Search Results (166)

Background: This study aims to evaluate the use of the endoscopic transorbital approach for reducing frontal sinus fractures and compare its outcomes with the traditional bicoronal approach. Methods: A retrospective comparative analysis of case studies including all patients with frontal sinus fractures treated at our institution between January 2013 and December 2023 was conducted. Patients were categorized based on treatment approach (through traumatic laceration, bicoronal, or endoscopic transorbital). For the comparative analysis, cases with associated maxillofacial fractures or cerebrospinal fluid (CSF) leakage were excluded. Results: Out of 133 patients, 35 underwent surgery, with 6 patients treated using the endoscopic transorbital approach. This group of patients treated with the transorbital endoscopic approach demonstrated significantly shorter operative times compared to the bicoronal approach (mean 102 vs. 168 min, p = 0.021). They also had only minor complications, including temporary hypoesthesia and one transient ptosis. One patient had a minimal residual defect. The technique has been concluded to require endoscopic expertise. Conclusions: The endoscopic transorbital approach is a safe, minimally invasive alternative to the bicoronal approach for selected anterior wall frontal sinus fractures. Proper patient selection and surgical experience are essential to achieving favorable outcomes. Studies with longer follow-up are required to assess potential late complications, such as the development of mucoceles. Full article

The single greatest annual production cost for an established cider apple (Malus domestica Borkh.) orchard is the labor required to hand harvest. Reducing harvest labor time may increase the appeal and profitability of growing cider apples. Over-the-row mechanical harvest of cider apples using a modified Oxbo-Korvan 930 was evaluated in northwestern Washington, USA, in 2021, 2022, and 2023 in a fully mature cider apple orchard that was planted in 2014–2016. Sixteen cider apple cultivars grafted on ‘Geneva 935’ rootstock were summer hedged between 7 and 20 July each year of this study. Plant growth regulators were applied before harvest to equalize the timing of harvest among cultivars. There were no differences among cultivars for the percent of apples captured by the Oxbo-Korvan 930 harvester for the 3 years of this study. Across all years and cultivars studied, 82% of fruit were captured by the harvester. There also were no differences among cultivars for the percentage of fruit left on the tree by the harvester (9% of fruit on average), nor in the percentage of fruit dropped on the ground during harvest (9% of fruit on average). The overall mean number of branches broken during mechanical harvest across all cultivars was 1.4 per tree, and there were no differences among cultivars. ‘Sweet Alford’ had high spur removal (26 removed per tree), but excluding this outlier, only 6 spurs on average were removed per tree for all other cultivars. Laceration to fruit during mechanical harvest were positively correlated with mean fruit weight and mean fruit diameter. The overall average time required to mechanically harvest one tree in this orchard (1.8 m in-row spacing, 1495 trees·ha⁻¹) was 5.3 s, averaging 2.9 s per row-meter traveled. The average time required to manually harvest one tree was 229 s (3.8 min). The juice quality of the mechanically harvested apples that were kept in cold storage and pressed within 42 d of harvest did not differ largely or consistently from juice quality of apples that were pressed within 3 d of harvest, except that sugars (measured through ºBrix and specific gravity) increased with storage time, as expected. Mechanical harvest using the modified Oxbo-Korvan 930 appears to be a labor-efficient and effective method of harvesting cider apples, and testing is needed in commercial orchards to evaluate its viability compared to other harvest technologies. Full article

Physical hazards are the most common source of health effects among waste recyclers, frequently leading to worker injuries. South Africa’s formal buy-back centres (BBCs) have emerged as key nodes in the recycling chain, yet the burden of non-fatal workplace injuries among BBC recyclers is not characterised. We conducted a cross-sectional study at ten BBCs in Johannesburg, enrolling 160 waste recyclers (median age 32 years; 55.6% female). A structured, interviewer-led questionnaire captured workers’ characteristics and self-reported injuries in the past six months. Robust Poisson regression was fitted to determine associations with frequent workplace injury. Overall, 69.4% of participants reported at least one injury. Cuts and lacerations (67.6%) and sprains or muscle strains (39.6%) predominated. Each additional year of age raised the risk of frequent workplace injury by 1% (adjusted relative risk [aRR] 1.01; 95% CI 1.00–1.02), each extra hour worked per day by 22% (aRR 1.22; 95% CI 1.04–1.42), and presence of hearing or vision problems by 45% (aRR 1.45; 95% CI 1.14–1.83). Targeted interventions—such as work hour regulation, sensory-friendly accommodations, and comprehensive, fit-focused PPE programs—are needed to reduce injury risk in this vulnerable workforce. Full article

