Predictors of multiple injuries in individual distance runners:A retrospective study of 75,401 entrants in 4 annual races-SAFER XX

Background There are limited data on factors that predict an increased risk of multiple injuries among distance runners.The objective of this study was to determine risk factors that are predictive of individual runners with a high annual multiple injury risk(MIR).Methods A retrospective,cross-sectional study at 4 annual(2012-2015)Two Oceans 21.1 km and 56.0 km races in South Africa with 75,401 consenting race entrants.Running-related injury data were collected retrospectively through an online pre-race medical screening questionnaire.The average number of injuries for each runner every year was calculated by taking a runner's race entry history and injury history into account and categorizing entrants into 4 MIR categories(high,intermediate,low,and very low(reference)).Multiple logistic regression modeling(odds ratios)was used to determine whether the following factors were predictive of a high MIR(average>1 injury/year):demographics,training and racing,chronic-disease history(composite chronic disease score(CCDS)),and history of allergies.Results Of all entrants,9.2%reported at least 1 injury,and 0.4%of entrants were in the high MIR category;the incidence rate was 2.5 injuries per 10 runner-years(95%confidence interval(95%CI):2.4-2.7).Significant factors predictive of runners in the high MIR category were:running for>20 years:OR=2.0(95%CI:1.3-3.1;p=0.0010);a higher CCDS:OR=2.2(95%CI:2.0-2.4;p<0.0001);and a history of allergies:OR=2.8(95%CI:2.0-3.8;p<0.0001).Conclusion Runners who have been running recreationally for>20 years and those with multiple chronic diseases or a history of allergies were at higher risk of multiple running-related injuries.This high-risk group can be targeted for further study and possible injury-prevention interventions.

Diagnosis and Treatment of 42 Cases of Multiple Injuries with Pancreatic Injury

In order to summarize the clinical diagnosis and treatment methods for 42 cases of multiple injuries with pancreatic injury, a retrospective analysis on 42 cases of multiple injuries with pancreatic injury from January 1990 to January 2006 was carried out in our hospital. Most cases were associated with hemopneumothorax and rib fractures （52.3%）, shock （50%）, multiple fractures （47.6%）, and severe brain injury （26.1%）. In 42 cases, one case died of severe hemorrhagic shock, and the remaining 41 cases （97.6%） were cured （including 40 cases receiving surgical operation and one case receiving the conservative treatment）. Postoperative complications occurred in 16 cases （21 cases/times）： pancreatic fistula （5 cases/times） and incisional wound infection （5 cases/times）, intra-abdominal infection （3 cases/times）, stress ulcer （3 cases/times）, pleural effusion （3 cases/times）, pulmonary infection （one case） and wound dehiscence （1 case）. The principle therapy of multiple injuries with pancreatic injury is to rescue life, followed by active treatment to prevent injuries which giving rise to the abnormal respiratory and circulatory functions, management of cerebral hernia and other injuries which endangers life at last, and the pancreatic injury to increase the survival rate and survival quality.

Emergency Treatment and Nursing Care of a Patient with Multiple Injuries and Right Main Bronchus Rupture

Objective: To investigate the rescue and nursing process of a trauma patient with multiple injuries and rupture of the right main bronchus. Methods: A patient with multiple injuries and rupture of the right main bronchus admitted to the emergency department of the Shenzhen Hospital of the University of Hong Kong was selected as the research object on December 11, 2019. Results: In this case, the medical team treated the patient under the guidance of ATLS (Advanced Traumatic Life Support), and for the first time in our department, we used bronchoscopy to replace the double-lumen endotracheal tube for left lung single-lung ventilation, finally the patient was successfully treated. Conclusion: Through a literature search, it is found that the main bronchus rupture is less common in clinical practice. In the trauma group, the use of fiberoptic bronchoscopy and the replacement of a double-lumen tracheal tube for left lung single-lung ventilation can improve the treatment rate of such patients and is worthy of clinical application.

