Category: Injury & Trauma

Categories : Injury & TraumaTags :

Evidence Piles up for Repetitive Head Impacts Resulting in Encephalopathy

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Over the past 17 years, evidence on chronic traumatic encephalopathy (CTE) has piled up. While some sports organisations like the National Hockey League and World Rugby still claim their sports do not cause CTE, a new review article in the journal Acta Neuropathologica strengthens the case that repetitive head impact (RHI) exposure is the chief risk factor for the condition.

CTE is characterised by a distinctive molecular structural configuration of p-tau fibrils that is unlike the changes observed with aging, Alzheimer’s disease, or any other diseases caused by tau protein.

Though CTE made US headlines in 2007, it wasn’t until 2016 that the National Institute of Neurological Disorders and Stroke/National Institute of Biomedical Imaging and Bioengineering (NINDS-NIBIB) criteria for the neuropathological diagnosis of CTE were published, and they were refined in 2021. Rare, isolated case studies reporting aberrant findings or using non-accepted diagnostic criteria have been disproportionately emphasised to cast doubt on the connection between RHI and CTE.

In the review, Ann McKee, MD, chief of neuropathology at VA Boston Healthcare System and director of the BU CTE Center, stresses that now over 600 CTE cases have been published in the literature from multiple international research groups. And of those over 600 cases, 97% have confirmed exposure to RHI, primarily through contact and collision sports. CTE has been diagnosed in amateur and professional athletes, including athletes from American, Canadian, and Australian football, rugby union, rugby league, soccer, ice hockey, bull-riding, wrestling, mixed-martial arts, and boxing.

What’s more, 82% (14 of the 17) of the purported CTE cases that occurred in the absence of RHI, where up-to-date criteria were used, the study authors disclosed that families were never asked what sports the decedent played.

According to the researchers, despite global efforts to find CTE in the absence of contact sport participation or RHI exposure, it appears to be extraordinarily rare, if it exists at all. “In studies of community brain banks, CTE has been seen in 0 to 3 percent of cases, and where the information is available, positive cases were exposed to brain injuries or RHI. In contrast, CTE is the most common neurodegenerative disease diagnosis in contact and collision sport athletes in brain banks around the world. A strong dose response relationship is perhaps the strongest evidence that RHI is causing CTE in athletes,” she added.

“The review presents the timeline for the development of neuropathological criteria for the diagnosis of CTE which was begun nearly 100 years ago by pathologist Harrison Martland who introduced the term “punch-drunk” to describe a neurological condition in prizefighters,” explained McKee, corresponding author of the study. The review chronologically describes the multiple studies conducted by independent, international groups investigating different populations that found CTE pathology in individuals with a history of RHI from various sources.”

Source: Boston University School of Medicine

Categories : Ageing Injury & TraumaTags :

Mandatory Cognitive Screening for Older Drivers Reduces Car Crashes

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New research published in the Journal of the American Geriatrics Society reports that motor vehicle collisions decreased after Japan implemented a mandatory cognitive screening test for older drivers when they renewed their drivers’ licences. For older pedestrians and cyclists, however, their number of collisions and injuries increased.

For the study, investigators analysed police-reported data on the number of collisions for drivers and injuries for pedestrians and cyclists among people aged 70 years or older in Japan from July 2012 to December 2019. As of March 2017, drivers aged 75 years or older who screen positive are required to see a physician before license renewal. If diagnosed with dementia, their licenses may be suspended or revoked.

From 2012 to 2019, there were 602 885 collisions for drivers and 196 889 injuries for pedestrians and cyclists among people aged 70 years or older. After the 2017 policy, collisions decreased among male drivers, and injuries increased among some age subgroups in both sexes. Cumulative estimated changes in the numbers of collisions and injuries from March 2017 to December 2019 were -3670 and 959, respectively.

“Safety measures need to be strengthened for older cyclists and pedestrians. We should also provide older people with necessary care to prepare for driving cessation and safe, alternative transport means,” said corresponding author Haruhiko Inada, PhD, a post-doctoral fellow at the Johns Hopkins Bloomberg School of Public Health.