Background: Post-traumatic corneal wounds that require suturing are quite common; they reduce corneal transparency and cause corneal distortion, leading to corneal astigmatism and higher-order aberrations. Excimer laser treatment can be a potentially beneficial intervention for such wounds. The observation aimed to evaluate the effectiveness of topography-guided custom ablation treatment (TCAT) in patients with corneal injuries. Methods: This observation included three patients with corneal penetrating trauma (full-thickness corneal scar) and one patient with corneal blunt trauma, i.e., a non-penetrating injury with corneal laceration (partial-thickness corneal scar). This cohort study was conducted from July 2021 to August 2023. After first-stage treatment (stabilization of the post-traumatic visual defect confirmed by refraction and topography examination, corneal healing, and improvement of the corneal scar), the patients underwent the second-stage treatment, i.e., TCAT with a 20 to 45 s application of mitomycin C solution to avoid haze induction. After TCAT, the uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (BCVA) were measured. Refractive astigmatism was assessed using autorefractometry. Topographic astigmatism was analyzed using corneal topography and pachymetry. The root mean square (RMS) of the higher-order aberration was calculated using Zernike coefficients. The patients’ corneal healing and refractive changes were monitored. Results: All patients were monitored for corneal healing and refractive changes and underwent the same second-stage treatment, which utilized TCAT to regularize the corneal surface and reduce higher-order aberrations (HOAs). The UDVA of patients 1, 2, 3 and 4 improved by 3, 7.5, 4 and 6 rows (Snellen chart), respectively. The resultant UDVA was 1.0, 0.9, 0.7 and 1.2, while BCVA was 1.0, 1.2, 1.0, and 1.5, respectively. Conclusions: TCAT regularized the patients’ corneal surfaces and reduced HOAs. We, therefore, conclude that TCAT may be a beneficial second-stage treatment for corneal trauma-induced astigmatism. Full article

Iatrogenic urinary tract injury is a known complication of pelvic surgery, most commonly occurring during gynecological procedures. The bladder and ureters are particularly vulnerable due to their close anatomical proximity to the uterus. Urinary tract damage can result from various mechanisms, including laceration, ligation, and thermal injury. Incidence rates vary according to the affected organ and surgical type; bladder injuries occur in 0.24% of benign and 0.4–3.7% of oncologic surgeries, whereas ureteral injuries are reported in 0.08% of benign and 0.39–1.1% of oncologic procedures. Timely diagnosis is essential for effective management. When detected intraoperatively, the injury can often be repaired immediately. Surgical treatment options vary depending on the specific nature and location of the bladder or ureteral damage. Delayed diagnosis can significantly impact the patient’s quality of life, increasing the risk of severe complications such as genitourinary fistulas. This narrative review aims to summarize current evidence on the diagnosis, prevention, and treatment of urinary tract injuries occurring during gynecological surgery. It evaluates risk factors, incidence, management, complications, and prevention strategies for iatrogenic bladder and ureteral injuries. Additionally, it highlights the innovative role of artificial intelligence in preventing urologic damage during gynecological procedures. The relevant literature was identified through a structured search of the PubMed database using predefined keywords related to gynecological surgery and urinary tract injury. Full article

Background/objectives: Falls are a leading cause of traumatic injury and hospitalization for adults over the age of 65. While common, bed-related falls are relatively understudied when compared to ambulatory falls. The aim of this study is to characterize the risk factors for the hospitalization of older adults presenting to U.S. emergency departments (EDs) after a fall from bed. Methods: This was a cross-sectional study using publicly available data from the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) from 2014 to 2023, including all adults over the age of 65 presenting to the NEISS’s participating EDs with bed-related fall injuries. We identified fall injuries using a keyword search of the NEISS narratives and determined how the fall occurred by manually reviewing a randomized 3% sample of the narratives. We summarized demographics and injury patterns with descriptive statistics. We constructed a multivariable logistic regression model to identify risk factors for hospitalization and used Poisson regression to assess temporal trends in fall incidence and hospital admissions. Results: An estimated average of 320,751 bed-related fall injuries presented to EDs annually from 2014 to 2023. ED visits increased by 2.85% per year, while hospital admissions rose by 5.67% per year (p < 0.001). The most common injury patterns were superficial injuries (contusions, abrasions, lacerations, avulsions, and punctures) (28.6%), fractures (21.7%), and internal injuries (including concussions) (21.6%). Most of the falls occurred while transitioning into or out of bed (34.4%) or falling out of bed (56.8%). Hospitalization was required in 34.1% of cases and was associated with male sex, medication use at time of injury, and fracture injuries. Conclusions: Bed-related falls and associated hospitalizations are increasing among older adults. ED providers should understand risk factors for hospitalization in these common injuries such as male sex, medication use at time of injury, and high-risk injury patterns. Additionally, prevention efforts should focus on helping older adults remain safely in bed and then assisting with transitions into or out of bed. Full article

