Playing-Related Musculoskeletal Disorders, Risk Factors, and Treatment Efficacy in a Large Sample of Oboists

ObjectivesDuring their lifetimes, a majority of musicians experience playing-related musculoskeletal disorders (PRMD). PRMD prevalence is tied to instrument choice, yet most studies examine heterogeneous groups of musicians, leaving some high-risk groups such as oboists understudied. This paper aims to (1) ascertain the prevalence and nature of PRMDs in oboists, (2) determine relevant risk factors, and (3) evaluate the efficacy of treatment methods in preventing and remedying injuries in oboe players.MethodsA 10-question online questionnaire on PRMDs and their treatments was completed by 223 oboists. PRMDs were compared across gender, weekly playing hours, career level, age, and years of playing experience.ResultsOf all respondents, 74.9% (167/223) reported having had at least one PRMD in their lifetime. A majority of these injuries (61.9% of all respondents) were of moderate to extreme severity (5 or higher on a scale of 1 to 10). Females (mean = 5.88) reported significantly more severe injuries than males. No significant effects of career level (i.e., professional vs. student vs. amateur), age, or years of playing experience were observed. We found significant non-linear relationships between weekly playing hours and PRMD prevalence and severity. Injuries were most commonly on the right side of the body, with the right thumb, wrist, hand, and forearm being most affected in frequency and severity. Of those injuries for which recovery information was provided, only 26.1% of injuries were “completely recovered.” The perceived effectiveness of a few treatments (physical therapy, rest, stretching, occupational therapy, massage) tended to be ranked more highly than others.ConclusionThe oboists in this study experienced high rates of PRMD, particularly in the right upper extremities. Females and those playing 7-9 and 16-18 h per week reported a significantly higher severity of injuries than other groups.

Management of Epileptic Seizures in Disorders of Consciousness: An International Survey

Epileptic seizures/post-traumatic epilepsy (ES/PTE) are frequent in persons with brain injuries, particularly for patients with more severe injuries including ones that result in disorders of consciousness (DoC). Surprisingly, there are currently no best practice guidelines for assessment or management of ES in persons with DoC. This study aimed to identify clinician attitudes toward epilepsy prophylaxis, diagnosis and treatment in patients with DoC as well as current practice in regards to the use of amantadine in these individuals. A cross-sectional online survey was sent to members of the International Brain Injury Association (IBIA). Fifty physician responses were included in the final analysis. Withdrawal of antiepileptic drug/anti-seizure medications (AED/ASM) therapy was guided by the absence of evidence of clinical seizure whether or not the AED/ASM was given prophylactically or for actual seizure/epilepsy treatment. Standard EEG was the most frequent diagnostic method utilized. The majority of respondents ordered an EEG if there were concerns regarding lack of neurological progress. AED/ASM prescription was reported to be triggered by the first clinically evident seizure with levetiracetam being the AED/ASM of choice. Amantadine was frequently prescribed although less so in patients with epilepsy and/or EEG based epileptic abnormalities. A minority of respondents reported an association between amantadine and seizure. Longitudinal studies on epilepsy management, epilepsy impact on neurologic prognosis, as well as potential drug effects on seizure risk in persons with DoC appear warranted with the goal of pushing guideline development forward and improving clinical assessment and management of seizures in this unique, albeit challenging, population.

Moderate and Severe Injuries at Five International Olympic-Style Wrestling Tournaments during 2016-2019

As a contact sport, wrestling may result in injuries. Based on the severity, they are classified as mild, moderate, severe and critical. All injuries occurring at international competitions are documented in a cloud-based surveillance system. The purpose of this study was to analyze the incidence and characteristics of moderate and severe (including critical) wrestling injuries that occurred during five international Olympic-style wrestling competitions in 2016-2019. Three Wrestling World Championships and two European Wrestling tournaments were organized by the Hungarian Wrestling Federation in 2016-2019. A total of 2483 wrestlers in three Olympic wrestling styles have competed in 3007 matches. Data from all injuries were recorded and analyzed to define rates, locations, types and severity, and to compare with previous reports. A total of 53 wrestlers sustained 55 injuries, which is equivalent to an overall injury incidence rate of 9.1‰ (9.1/1000 athletic exposures). Greco-Roman and Women Wrestling had the same injury incidence rate, while Freestyle had a lower one (9.5‰ versus 8.5‰). The injury proportion by regions and anatomic locations were on head and face 29.1%, spine and trunk 16.4 % and the upper-and-lower extremity injuries equally 27.3%. The most common types of injuries included ligament lesions, joint injuries, skin lacerations, and contusions. Five wrestlers (0.8‰) sustained strangulation or concussion. Wrestling injury rates during United World Wrestling competitions are not high, but when happen they can be serious. Despite relatively low incidence rate of injuries, there is a need for continuous education for medical teams, referees and coaches to avoid wrestling injuries.