Source: Wiley

Categories : Injury & TraumaTags :

A Handheld Terahertz Scanner Could Accurately Assess Burns

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Ambulance
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Researchers have developed a handheld terahertz (THz) wave imaging device to assess burns faster and more accurately than current methods. The new device uses neural network model that uses terahertz time-domain spectroscopy (THz-TDS) data for non-invasive burn assessment.

“It is important for healthcare professionals to accurately assess the depth of a burn to provide the most appropriate treatment,” said research team leader M. Hassan Arbab from Stony Brook University. “However, current methods of burn depth evaluation, which rely on visual and tactile examination, have been shown to be unreliable, with accuracy rates hovering around 60–75%. Our new approach could potentially improve the accuracy of burn severity assessments and aid in treatment planning.”

THz-TDS uses short pulses of terahertz radiation, which lies between infrared and microwave wavelengths, to probe a sample. It is being examined for assessing burn injuries because physical changes caused by a burn will produce alterations in the skin’s terahertz reflectivity.

In the journal Biomedical Optics Express, the researchers reported that their artificial neural network classification algorithm was able to accurately predict the ultimate healing outcome of in vivo burns in an animal study with 93% accuracy. Their method needs much less training data, potentially making it more practical to process big data sets obtained over large clinical trials.

“In 2018, approximately 416 000 patients were treated for burn injuries in emergency departments in the United States alone,” said Arbab. “Our research has the potential to significantly improve burn healing outcomes by guiding surgical treatment plans, which could have a major impact on reducing the length of hospital stays and number of surgical procedures for skin grafting while also improving rehabilitation after injury.”

Better burn assessment

Various technologies have been developed to improve burn assessment, but they haven’t been widely adopted in the clinic due to drawbacks such as long acquisition times, high costs and limited penetration depth and field of view. Although THz-TDS looks promising for burn assessment, early demonstrations were limited to point spectroscopy measurements, which don’t account for burn heterogeneity and spatial variations. THz spectroscopy setups also tend to be bulky and difficult to set up.

“To address these challenges, we developed the portable handheld spectral reflection (PHASR) scanner, a user-friendly device for fast hyperspectral imaging of in vivo burn injuries using THz-TDS,” said Arbab. The device allows for “rapid imaging of a 37 x 27 mm2 field of view in just a few seconds.”

Previously, the researchers used numerical methods to extract features from the THz-TDS images and machine learning techniques to estimate the severity grade of in vivo burn injuries using measurements from the PHASR scanner. However, this approach did not consider the physical dynamics and macroscopic changes of the dielectric permittivity of burned skin tissue. Dielectric permittivity describes how a material responds to an electric field, and the researchers used Debye theory to explain how biological material interacts with THz waves.

The researchers tested their method by using the PHASR scanner to obtain spectroscopic images of skin burns and measure the permittivity of the burns. The researchers used this data to create a neural network model based on labelled biopsies. The model estimated the severity of the burns with an average accuracy rate of 84.5% and predicted the outcome of the wound healing process with an accuracy rate of 93%.

The researchers note that clinical testing of both the technique and the handheld imaging device are needed before this technique could be integrated into the existing workflow of clinical burn assessment.

Source: Optica

Categories : Injury & TraumaTags :

Head Injury Doubles Long-term Mortality Risk

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Adults who suffered any head injury during a 30-year study period had two times the rate of mortality than those who did not have any head injury, and mortality rates among those with moderate or severe head injuries were nearly three times higher, according to new research published in JAMA Neurology.

Head injury can be attributed to a number of causes, from motor vehicle crashes, unintentional falls, or sports injuries. Furthermore, head injury has been linked with a number of long-term health conditions, including disability, late-onset epilepsy, dementia, and stroke.

Previous studies have shown increased short-term mortality among hospitalised patients with head injuries. This longitudinal study evaluated 30 years of data from over 13 000 community-dwelling participants (ie not hospitalised or in nursing homes) to determine if head injury has an impact on mortality rates in adults over the long term. Of these, 18.4% reported one or more head injuries during the study period, and of those who suffered a head injury, 12.4% were recorded as moderate or severe. The median period of time between a head injury and death was 4.7 years.