This case report describes index pancreatoduodenectomy in a 32-year-old male following a close-range gunshot wound to the abdomen, with consequent 4 cm pancreatic head defect, duodenal and common bile duct perforation, right kidney laceration, and through-and-through inferior vena cava (IVC) injury. Although standard trauma protocols often favor damage control surgery (DCS) with delayed reconstruction in unstable patients, this patient’s hemodynamic stability—attributed to retroperitoneal self-tamponade—enabled a single-stage definitive approach. The rationale for immediate reconstruction was to prevent the risks associated with delayed management, such as ongoing pancreatic and biliary leakage, chemical peritonitis, and subsequent sepsis or hemorrhage. This case highlights that, in select stable patients with severe pancreaticoduodenal trauma, immediate pancreatoduodenectomy may be preferable to DCS, provided care is delivered in a high-volume hepatopancreaticobiliary (HPB) center with appropriate expertise and resources. Full article

This study aims to rapidly in situ identify starch sausage samples with the improper addition of chicken bone paste. Chicken bones play important roles in building materials, biomass fuels, and as food additives after enzymatic hydrolysis, but no current research indicates that chicken bones can be directly added to food for consumption. Especially in starch sausages, the addition of chicken bone paste is highly controversial due to potential risks of esophageal laceration and religious concerns. This paper first uses laser-induced breakdown spectroscopy (LIBS) to investigate the elemental differences between starch sausages and chicken bone paste. By preparing mixtures of starch sausages and chicken bone paste at different ratios, the relationships between the spectral peak intensities of elements, such as Ca, Ba, and Sr, and the proportion of chicken bone paste were determined. Through processing methods such as normalization with reference spectral lines, selection of the signal of the second laser pulse at the same position, and electron temperature correction, the determination coefficients (R²) of each element’s spectral lines have significantly improved. Specifically, the R² values for Ca I, Ca II, Ba II, and Sr II have increased from 0.302, 0.694, 0.857, and 0.691 to 0.972, 0.952, 0.970, and 0.982, respectively. Finally, principal component analysis (PCA) was used to distinguish starch sausages, chicken bone paste, and their mixtures at different ratios, with further effective differentiation achieved through t-distributed stochastic neighbor embedding (t-SNE). The results show that LIBS technology can serve as an effective and rapid method for detecting elemental composition in food and distinguishing different food products, providing safety guarantees for food production and supervision. Full article

Background: Gluteal augmentation and reshaping have recently gained popularity due to growing patient demand. The rising number of intramuscular gluteal augmentation procedures has led to a corresponding increase in implants, although this has not reduced noticeable esthetic flaws and relatively common postoperative complications. The patient often opts for a secondary gluteal replacement implant. However, studies on this procedure are scarce. Methods: We describe our secondary submuscular gluteal implant replacement technique in patients complaining about dislocation or complications with the primary intramuscular gluteal implant. This procedure involved creating a new round implant pocket in a deeper anatomical plane while keeping the gluteus maximus muscle bridge that joins the intramuscular pocket with the submuscular pocket as intact as possible. To achieve this result, we describe the safest way to remove the intramuscular implant: a small incision is performed posterior to the iliac crest, through which the intramuscular gluteal implant is removed via a small intramuscular-subcutaneous tunnel. We reviewed surgical data, focusing on implant size choice and postoperative complications. Results: We performed this technique on 108 patients. The most frequent complications included three cases of laceration of the muscular bridge between the old intramuscular plane and the new submuscular pocket, resulting in both pockets merging, and eight cases with temporary nerve pain lasting a few days postoperatively. Conclusions: This study validates our approach for addressing and preventing dislocation or other complications from intramuscular gluteal augmentation procedures with implants by applying a safe technique that involves replacing the intramuscular implant with a submuscular one. Full article

