a significant predictive relationship with right LEMS percentage recovered (β=0.56; 95% confidence interval [CI], 0.37-0.73; R=0.43; P<.001). Left LCST spared tissue demonstrated a significant predictive relationship with left LEMS percentage recovered (β=0.66; 95% CI, 0.50-0.82; R=0.51; P<.001). DC spared tissue demonstrated a significant predictive relationship with LT percentage recovered (β=0.69; 95% CI, 0.52-0.87; R=0.55; P<.001). When subgrouping the participants into motor complete vs incomplete SCI, motor relationships were no longer significant, but the sensory relationship remained significant. Those who had no voluntary motor function but recovered some also had significantly greater LCST spared tissue than those who did not recover motor function.ConclusionsLCST demonstrated significant moderate predictive relationships with lower extremity motor function at the time of discharge from inpatient rehabilitation, in an ipsilesional manner. DC integrity demonstrated a significant moderate predictive relationship with recovered function of LT. With further development, these neuroimaging methods might be used to predict potential deficits after SCI and to provide corresponding targeted interventions.     

Sports injury prevention programmes from the sports physical therapist's perspective: An international expert Delphi approach

ObjectiveTo provide consensus on how to plan, organize and implement exercise-based injury prevention program (IPP) in sports.DesignDelphi.SettingLimeSurvey platform.ParticipantsExperienced sports physical therapists from the International Federation of Sports Physical Therapy member countries.Main outcome measuresFactors related to sports IPP planning, organization and implementation.ResultsWe included 305 participants from 32 countries. IPP planning should be based on an athlete's injury history, on pre-season screening results, and on injury rates (respectively, 98%, 92%, 89% agreement). In total 97% participants agreed that IPP organization should depend on the athlete's age, 93% on the competition level, and 93% on the availability of low-cost materials. It was agreed that IPP should mainly be implemented in warm-up sessions delivered by the head or strength/conditioning coach, with physical training sessions and individual physical therapy sessions (respectively, 94%, 92%, 90% agreement).ConclusionStrong consensus was reached on (1) IPP based on the athlete's injury history, pre-season screening and evidence-based sports-specific injury rates; (2) IPP organization based on the athlete's age, competition level, and the availability of low-cost materials and (3) IPP implementation focussing on warm-up sessions implemented by the strength/conditioning coach, and/or individual prevention sessions by the physical therapist.     

短时程脊髓电刺激治疗爆发痛合并触诱发痛的急性期带状疱疹的临床研究

目的探讨短时程脊髓电刺激(temporary spinal cord stimulation, tSCS)治疗爆发痛合并触诱发痛的急性期带状疱疹的临床疗效。方法回顾性地分析同济大学附属第十人民医院疼痛科2020年1月—2020年12月收治的52例接受tSCS治疗的爆发痛合并触诱发痛的急性期带状疱疹患者的临床资料，评估在治疗前、治疗后3d、7d、14d、3个月、6个月的总体疼痛情况(numerical rating scale, NRS)评分、(simple McGill scores, McGill)评分、爆发痛情况(发生率、NRS评分、次数以及持续时间)、触诱发痛情况(发生率、分级)、术后不良反应等；评估在治疗前、治疗后7d、3个月、6个月的睡眠时长、睡眠中醒来次数、疼痛障碍指数(pain disorder index, PDI)、功能状态评分(Karnofsky score, KPS)、抑郁症筛查量表(patient health questionnaire depression module scale, PHQ-9)和焦虑症筛查量表(generalized anxiety disorder-7 scale, GAD-7)等。结果与治疗前相比，治疗后3d、7d、14d、3个月、6个月的总体疼痛NRS评分、总体疼痛MCGILL评分、静息痛NRS评分明显降低(均P<0.001)；与治疗前相比，治疗后3d、7d、14d、3个月、6个月的的爆发痛NRS评分明显降低(均P<0.05)，治疗后14d、3个月、6个月时的爆发痛次数以及持续时间都明显降低(均P<0.05)；与治疗前比较，患者治疗后7d、14d、3个月、6个月时的触诱发痛的分级都明显降低，差异均有统计学意义(均P<0.05)；与治疗前相比，治疗后14d、3个月、6个月的PDI评分明显降低(P<0.05)；与治疗前相比，治疗后14d、3个月、6个月的PHQ-9评分和GAD-7评分都明显减少(P<0.05)，与术前的药物使用情况相比，治疗后各镇痛药使用人数普遍呈下降趋势；术中及整个随访期间未观察到严重不良事件。结论短时程脊髓电刺激对爆发痛合并触诱发痛的急性期带状疱疹具有较好的临床疗效。     

The hidden aspect of carotid lesions in traffic accidents: A little-known phenomenon

Vascular injuries that occur during traffic accidents are a commonly neglected aspect that can add more detail to the framework of a case. In this study, we analysed a case series of 150 traffic accidents, 39 of which were marked by microscopically identifiable vascular lesions. The purpose was to identify the presence of carotid injuries in individuals who died due to traffic accidents and had nonpenetrating trauma of the neck. We focused on the discrepancies regarding the macroscopical aspect and the histology and demonstrated how histological analysis of the carotids in cases of trauma can reveal injuries that are attributable to the trauma itself. We conducted a histological analysis of the lesions to describe their distribution and type and investigate potential correlations. The study offers insight on how to examine road accidents that involve traumatic injury of the carotid arteries. Indeed the main task of the forensic pathologist in the case of death is to establish the existence of a causal relationship between the micro- or macroscopic alterations observed in the autopsy and the traumatic event that led to the death of the subject. Thus, further morphological elements were provided to the forensic practitioners that may reveal injuries attributable to the trauma itself and should be evaluated in cases of trauma in traffic accidents.     