Death from all causes was recorded in 64.6% of those individuals who suffered a head injury, and in 54.6% of those without any head injury. Accounting for participant characteristics, investigators found that the mortality rate from all-causes among participants with a head injury was 2.21 times the mortality rate among those with no head injury. Further, the mortality rate among those with more severe head injuries was 2.87 times the mortality rate among those with no head injury.

“Our data reveals that head injury is associated with increased mortality rates even long-term. This is particularly the case for individuals with multiple or severe head injuries,” explained the study’s lead author, Holly Elser, MD, PhD, MPH a Neurology resident at Penn. “This highlights the importance of safety measures, like wearing helmets and seatbelts, to prevent head injuries.”

Investigators also evaluated the data for specific causes of death among all participants. Overall, the most common causes of death were cancers, cardiovascular disease, and neurologic disorders (which include dementia, epilepsy, and stroke). Among individuals with head injuries, deaths caused by neurologic disorders and unintentional injury or trauma (like falls) occurred more frequently.

When investigators evaluated specific neurologic causes of death among participants with head injury, they found that nearly two-thirds of neurologic causes of death were attributed to neurodegenerative diseases, like Alzheimer’s and Parkinson’s disease. These diseases composed a greater proportion of overall deaths among individuals with head injury (14.2%) versus those without (6.6%). Further research into this association is recommended.

Source: University of Pennsylvania School of Medicine

Categories : Injury & TraumaTags :

New Microneedle Patch Rapidly Stops Bleeding

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Haemostatic microneedle technology can be applied like a typical adhesive bandage to quickly stop bleeding. The biocompatible and biodegradable microneedle arrays (MNAs) on the patch increase its surface contact with blood to accelerate the clotting process and also increase the adhesive properties of the patch via mechanical interlocking to promote wound closure. Credit: Designed by Amir Sheikhi and Reihaneh Haghniaz/Executed by Natan Barros. All Rights Reserved.

In the US, secondary, uncontrolled bleeding from traumatic injury is the leading cause of death from ages one to 46. Amir Sheikhi, assistant professor of chemical engineering and of biomedical engineering at Penn State, has a plan to change that with a novel microneedle patch that can immediately stop bleeding after injury.

He described his technology in a new paper in the journal Bioactive Materials.

“Excessive bleeding is a serious challenge for human health,” Sheikhi said. “With haemorrhaging injuries, it is often the loss of blood – not the injury itself – that causes death. There is an unmet medical need for ready-to-use biomaterials that promote rapid blood coagulation.”

Sheikhi’s haemostatic microneedle technology can be applied like a typical adhesive bandage to quickly stop bleeding. The biocompatible and biodegradable microneedle arrays (MNAs) on the patch increase its surface contact with blood, accelerating the clotting process. The needles also increase the adhesive properties of the patch via mechanical interlocking to promote wound closure.

“In vitro, the engineered MNAs reduced clotting time from 11.5 minutes to 1.3 minutes; and in a rat liver bleeding model, they reduced bleeding by more than 90%,” Sheikhi said. “Those 10 minutes could be the difference between life and death.”

The MNA patch is comparable hydrogel technology that is currently used to treat bleeding wounds in hospitals, but hydrogel applications require preparation and medical expertise. The microneedle patch is pre-engineered for immediate application that anyone can use to stop bleeding, Sheikhi said, much like a typical over-the-counter adhesive bandage.

Microneedles – which are already in use to deliver biologics, such as cells or drugs, through the skin or for cosmetic procedures to stimulate collagen production – are tiny, making their application pain-free, according to Sheikhi.

The researchers are now working to commercialise the patch, with more testing plans.

Source: Penn State

Categories : Injury & Trauma PaediatricsTags :

After Concussion, Kids Returning to School Sooner is Better

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Contrary to popular belief, rest may not always be the best treatment after a concussion, according to the results of a large multi-centre study published in JAMA Network Open. In fact, an early return to school may be associated with a lower symptom burden after suffering a concussion and, ultimately, faster recovery.