Incidence of emergency neurosurgical TBI procedures: a population-based study

Background The rates of emergency neurosurgery in traumatic brain injury (TBI) patients vary between populations and trauma centers. In planning acute TBI treatment, knowledge about rates and incidence of emergency neurosurgery at the population level is of importance for organization and planning of specialized health care services. This study aimed to present incidence rates and patient characteristics for the most common TBI-related emergency neurosurgical procedures. Methods Oslo University Hospital is the only trauma center with neurosurgical services in Southeast Norway, which has a population of 3 million. We extracted prospectively collected registry data from the Oslo TBI Registry – Neurosurgery over a five-year period (2015–2019). Incidence was calculated in person-pears (crude) and age-adjusted for standard population. We conducted multivariate multivariable logistic regression models to assess variables associated with emergency neurosurgical procedures. Results A total of 2151 patients with pathological head CT scans were included. One or more emergency neurosurgical procedure was performed in 27% of patients. The crude incidence was 3.9/100,000 person-years. The age-adjusted incidences in the standard population for Europe and the world were 4.0/100,000 and 3.3/100,000, respectively. The most frequent emergency neurosurgical procedure was the insertion of an intracranial pressure monitor, followed by evacuation of the mass lesion. Male sex, road traffic accidents, severe injury (low Glasgow coma score) and CT characteristics such as midline shift and compressed/absent basal cisterns were significantly associated with an increased probability of emergency neurosurgery, while older age was associated with a decreased probability. Conclusions The incidence of emergency neurosurgery in the general population is low and reflects neurosurgery procedures performed in patients with severe injuries. Hence, emergency neurosurgery for TBIs should be centralized to major trauma centers.

Review of Traumatic Duodenal Injuries: Etiology, Diagnosis, and Management

Traumatic duodenal injuries are rare and often challenging to diagnose and treat. Management of these injuries remains controversial and continues to evolve. Here, we performed a review of the literature and guidelines for the diagnosis and management of traumatic duodenal injuries. A common recommendation in more recent literature is primary, tension-free repair of duodenal injuries when possible if surgical repair is necessary. Conversely, if duodenal injuries are unamenable to primary repair, more complex procedures such as Roux-en-Y duodenojejunostomy or pancreaticoduodenectomy may be necessary. Regardless of injury grade or type of surgical repair, the literature continues to support wide extraluminal drainage. Over time, the management of complex duodenal injuries has evolved to favor simple primary repair whenever possible. According to recent studies, more complex procedures are associated with higher rates of post-operative complications and should be reserved for severe injuries when primary repair is not possible.

Detecting Real-Time Fall of Elderly People Using Machine Learning

Fall is a significant national health issue for the elderly people, generally resulting in severe injuries when the person lies down on the floor over an extended period without any aid after experiencing a great fall. Thus, elders need to be cared very attentively. A supervised-machine learning based fall detection approach with accelerometer, gyroscope is devised. The system can detect falls by grouping different actions as fall or non-fall events and the care taker is alerted immediately as soon as the person falls. The public dataset SisFall with efficient class of features is used to identify fall. The Random Forest (RF) and Support Vector Machine (SVM) machine learning algorithms are employed to detect falls with lesser false alarms. The SVM algorithm obtain a highest accuracy of 99.23% than RF algorithm. Keywords: Fall detection, Machine learning, Supervised classification, Sisfall, Activities of daily living, Wearable sensors, Random Forest, Support Vector Machine