Background: Work-related injuries remain a considerable global burden; nevertheless, progress in occupational safety has been made in decreasing the time to return to work. This study aimed to assess the pooled incidence of Return to Work (RTW) among workers with occupational injuries and to identify the key factors influencing RTW outcomes. Methods: A systematic review was conducted by searching electronic databases (PubMed, Embase, Cochrane CENTRAL, Web of Science, and Scopus) to include eligible cohorts. Meta-analysis was undertaken using R software 4.5.1 with random-effects models, and heterogeneity was evaluated using the I² statistic. Results: This meta-analysis included 16 cohorts, with 4164 workers. A pooled analysis of 14 studies showed that 79% of workers successfully returned to their jobs after treatment for work-related injuries (95% CI: 0.67–0.88; p < 0.0001; I² = 97.5%). Meta-regression identified age as a significant moderator, with older workers showing a higher incidence of RTW. The mean time to RTW, pooled from 9 studies, was approximately 102 days, with no significant age association (p = 0.222). Regarding predictors, male workers had a significantly higher RTW rate than females (p < 0.0001). Married persons showed greater RTW rates (p < 0.0001). Also, workers with higher education levels were more likely to return to work (p = 0.0033). For injury type, lacerations were related to a greater RTW rate than crushing injuries. Conclusions: This meta-analysis underscored a significant overall return-to-work rate after work-related injuries, with age, sex, marital status, education level, and injury type affecting results. Advanced age and male sex were substantially correlated with increased return-to-work rates. These findings support the necessity for personalized rehabilitation programs and focused support to enhance work reintegration following occupational accidents. Full article

Wound dressings have a significant role in managing trauma-related injuries, chronic lacerations, as well as post-operative complications, by preventing infections and promoting tissue regeneration. Conventional methods using sutures and gauze often pose constraints in healing effectiveness and cost. Emerging materials, particularly cellulose-based nanofibers, offer a favorable choice due to their biodegradability, biocompatibility, and structural similarity to the extracellular matrix. Cellulose, being an abundant, naturally available biopolymer, forms the basis for modern materials for wound dressing. It is a very resourceful material due to its capability to be processed into films, fibers, and membranes with tailored properties. Surface modification of cellulose membranes with nanoparticles or bioactive compounds assists in enhancing the antimicrobial properties and supports sustained drug release, essential in chronic wound infections. Electrospinning and other modern fabrication techniques allow for controlling the fiber morphology and drug-delivery characteristics. This review highlights the properties, fabrication techniques, surface functionalization, and biomedical applications of cellulose-based materials in wound care. With increasing demand for effective and cost-effective wound treatments, cellulose nanofibers stand out as a sustainable, multifunctional platform for cutting-edge wound dressings, offering improved healing, reduced scarring, and potential for amalgamation with several drug delivery and tissue engineering approaches. Full article

Background/Objectives: Despite recent advances in minimally invasive extrapleural lateral approaches, oblique lateral interbody fusion (OLIF) at the upper lumbar level is often difficult and limited to optimal reconstruction. We aimed to compare the radiological outcomes and approach-related complications of OLIF between the upper (L1–2 or L2–3) and lower (L3–4 or L4–5) levels. Methods: This study is a retrospective review of OLIF in the upper (n = 63) and lower (n = 60) lumbar level groups. Radiological parameters included the anterior/posterior disc height, coronal/sagittal disc angle, cage position, cage subsidence, and fusion rate at a postoperative 1-year follow-up. Approach-related complications including pleural/peritoneal lacerations, neurovascular injury, and other organ injuries were examined. Results: The baseline radiological parameters were similar between the two groups (all p > 0.05). At 1-year postoperatively, the anterior disc height (ADH) was significantly greater in the lower-level group (p = 0.031), while no significant differences were observed in the posterior disc height, coronal/sagittal disc angle, cage anterior position, or cage subsidence rate (all p > 0.05). The fusion rates were 97.9% and 95.0% at the upper and lower lumbar levels, respectively (p = 0.146). During OLIF at the upper lumbar level, chest tube insertion due to pleural laceration was observed in 11 (17.5%) cases. One case (1.2%) of segmental artery injury and two cases (3.2%) of pseudo-hernia were attributed to iliohypogastric nerve injury. Conclusions: Although the extrapleural approach in OLIF at the upper lumbar level is often limited, the radiological outcomes were comparable to those of OLIF at the lower lumbar level. Full article