“We know that absence from school can be detrimental to youth in many ways and for many reasons,” says study lead author Christopher Vaughan, PsyD, neuropsychologist at Children’s National Hospital. “The results of this study found that, in general, an earlier return to school after a concussion was associated with better outcomes. This helps us feel reassured that returning to some normal activities after a concussion – like going to school – is ultimately beneficial.”

In this cohort study, data from over 1600 youths aged five to 18 were collected across nine paediatric emergency departments in Canada. Because of the large sample size, many factors associated with greater symptom burden and prolonged recovery were first accounted for through the complex statistical approach used to examine the data. The authors found that an early return to school was associated with a lower symptom burden 14 days post-injury in the 8 to 12 and 13 to 18-year-old age groups.

“Clinicians can now confidently inform families that missing at least some school after a concussion is common, often between 2 and 5 days, with older kids typically missing more school,” Dr Vaughan says. “But the earlier a child can return to school with good symptom management strategies and with appropriate academic supports, the better that we think that their recovery will be.”

The results suggest a possible mechanism of therapeutic benefit to the early return to school. This could be due to:

  • Socialisation (or avoiding the deleterious effects of isolation).
  • Reduced stress from not missing too much school.
  • Maintaining or returning to a normal sleep/wake schedule.
  • Returning to light-to-moderate physical activity sooner (also consistent with previous literature).

Source: Children’s National Hospital 

Categories : Emergency Medicine Injury & TraumaTags :

Aspirin as Effective as Heparin for Clot Prevention in Bone Fracture Hospitalisation

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Patients hospitalised with fractures typically receive low-molecular-weight heparin to prevent life-threatening blood clots. A new clinical trial, however, found that inexpensive over-the-counter aspirin is just as effective. The findings, published today in the New England Journal of Medicine, may lead surgeons to change their practice and administer aspirin to these patients.

With more than 12 000 patients, the multi-centre randomised clinical trial is the largest trial ever conducted on orthopaedic trauma patients. This multidisciplinary collaboration between orthopaedic surgeons and trauma surgeons points to the importance of evaluating techniques used to prevent post-surgical complications, like blood clots and infections, through high-quality, head-to-head comparison studies.

“Many patients with fractures will likely strongly prefer to take a daily aspirin over receiving injections after we found that both give them similar outcomes for prevention of the most serious outcomes from blood clots,” said the study’s principal investigator Robert V. O’Toole, MD. “We expect our findings from this large-scale trial to have an important impact on clinical practice that may even alter the standard of care.”

Patients who experience fractures that require surgery are at increased risk of developing blood clots, including life-threatening pulmonary embolisms. Current guidelines recommend prescribing low-molecular-weight heparin (enoxaparin) to prevent these clots, although smaller clinical trials in total joint replacement surgery suggested a potential benefit of aspirin as a less-expensive, widely available option.

The study enrolled 12 211 patients with leg or arm fractures that necessitated surgery or pelvic fractures regardless of the treatment. Half were randomised to 30mg of injectable enoxaparin twice daily. The other half received 81mg of aspirin twice daily. Patients were followed for 90 days to measure health outcomes from the two treatments.

The main finding of the study was that aspirin was “non-inferior,” or no worse than low molecular-weight heparin in preventing death from any cause – 47 patients in the aspirin group died, compared with 45 patients in the heparin group. For other important complications, the researchers also found no differences in pulmonary embolisms between the two groups. The incidence of bleeding complications, infection, wound problems, and other adverse events from the treatments was also similar in both groups.

Of all the outcomes studied, the only potential difference noted was in deep vein thrombosis. This condition was relatively uncommon in both groups as it occurred in 2.5% of patients in the aspirin group, and in 1.7% of patients in the heparin group.

“This relatively small difference was driven by clots lower in the leg, which are thought to be of less clinical significance and often do not require treatment,” said study co-principal investigator Deborah Stein, MD, MPH.

“Many patients don’t like giving themselves injections. It’s not fun in terms of giving the actual injection because it burns, and your stomach tends to bruise more easily compared to aspirin,” said Debra Marvel, a 53-year-old from Columbia, MD, who served as a patient advisor on the study. She received Lovenox (low-molecular-weight heparin) after her legs were crushed in a 2015 pedestrian accident, requiring multiple surgeries at the University of Maryland Shock Trauma Center. “Patients also prefer aspirin because Lovenox can be expensive based on insurance.”