Clinical features of multiple trauma patients combined with spine and spinal cord injuries

Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in143multiple trauma patients combined with spine and spinal

Effects of Qingwen Baidu decoction on coagulation and multiple organ injury in rat models of sepsis

Background:Sepsis-induced coagulopathy and multiple organ dysfunction syndromes are the leading causes of death in patients with sepsis.Qingwen Baidu decoction(QWBD)can effectively improve the clinical manifestations of sepsis and ease inflammation,but its effects on coagulation functions and multiple organ injuries remain unclear.Methods:100 healthy,male Sprague-Dawley rats were randomly divided into the sham group,the cecal ligation and puncture(CLP)group,the low-dose QWBD group,and the high-dose QWBD group,with 25 rats in each group.The sepsis model was established using CLP.Blood was collected to measure platelet count,serum creatinine(Cr),blood urea nitrogen(BUN),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)levels,as well as coagulation function.The total protein in bronchoalveolar lavage fluid(BALF)was determined in each group of rats.The lung,liver,and kidney tissues were harvested,and statistics were calculated on the wet-to-dry(W/D)weight ratio.Changes in histopathology and thrombin level were evaluated in each group.The remaining ten rats in each group were observed daily to record the number of surviving rats.Such observation was made consecutively for 7 days to calculate survival rates.Results:After model establishment,ALT,AST,Cr,and BUN levels were significantly elevated(P<0.01).The BALF protein content and lung W/D weight ratio were significantly increased(P<0.01).Furthermore,the survival rate of rats was significantly reduced in the CLP group compared with the sham group.After the treatment,rats in the high-dose QWBD group had lower ALT(P<0.05),AST(P<0.01),Cr(P<0.05),BUN(P<0.01)levels,lower BALF protein content(P<0.05)and lower lung W/D weight ratio(P<0.01)than the CLP group.However,rats in the high-dose QWBD group had significantly better pathological changes in the lung,liver,and kidney compared to the sham group.After the treatment,the platelet level in the peripheral blood was elevated(P<0.05)and both activated partial thromboplastin time and prothrombin time were significantly shortened(P<0.01).The fibrinogen level was significantly increased(P<0.01).Finally,thrombin positive expression areas in the lung,liver,and kidney were significantly decreased in the high-dose QWBD group.Conclusion:QWBD can improve coagulation disorders caused by sepsis and has a protective effect on multiple organ injuries in rats.

An Improved Transosseous Pullout Suture Technique for Arthroscopic Repair of a Meniscus Root Tear

Objective:This study aimed to explore the clinical efficiency of an improved transosseous pullout suture technique for arthroscopic repair of a meniscus root tear.Methods:From January 2017 to January 2021,53 patients with posterior meniscus root tears combined with anterior cruciate ligament(ACL)and/or posterior cruciate ligament(PCL)tears were collected.Totally,in 29 patients(group A),the 2.0 mm modified pullout tunnel method was used to suture the posterior meniscus root,while 24 patients(group B)were treated with the traditional 4.5 mm pullout tunnel method.In group A,20 patients had lateral meniscus posterior root(LMPR)combined with ACL tears,5 patients had LMPR combined with ACL and PCL tears,and 4 patients had medial meniscus posterior root(MMPR)combined with ACL tears.In group B,19 patients had LMPR combined with ACL tears,3 patients had LMPR combined with ACL and PCL tears,and 2 patients had MMPR combined with ACL tears.The improvement of the Lysholm and VAS scores and the incidence of complications in group A and group B before the operation,1 month and 3 months after the operation,and after the final follow-up were compared.Results:Preoperative Lysholm score was 26.0±5.6 in group A and 26.7±5.8 in group B(P>0.05).One-month postoperative Lysholm score was 66.5±5.7 in group A and 54.3±2.4 in group B(P<0.001).Three-month postoperative Lysholm score was 81.1±7.2 in group A and 73.2±9.7 in group B(P<0.05).Lysholm scores after the final follow-up was 90.3±5.6 in group A and 90.0±5.0 in group B(P>0.05).Preoperative VAS score was 6.3±1.4 in group A and 6.3±1.2 in group B(P>0.05).One-month postoperative VAS score was 1.8±0.7 in group A and 2.4±0.9 in group B(P<0.05).Three-month postoperative VAS score was 0.7±0.6 in group A and 0.8±0.6 in group B(P>0.05).VAS score after the final follow-up was 0.2±0.4 in group A and 0.3±0.5 in group B(P>0.05).Conclusion:The improved transosseous pullout suture technique using a smaller 2.0 mm bone tunnel can virtually eliminate the risk of conflict with other bone tunnels and facilitate the management of bone tunnels in multiple ligament injuries,while also diminishing suture abrasion caused by the windshield wiper effect.The technique achieves good clinical efficacy.

edox factor-1 may mediate the repair of multiple organ injuries lfter fiver transplantation