Penetrating Brain Trauma due to Air Gun Shot – a Case Report

Cases of severe injuries caused by air guns are really uncommon, but they can lead to a fatal outcome. Usually, these injuries occur in children due to their not fully developed skull bones or in adults through less resistant and thin regions of the cranium. Most of them are accidental events, followed by low percentage of suicidal attempts. In this paper, we present the case of a 68-year-old man suffering from severe depression, with self-inflicted air gun injury to the head. The patient was admitted to the hospital in a coma with a Glasgow Coma Scale (GCS) score of 8, with severe penetrating head injury manifested with brain contusion and intraventricular bleeding seen at the CT examination. Metal particles from the projectile were seen inside the brain. The entry wound had inverted margins, abraded collar and skin defect. The additional neurological examination of the patient showed symptoms of increased intracranial pressure. The treatment started with the air gun wound care. Craniotomy surgery was also done and bone fragments around the entry wound were successfully extracted with subsequent debridement and duraplasty. The patient was treated with new-generation combined antibiotics for preventing inflammatory complications. On the nineteenth day, the patient was discharged with mild hemiparesis on the left side and with GCS score of 15. Air-gun traumatic cases with head injury or with injury to other parts of the body are often mistaken for firearm accidents, because air guns are seriously underestimated devices. Nevertheless, they could lead to severe health consequences and severe disability. This case highlights the necessity of strict monitoring of air guns by the responsible government institutions which should apply the same regulations in controlling these weapons as they implement in controlling the firearm guns. Presence of severe depression, mental illnesses, and neoplasms are risk factors for committing suicide with this type of weapons and the control over the air weapons in this group of people should be stricter.

Macrophages break interneuromast cell quiescence by intervening the inhibition of Schwann cells in zebrafish lateral line

In the zebrafish lateral line system, interneuromast cells (INCs) between neuromasts are normally kept quiescent by underlying Schwann cells (SWCs). Upon severe injuries that cause the complete loss of an entire NM, INCs can occasionally differentiate into NMs but how they escape from the inhibition by SWCs is still unclear. Using a genetic/chemical method to specifically ablate a neuromast, we found a small portion of larvae can regenerate a new neuromast, but the regeneration was hindered by inhibiting macrophages. We also demonstrated that the inhibition of macrophage can reduce the percentage of tail fin-amputated larvae to regenerate a new NM. By in toto imaging, we further discovered heterogeneities in macrophage behavior and distribution along lateral line. We witnessed the crawling of macrophages in between injured lateral line and SWCs during regeneration and also in between the second primordium and the first mature lateral line during development. It implies that macrophages may physically separate and alleviate the inhibition from pLLn and SWCs to break the quiescence of INCs during regeneration and development in the zebrafish lateral line.

Оpen globe injury in children: epidemiology and predictors of an adverse outcome

Here we aimed to analyse the prevalence, clinical course, and current approaches to the prevention and treatment of open globe injury in children as well as its complications: hyphema, retinal detachment, traumatic uveitis, and endophthalmitis. Currently, children are responsible for the 10-15% of open globe injuries. In developed countries, open globe injury is the leading cause of monocular blindness in children. Open globe injury mainly affects boys (60−70% cases), yet severe injuries are rare, and closed globe injury is the most common type of eye injury. Most injuries are accidental and occur at home in daily life (50−60%), outdoors (20−35%), at school (1−5%), or while playing sports (1−3%). Open globe injury most often affects cornea and is associated with a high risk of early and late complications and poor outcomes. Wearing of protective glasses during sports and active recreation is recognised as an efficient tool for primary prevention of open globe injury in children. The main problems in prevention of complications of open globe injury are the lack of specialised care in low-income countries and the limited awareness of parents.

Concomitant Assessment of Monocyte HLA-DR Expression and Ex Vivo TNF-α Release as Markers of Adverse Outcome after Various Injuries—Insights from the REALISM Study

Intensive care unit (ICU) patients develop an altered host immune response after severe injuries. This response may evolve towards a state of persistent immunosuppression that is associated with adverse clinical outcomes. The expression of human leukocyte antigen DR on circulating monocytes (mHLA-DR) and ex vivo release of tumor necrosis factor α (TNF-α) by lipopolysaccharide-stimulated whole blood are two related biomarkers offered to characterize this phenomenon. The purpose of this study was to concomitantly evaluate the association between mHLA-DR and TNF-α release and adverse clinical outcome (i.e., death or secondary infection) after severe trauma, sepsis or surgery in a cohort of 353 ICU patients. mHLA-DR and TNF-α release was similarly and significantly reduced in patients whatever the type of injury. Persistent decreases in both markers at days 5–7 (post-admission) were significantly associated with adverse outcomes. Overall, mHLA-DR (measured by flow cytometry) appears to be a more robust and standardized parameter. Each marker can be used individually as a surrogate of immunosuppression, depending on center facilities. Combining these two parameters could be of interest to identify the most immunosuppressed patients presenting with a high risk of worsening. This last aspect deserves further exploration.