“An estimated one million Americans are hospitalised each year with extremity fractures, and this new finding could help prevent potentially fatal blood clots in these patients using a medication that is cheaper and far easier to administer,” said Mark T. Gladwin, MD, Vice President for Medical Affairs, University of Maryland, Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine. “Given these important results, we can expect the guidelines for the prevention of blood clots to be revised to include the option of aspirin for patients with traumatic bone fractures.”

Source: University of Maryland School of Medicine

Categories : Injury & TraumaTags :

Slower Concussion Recovery for Athletes not All Bad News

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Athletes who recover more slowly from concussion may be able to return to play with an additional month of recovery beyond the typical recovery time, according to a new study published in the journal Neurology. Slow recovery was defined as taking more than 14 days for symptoms to resolve or taking more than 24 days to return to play, both of which are considered the typical recovery times for about 80% of athletes with concussion.

“Although an athlete may experience a slow or delayed recovery, there is reason to believe recovery is achievable with additional time and injury management,” said study author Thomas W. McAllister, MD, of the Indiana University School of Medicine in Indianapolis. “This is an encouraging message that may help to relieve some of the discouragement that athletes can feel when trying to return to their sport. While some athletes took longer than 24 days to return to play, we found that three-quarters of them were able to return to sports if given just one more month to recover.”

The study looked at 1751 American college athletes diagnosed with a concussion by a team physician. Of Male athletes (63%) participated primarily in football, soccer and basketball. Female athletes (37%) participated primarily in soccer, volleyball and basketball.

Participants were evaluated five times: within six hours after their injury, one to two days later, once free of symptoms, once cleared to return to play and at six months.

Participants reported symptoms daily to medical staff, up to 14 days following injury and then weekly if they had not yet returned to play.

A total of 399 athletes, or 23%, had a slow recovery.

Researchers found that of the athletes who took longer than 24 days to return to play, more than three-fourths, or 78%, were able to return to play within 60 days of injury, and four-fifths, or 83%, were able to return to play within 90 days of injury. Only 11% had not returned to play six months after injury.

For the slow recovery group, the average time for returning to play was 35 days after injury, compared to 13 days in the overall group.

“The results of this study provide helpful information for athletes and medical teams to consider in evaluating expectations and making difficult decisions about medical disqualification and the value of continuing in their sport,” McAllister said.

A limitation of the study is that participants were all collegiate varsity athletes and may not be representative of other age groups or levels of sport, and the results may not apply to other types of mild brain injuries.

Source: American Academy of Neurology

Categories : Injury & Trauma Regenerative MedicineTags :

Transplanted Hair Follicles Successfully Reduced Scars

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By treating skin scars in three volunteers with hair follicle transplants, researchers found that the scarred skin began to behave more like uninjured skin. According to the results published in Nature Regenerative Medicine, the scarred skin harboured new cells and blood vessels, remodelled collagen to restore healthy patterns, and even expressed genes found in healthy unscarred skin.

The findings could lead to better treatments for scarring both on the skin and inside the body, leading to hope for patients with extensive scarring, which can impair organ function and cause disability.

Lead author Dr Claire Higgins, of Imperial’s Department of Bioengineering, said: “After scarring, the skin never truly regains its pre-wound functions, and until now all efforts to remodel scars have yielded poor results. Our findings lay the foundation for exciting new therapies that can rejuvenate even mature scars and restore the function of healthy skin.”

Hope in hair

Scar tissue in the skin lacks hair, sweat glands, blood vessels and nerves, impairing temperature regulation and sensation. Scarring can also hinder movement as well as potentially causing discomfort and emotional distress.

Compared to scar tissue, healthy skin undergoes constant remodelling by the hair follicle. Hairy skin heals faster and scars less than non-hairy skin- and hair transplants had previously been shown to aid wound healing. Inspired by this, the researchers hypothesised that transplanting growing hair follicles into scar tissue might induce scars to remodel themselves.

