Pressure. A Qualitative Analysis of the Perception of Concussion and Injury Risk in Retired Professional Rugby Players

This study interviewed retired professional rugby union players (≤10 years since retirement) to discuss their careers in the game of rugby union. The primary aim of the study was to document their understanding of concussion knowledge and the analogies they use to describe concussion. In addition, these interviews were used to determine any explicit and implicit pressures of playing professional rugby as described by ex-professional rugby players. Overall, 23 retired professional rugby players were interviewed. The participants had played the game of rugby union (n = 23) at elite professional standard. A semi-structured individual interview design was conducted with participants between June to August 2020. The research team reviewed the transcripts to identify the major themes from the interviews using a reflexive thematic analysis approach. Four major themes were identified: (1) medical and theoretical understanding of concussion, (2) descriptions of concussion and disassociated language, (3) personal concussion experience, and (4) peer influences on concussion within the sport. These were further divided into categories and subcategories. The interviews highlighted that players did not fully understand the ramifications of concussive injury and other injury risk, as it became normalised as part of their sport. This normalisation was supported by trivialising the seriousness of concussions and using dismissive language amongst themselves as players, or with coaching staff. As many of these ex-professional players are currently coaching rugby (48%), these interviews could assist coaches in treating concussion as a significant injury and not downplaying the seriousness of concussion in contact sports.

“Self-inflicted ballpoint pen in a male urinary bladder and successful endoscopic management - a rare case report ”

Background: Self-inflicted foreign bodies in the urinary bladder are extremely rare sometimes posing a great challenge in the management. Most of these objects are introduced through the urethra for sexual gratification. It is very rare for foreign bodies inserted per the urethra, to reach the bladder, especially in men owing to the anatomy of the urethra. Case presentation: We report a case of the self-inflicted ball-point pen in the urinary bladder of a male patient during the COVID-19 pandemic lock-down. The uniqueness of this presentation is the patient was able to negotiate the foreign body through the normal curvatures of the urethra to reach the urinary bladder in its entirety without causing any significant injury to the lower urinary tract and its successful endoscopic extraction using nephroscope and the challenges faced during the extraction. Conclusion: This is the first reported successful endoscopic extraction of a long rigid foreign body from a male urinary bladder. A combined or open procedure is the usual approach for the removal of large bladder foreign bodies. It is now clear to us that the even long rigid bladder foreign bodies in men can be extracted successfully with endoscopy provided adequate endoscopic instruments and armamentarium are available

Locked Intramedullary Nailing versus Compression Plating for Stable Ulna Fractures: A Comparative Study

Background: Isolated ulna shaft fractures (USFs) are a relatively uncommon, but significant, injury. For unstable USF treatment, open reduction and internal fixation (ORIF) is the gold standard, while for stable USFs several procedures were described. The aim of this study is to compare the outcomes in patients with stable USFs treated by either ORIF or intramedullary nail (IMN). Methods: According to their surgical treatment, 23 eligible USF-affected patients were divided into ORIF (14 subjects) and IMN (nine subjects) groups. The subjects underwent postoperative clinical follow-up at 1, 3, 6, and 12 months, which included calculation of the Disabilities of the Arm, Shoulder and Hand (DASH) score and radiological follow-up. Time to union, time to return to sporting and occupational activities, duration of physical therapy, and surgical complications were recorded. Results: DASH scores improved in both groups at the 6-month follow-up (p < 0.001). The IMN cohort recorded better DASH scores at the 1- and 3-month follow-ups, while similar results were reported at the 6- and 12-month follow-ups. Earlier fracture union (p = 0.001) and return to sporting activities and work (p = 0.002) were seen in the IMN group, compared with the ORIF group. No complications were observed in the IMN group. Conclusions: The surgical treatment of isolated USF results in excellent functional and radiographic outcomes. IMN may be preferable, compared with ORIF, due to its faster recovery time, expedited union, and reduced likelihood of complications.