Background Apurinic apyrimidinic endonuclease/redox effector factor 1 （APE1/Ref-1） is an important enzyme in the repair of reactive oxygen species-induced DNA damage, and its expression/activation can be induced by reactive oxygen species. The aim of this research was to investigate the relationship between multiple-organ injuries and expression of Ref-1 in the early period after liver transplantation. Methods One hundred and fifty adult male Wistar rats were divided randomly into three groups： liver transplantation, sham surgery, and untreated control. After liver transplantation, animals were sacrificed at different time points. Hepatic and renal functions were analyzed by serology. Histology, apoptotic levels, and Ref-1 expression were examined by immunohistochemistry in the liver, kidneys, intestines, and lungs. Results Serum levels of alanine aminotransferase and aspartate aminotransferase peaked 6 hours after liver transplantation and decreased appreciably after 12 hours in the transplantatior~ group, suggesting that the degree of liver injury in the early period after transplantation peaked at 6 hours and then decreased. Pathological analyses showed that hepatic tissues were more severely injured in the transplantation group than in the sham and untreated groups. A considerable number of infiltrating inflammatory cells was observed around the portal vein in the transplantation group. Injuries to the kidneys, intestines, and lungs were milder after liver transplantation. Apoptotic levels increased after liver transplantation in all four organs examined. Ref-1 expression was higher in the transplantation group in the early period after liver transplantation than in the sham surgery and untreated control groups. Conclusion Ref-1 expression induced by ischemia-reperfusion injury may have a critical role in repairing multiple-organ injuries after liver transplantation.

Protective Effects of Erythropoietin on Endotoxin-related Organ Injury in Rats

Summary： The protective effect of erythropoietin （EPO） on tissues following ischemia and reperfusion injuries remains poorly understood. We aimed to investigate the effect of EPO in preventing en- dotoxin-induced organ damage. Rat model of multiple organ failure （MOF） was established by tail vein injection of 10 mg/kg lipopolysaccharide （LPS）. Recombinant human EPO treatment （5000 U/kg） was administered by tail vein injection at 30 min after LPS challenge. Twenty-four h after EPO treatment, changes in serum enzyme levels, including aspartate aminotransferase （AST）, alanine transaminase （ALT）, blood urea nitrogen （BUN） and creatinine （Cr）, were evaluated by biochemical analysis. Serum levels of tumor necrosis factor-tx （TNF-ct） were determined by using immunoradiometric assay. Histological examination of tissue sections was carried out by hematoxylin and eosin staining, while ul- trastructure evaluation of organ tissues was assessed by transmission electron microscopy. Protein ex- pression levels were detected by using Western blotting. EPO treatment showed a modest effect in pre- venting LPS-induced elevation of AST, ALT, BUN, Cr, and TNF-ct levels, and in protecting against LPS-induced tissue degeneration and injured ultrastructure in the lung, liver, and kidney. Moreover, LPS promoted phosphorylation of alanine aminotransferase （AKT） and increased nuclear factor-r,B （NF-rB） activation in the lung, liver, and kidney （P〈0.05 vs. control）. However, EPO treatment significantly de- creased the LPS-induced pAKT up-regulation in these tissues （P〈0.05 vs. LPS treatment alone）. The present study demonstrates that EPO may play a protective role against LPS-induced MOF by reducing the inflammatory response and tissue degeneration, possibly via the phosphatidylinositol 3-kinase/AKT and NF-r,B signaling pathways.

Intratracheal administration of umbilical cord-derived mesenchymal stem cells attenuates hyperoxia-induced multi-organ injury via heme oxygenase-1 and JAK/STAT pathways