To test their hypothesis, Imperial researchers worked with Dr Francisco Jiménez, lead hair transplant surgeon at the Mediteknia Clinic and Associate Research Professor at University Fernando Pessoa Canarias, in Gran Canaria, Spain. They transplanted hair follicles into the mature scars on the scalp of three participants in 2017. The researchers selected the most common type of scar, called normotrophic scars, which usually form after surgery.

They took and microscope imaged 3mm-thick biopsies of the scars just before transplantation, and then again at two, four, and six months afterwards.

The researchers found that the follicles inspired profound architectural and genetic shifts in the scars towards a profile of healthy, uninjured skin.

Dr Jiménez said: “Around 100 million people per year acquire scars in high-income countries alone, primarily as a result of surgeries. The global incidence of scars is much higher and includes extensive scarring formed after burn and traumatic injuries. Our work opens new avenues for treating scars and could even change our approach to preventing them.”

Architects of skin

After transplantation, the follicles continued to produce hair and induced restoration across skin layers.

Scarring causes the epidermis to thin out, leaving it vulnerable to tears. At six months post-transplant, the epidermis had doubled in thickness alongside increased cell growth, bringing it to around the same thickness as uninjured skin.

The next skin layer down, the dermis, is populated with connective tissue, blood vessels, sweat glands, nerves, and hair follicles. Scar maturation leaves the dermis with fewer cells and blood vessels, but after transplantation the number of cells had doubled at six months, and the number of vessels had reached nearly healthy-skin levels by four months. This demonstrated that the follicles inspired the growth of new cells and blood vessels in the scars, which are unable to do this unaided.

Scarring also increases the density of collagen fibres, causing them to align and make the scar stiffer. The hair transplants reduced the fibre density, allowing them to form a healthier, ‘basket weave’ pattern, which reduced stiffness – a key factor in tears and discomfort.

The authors also found that after transplantation, the scars expressed 719 genes differently to before. Genes that promote cell and blood vessel growth were expressed more, while genes that promote scar-forming processes were expressed less.

Underling mechanism still unknown

It is not known how exactly the transplants brought about the change. Having of a hair follicle in the scar was cosmetically acceptable for the participants as the scars were on the scalp. The researchers are now working to uncover the underlying mechanisms so they can develop therapies that remodel scar tissue towards healthy skin, without the hair follicle transplant. They can then test their findings on non-hairy skin, or on organs like the heart, which can suffer scarring after heart attacks, and the liver, which can suffer scarring through fatty liver disease and cirrhosis.

Dr Higgins said: “This work has obvious applications in restoring people’s confidence, but our approach goes beyond the cosmetic as scar tissue can cause problems in all our organs.

“While current treatments for scars like growth factors focus on single contributors to scarring, our new approach tackles multiple aspects, as the hair follicle likely delivers multiple growth factors all at once that remodel scar tissue. This lends further support to the use of treatments like hair transplantation that alter the very architecture and genetic expression of scars to restore function.”

Source: Imperial College London

Categories : Injury & Trauma Metabolic DisordersTags :

New Material Speeds up Diabetic Wound Healing

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University of Nottingham researchers have discovered a new class of polymer that can aid healing in hard-to-treat diabetic wounds by providing instructions to both immune and non-immune cells. This new material that can be applied to diabetic wounds to accelerated healing with just one application. The findings have been published in Advanced Materials.

Wound healing is a complex biological process that involves various cell types working together, with a cell type called fibroblasts playing a critical role in forming new tissue required for healing. Diabetes can disrupt these processes in cells making wound healing slow and difficult to treat. This can lead to infection and in extreme cases the need for amputation.

Experts from the School of Life Sciences and Pharmacy screened 315 different polymer surfaces, examining the different chemical make-up of each until they identified a polymer type that actively drives fibroblasts and immune cells to promote healing. A team from the School of Engineering made small particles that are decorated with this polymer on their surface. These particles could be directly applied to the wound area.

The long, repeating chain structure of polymers gives them unique properties that can be tailored for different uses. Using polymer microparticles the team showed how this new material, when delivered to a wound on an animal model, produces three times more fibroblast activity over a period of up to 96 hours and achieved more than 80% wound closure.

This new polymer could be applied as a coating to standard wound dressings to provide a fast and effective treatment.

Source: University of Nottingham