Background: Chainsaw-related injuries vary from skin lacerations to amputation and may cause serious loss of work time in addition to temporary or permanent disability. Most studies in the literature have reported injuries to the lower or upper extremities separately. The aim of our study is to compare the loss of work time between upper- and lower-extremity chainsaw-related non-occupational injuries in rural areas. Methods: Chainsaw-related injuries that occurred in rural areas and were treated in our center between 2012 and 2022 were retrospectively reviewed. The patients’ demographics, the injured side and structures, the hand dominance of operators, lengths of hospital stays, the numbers of operations, complications, and loss of work time were recorded. Results: In total, 185 patients (181 males and four females) were enrolled in this study. The mean age was 45.5 years (range: 17–81). The mean follow-up time was 9.3 months (range: 6–24). The lower extremities were affected in 109 patients, while the upper extremities were affected in 76. The loss of work time was 60 and 75 days for lower- and upper-extremity injuries, respectively, and was statistically significantly higher for upper-extremity injuries (p < 0.001). The fracture rate was higher in the upper than the lower extremities, at 50% and 26.6%, respectively. Conclusions: Chainsaws may cause severe injuries in both the upper and lower extremities, and while the lower extremities were affected more frequently, upper-extremity injuries caused a greater loss of work time. Through the use of protective gear and simple precautions, chainsaw-related injuries and the associated loss of work time can be prevented. Full article

Background and Clinical Significance: In recent years, the catheter ablation of cardiac arrhythmias has significantly reduced the incidence of sudden cardiac deaths and the need for chronic antiarrhythmic therapy. Endocardial ablation of ventricular arrhythmias is less common than atrial ablation and is technically more challenging. There are few documented extracardiac complications for ventricular ablation, and there is no report of diaphragmatic laceration. Case Presentation: We report a case of acute diaphragmatic laceration following endovascular ventricular ablation resulting in the strangulation of the gastric fundus in a patient who experienced previous transcutaneous ventricular ablation two years before. The patient underwent exploratory laparoscopy, revealing a diaphragmatic laceration with incarceration of the gastric fundus. Resection of the gastric fundus, showing acute ischemic damage, and closure of the diaphragmatic defect near the right ventricle with sutures were required. No complications were observed in the postoperative course. Conclusions: Although diaphragmatic injury is extremely rare, it should be considered among the complications associated with ventricular ablation. Full article

Background/Objectives: Leishmaniasis is a neglected tropical disease caused by a protozoan parasite of Leishmania. This study aimed to evaluate the in vitro efficacy and toxicity of a previously developed amphotericin gel as a possible treatment for cutaneous leishmaniasis. Methods: First, quality control of the AmB-gel was carried out, including microbiological stability. The permeated and retained drug was tested on healthy and lacerated human skin. Tolerance to the AmB-gel was tested in vitro using HaCaT, RAW 264.7, and J774 cell lines and by an irritation test (HET-CAM). Promastigotes and amastigotes of various Leishmania species were tested, and the microscopic morphology of promastigotes exposed to the formulation was analyzed. Computational analysis was performed on the drug, polymer, and ergosterol in the promastigote. Results: The AmB-gel presented appropriate characteristics for topical use, including no microbial contamination after storage. The amount of drug retained on the intact and injured skin was 1180.00 ± 13.54 µg/g/cm² and 750.18 ± 5.43 µg/g/cm², respectively. The AmB-gel did not cause significant signs of toxicity. The IC₅₀ of the AmB-gel for promastigotes was less than 1 µg/mL for the four species examined, i.e., Leishmania infantum, Leishmania tropica, Leishmania major, and Leishmania braziliensis, and less than 2 µg/mL for amastigotes of Leishmania infantum and Leishmania tropica. The AmB-gel caused notable effects on the surface of promastigotes. Computational analysis revealed primarily hydrophobic and van der Waals interactions between AmB and Pluronic^® F127 and ergosterol. Conclusions: Based on the drug retention content and IC₅₀ values observed for both parasite stages, the AmB-gel may be a promising candidate for in vivo studies in patients with cutaneous leishmaniasis. Full article