BACKGROUND Bronchopulmonary dysplasia(BPD)is not merely a chronic lung disease,but a systemic condition with multiple organs implications predominantly associated with hyperoxia exposure.Despite advances in current management strategies,limited progress has been made in reducing the BPD-related systemic damage.Meanwhile,although the protective effects of human umbilical cord-derived mesenchymal stem cells(hUC-MSCs)or their exosomes on hyperoxia-induced lung injury have been explored by many researchers,the underlying mechanism has not been addressed in detail,and few studies have focused on the therapeutic effect on systemic multiple organ injury.AIM To investigate whether hUC-MSC intratracheal administration could attenuate hyperoxia-induced lung,heart,and kidney injuries and the underlying regulatory mechanisms.METHODS Neonatal rats were exposed to hyperoxia(80%O_(2)),treated with hUC-MSCs intratracheal(iT)or intraperitoneal(iP)on postnatal day 7,and harvested on postnatal day 21.The tissue sections of the lung,heart,and kidney were analyzed morphometrically.Protein contents of the bronchoalveolar lavage fluid(BALF),myeloper oxidase(MPO)expression,and malondialdehyde(MDA)levels were examined.Pulmonary inflammatory cytokines were measured via enzyme-linked immunosorbent assay.A comparative transcriptomic analysis of differentially expressed genes(DEGs)in lung tissue was conducted via RNA-sequencing.Subsequently,we performed reverse transcription-quantitative polymerase chain reaction and western blot analysis to explore the expression of target mRNA and proteins related to inflammatory and oxidative responses.RESULTS iT hUC-MSCs administration improved pulmonary alveolarization and angiogenesis(P<0.01,P<0.01,P<0.001,and P<0.05 for mean linear intercept,septal counts,vascular medial thickness index,and microvessel density respectively).Meanwhile,treatment with hUC-MSCs iT ameliorated right ventricular hypertrophy(for Fulton’s index,P<0.01),and relieved reduced nephrogenic zone width(P<0.01)and glomerular diameter(P<0.001)in kidneys.Among the beneficial effects,a reduction of BALF protein,MPO,and MDA was observed in hUC-MSCs groups(P<0.01,P<0.001,and P<0.05 respectively).Increased pro-inflammatory cytokines tumor necrosis factor-alpha,interleukin(IL)-1β,and IL-6 expression observed in the hyperoxia group were significantly attenuated by hUC-MSCs administration(P<0.01,P<0.001,and P<0.05 respectively).In addition,we observed an increase in anti-inflammatory cytokine IL-10 expression in rats that received hUC-MSCs iT compared with rats reared in hyperoxia(P<0.05).Transcriptomic analysis showed that the DEGs in lung tissues induced by hyperoxia were enriched in pathways related to inflammatory responses,epithelial cell proliferation,and vasculature development.hUC-MSCs administration blunted these hyperoxia-induced dysregulated genes and resulted in a shift in the gene expression pattern toward the normoxia group.hUC-MSCs increased heme oxygenase-1(HO-1),JAK2,and STAT3 expression,and their phosphorylation in the lung,heart,and kidney(P<0.05).Remarkably,no significant difference was observed between the iT and iP administration.CONCLUSION iT hUC-MSCs administration ameliorates hyperoxia-induced lung,heart,and kidney injuries by activating HO-1 expression and JAK/STAT signaling.The therapeutic benefits of local iT and iP administration are equivalent.

Five-level noncontiguous spinal injuries of cervical region： report of a case and literature review

The incidence of multiple noncontiguous spinal injuries （MNSI） in the cervical spine is rare but has catastrophic consequences. The patient in this report was a 34-year-old woman with five-level cervical MNSI. CT and MRI showed that injuries included atlantoaxial instability, burst fracture of C6, dislocation of C6/7, rupture of the intervertebal disc or ligamentous complex, and irreversible cord damage. The mechanism for this case was a combined pattern of hyperflexion, compression, and hyperextension injuries. A review of the literature revealed that this case is the first report in the literature of a vehicle related accident causing five-level noncontiguous injuries of the cervical spine.

Road Traffic Accident Fatalities and its Association with Key SocioDemographic Determinants in Nashik,Maharashtra:A Recurring Challenge

Background:Road traffic accidents are not a new phenomenon,rather ifs a disturbing occurrence which shows no sign of abating very soon.Rather,it remains one of those public health issues which even the most educated and civilized populations tend to ignore,primarily for the thrill of it.This study aims to identify the outcome associated with vehicular accidents and its association with socio-demographic factors.Method:This is a retrospective,record-based study of victims of road traffic accidents admitted in a tertiary care hospital in Nashik,Maharashtra.The data would include records from the 2018 to 2019.The variables will include the socio-demographic factors,site of injuries and its severity.A descriptive analysis would be done by SPSS software to find out the prevalence of vehicular accidents,association of site of injury with age and severity of the trauma.Ethical approval would be taken before the initiation of the study.Result:A total of486 victims ofRTAs were included from the medical records of the casualty of a tertiary care hospital,out of which 330 were from the year 2018 and 156 from 2019.A look at the sociodemographic profiles of the RTA victims showed that females comprised only 19.3%(2018)and 18.6%(2019)of the total victims in road traffic accidents,while majority,80.6%(2018)and 81.4%(2019)were males during the same period.Overall,we can also observe that both in 2018(38.5%)and 2019(50.6%)most of the road traffic accidents among the victims were of moderate grade.Conclusion:The need of the hour is to bring about a change from within through self-reflection of lawmakers,strict implementation of traffic rules and guidelines with hefty fines,lockup,and criminal punishment to habitual wrongdoers.