Forensic pathological characteristics of explosion trauma in confined space terrorist mass fatalities classified with a 3-dimensional model

BackgroundExplosion fatalities are the severest type of violent crimes. These involve the use of explosive devices in terrorist like activities in confined spaces in civilian or military settings, with mass number of people present all around. A stark dearth of literature for the forensic interpretation of such catastrophes is astonishing.PurposeCharacterization of the pattern of the multitude of injuries in explosions in confined spaces as guide for investigations and growth of literature on this entity.MethodologyA review of the archives of the forensic examinations of mass fatalities due to an explosion in a metro car was undertaken. It was combined with the reconstruction of the events by developing a three-dimensional model of this incident that involved seventeen fatalities.ResultsAll the decedents showed differential pattern of fatal injuries under the influence of damaging explosion factors (DEFs). The causative forces were characterized as gas-detonation (in all the cases), damaging effect by shock waves (59% of the cases), and impact of fragmentation and collision of the body (thrown off) with nearby objects. Traumatic effect due to shrapnel as well as blunt force was noted in 82% of the cases. Gross destruction of head due to combined effect of gas-detonation and fragmentation was seen in 29% of the cases.ConclusionAn interpretation of the nature and pattern of injuries in confined space explosions can help to estimate the location of deceased/s with respect to the epicenter and the type of DEFs.     

The role of hip arthroplasty in management of the hip fracture patient

Hip fractures are becoming increasingly common in a growing elderly population, and are associated with significant morbidity and mortality. Displaced intracapsular femoral neck fractures are usually treated with either total hip arthroplasty (THA) or hemiarthroplasty, although the indication for each operation remains an area for debate. THA has been associated with longer operative time, increased risk of dislocation and a slight increase in general complications compared with hemiarthroplasty. However, it has also been associated with a modest improvement in functional outcomes and quality of life. Guidelines have been created within the UK to aid the decision-making process based upon current available literature. The principal focus of these has been to identify patients suitable for THA, and include patients who are cognitively intact, mobile outside their home with the use of no more than one stick, and who are medically fit enough for the procedure. However, implant selection must also be taken into consideration in order to achieve the best outcomes for patients. Options for implants include use of dual mobility cups and choice of femoral head size in THA, bipolar versus unipolar hemiarthroplasty, and cemented versus uncemented implants. Further research is required into this area to make additional recommendations.     

Sleep in Paralympic athletes and its relationship with injuries and illnesses

ObjectivesTo evaluate sleep characteristics and investigate the relationship of sleep with injuries and illnesses in Paralympic athletes.DesignCross-sectional.SettingSports Training Center.Participants20 Paralympic athletes of athletics, swimming, and powerlifting.OutcomesInjury and illnesses were recorded during the sports season through the Oslo Sports Trauma Research Center questionnaire (OSTRC-BR). Sleep-wake pattern was monitored for 2 weeks using actigraphy. Chronotype, sleep quality, sleep behavior, and sleep complaints were cross-sectionally collected.ResultsPoor sleep quality and poor sleep behavior were highly prevalent. The mean total sleep time was 6.57 ± 49.91. Duration of naps (r= −0.46; p=0.04) was associated with occurrence of health problems; frequency of insomnia (r= 0.51; p= 0.02), Pittsburgh Sleep Quality Index score (r= 0.45; p=0.04), and frequency of awakenings at night (r= 0.58; p= 0.01) were associated with severity of health problems; frequency of movements during sleep was associated with OSTRC-BR cumulative score (r= 0.58; p=0.00); and frequency of nightmares was associated with OSTRC mean score.ConclusionsParalympic athletes tend to report poor sleep quality, have poor sleep behavior and sleep less than the recommended. Insomnia symptoms, awakenings at night, movements during sleep and poor sleep quality were associated with the occurrence and/or severity of health problems.     

The measurement of neck strength: A guide for sports medicine clinicians

This masterclass aims to provide an overview of the measurement of neck strength and the factors which can increase the ecological validity of the testing protocol within an athletic population. Adopting a ‘gold standard’ method for measuring neck strength is of vital importance when determining strength differences across sports, ages and sexes. Without a ‘gold standard’ method current variations in testing procedure and equipment have created challenges in establishing normative neck strength data. With encouraging evidence that higher neck strength can have a protective effect against sports-related head and neck injuries, including concussion, new injury prevention knowledge may be impeded by a lack of consensus on how to accurately measure neck strength, with a number of different methods available. This masterclass will outline the factors clinicians should consider when selecting a device and measurement protocol when measuring maximal neck strength as well as how to interpret the results.