“Self-inflicted ballpoint pen in a male urinary bladder and successful endoscopic management - a rare case report ”

Background: Self-inflicted foreign bodies in the urinary bladder are extremely rare sometimes posing a great challenge in the management. Most of these objects are introduced through the urethra for sexual gratification. It is very rare for foreign bodies inserted per the urethra, to reach the bladder, especially in men owing to the anatomy of the urethra.Case presentation: We report a case of the self-inflicted ball-point pen in the urinary bladder of a male patient during the COVID-19 pandemic lock-down. The uniqueness of this presentation is the patient was able to negotiate the foreign body through the normal curvatures of the urethra to reach the urinary bladder in its entirety without causing any significant injury to the lower urinary tract and its successful endoscopic extraction using nephroscope and the challenges faced during the extraction.Conclusion: This is the first reported successful endoscopic extraction of a long rigid foreign body from a male urinary bladder. A combined or open procedure is the usual approach for the removal of large bladder foreign bodies. It is now clear to us that the even long rigid bladder foreign bodies in men can be extracted successfully with endoscopy provided adequate endoscopic instruments and armamentarium are available

Hydrogen Sulfide: Novel Endogenous and Exogenous Modulator of Oxidative Stress in Retinal Degeneration Diseases

Oxidative stress (OS) damage can cause significant injury to cells, which is related to the occurrence and development of many diseases. This pathological process is considered to be the first step to trigger the death of outer retinal neurons, which is related to the pathology of retinal degenerative diseases. Hydrogen sulfide (H2S) has recently received widespread attention as a physiological signal molecule and gas neuromodulator and plays an important role in regulating OS in eyes. In this article, we reviewed the OS responses and regulatory mechanisms of H2S and its donors as endogenous and exogenous regulators in retinal degenerative diseases. Understanding the relevant mechanisms will help to identify the therapeutic potential of H2S in retinal degenerative diseases.

Genetic Divergence and Polyphyly in the Octocoral Genus Swiftia [Cnidaria: Octocorallia], Including a Species Impacted by the DWH Oil Spill

Mesophotic coral ecosystems (MCEs) are recognized around the world as diverse and ecologically important habitats. In the northern Gulf of Mexico (GoMx), MCEs are rocky reefs with abundant black corals and octocorals, including the species Swiftia exserta. Surveys following the Deepwater Horizon (DWH) oil spill in 2010 revealed significant injury to these and other species, the restoration of which requires an in-depth understanding of the biology, ecology, and genetic diversity of each species. To support a larger population connectivity study of impacted octocorals in the GoMx, this study combined sequences of mtMutS and nuclear 28S rDNA to confirm the identity of Swiftia sea fans in the GoMx, compare these markers for different polyp colors in the GoMx and Atlantic, and examine the phylogeny of the genus. Two mtMutS haplotypes were identified, one seemingly endemic to the northern GoMx. Compared to other North Atlantic Swiftia, S. exserta, the type of the genus was found to be extremely divergent and distinct from the two other Swiftia at both loci, with strong evidence of polyphyly in the genus. This information refines our understanding of the geographical distribution of injured coral and highlights how little is known about MCEs. Substantial taxonomic revisions may be needed for several taxa injured by the DWH oil spill.

Prehospital shock index outperforms hypotension alone in predicting significant injury in trauma patients

BackgroundThe American College of Surgeons Resources for Optimal Care of the Injured Patient recommends using hypotension, defined as systolic blood pressure ≤90 mm Hg, as an indicator of a full team trauma activation. We hypothesized that an elevated shock index (SI) predicts significant traumatic injuries better than hypotension alone.MethodsThis is a retrospective cohort study analyzing full team trauma activations between February 2018 and January 2020, excluding transfers and those who had missing values for prehospital blood pressure or heart rate. We reviewed patients’ demographics, prehospital and emergency department vitals, injury pattern, need for operation, and clinical outcomes. The primary outcome was rate of significant injury defined as identified injured liver, spleen, or kidney, pelvis fracture, long bone fracture, significant extremity soft tissue damage, hemothorax, or pneumothorax.ResultsAmong 544 patients, 82 (15.1%) had prehospital hypotension and 492 had normal blood pressure. Of the patients with prehospital hypotension, 34 (41.5%) had a significant injury. There was no difference in age, gender, medical history, or injury pattern between the two groups. There was no difference between the two groups in rate of serious injury (41.5% vs. 46.1%, NS), need for emergent operation (31.7% vs. 28.1%, NS) or death (20.7% vs. 18.8%, NS). On the other hand, SI ≥1 was associated with increased rate of serious injury (54.6% vs. 43.4%, p=0.04). On a logistic regression analysis, prehospital hypotension was not associated with significant injury or need for emergent operation (OR 0.83, 95% CI 0.51 to 1.33 and OR 1.32, 95% CI 0.79 to 2.25, respectively). SI ≥1 was associated with both increased odds of significant injury and need for emergent operation (OR 1.57, 95% CI 1.01 to 2.44 and OR 1.64, 95% CI 1.01 to 2.66).DiscussionSI was a better indicator and could replace hypotension to better categorize and triage patients in need of higher level of care.Level of evidencePrognostic and epidemiologic, level III.