Injury
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The use of the intramedullary lengthening nail has gained in popularity over the last decade. The reduction in complications associated with the use of external fixators and excellent patient outcomes has resulted in the largest change in management of limb length discrepancy since the concept of distraction osteogenesis was accepted by the Western world in the 1980s. ⋯ This would offer the opportunity to consider simultaneous limb lengthening. The aim of this review is to evaluate the literature published over the last five years and highlight important learning points and technical tips for these expanding indications.
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The mechanical properties and microstructure of brain tissue, as its two main physical parameters, could be affected by mechanical stimuli. In previous studies, microstructural alterations due to mechanical loading have received less attention than the mechanical properties of the tissue. Therefore, the current study aimed to investigate the effect of ex-vivo mechanical forces on the micro-architecture of brain tissue including axons and glial cells. ⋯ Moreover, the results revealed that in both loading steps, the maximum cell-cell distance occurred at 15% strain, and this distance decreased for higher strains. Since 15% strain is close to the previously reported brain injury threshold, this evidence could suggest that at higher strains, the axons start to rupture, causing a reduction in the displacement of glial cells. Accordingly, it was concluded that more attention to glial cells' architecture during mechanical loading may lead to introduce a new biomarker for brain injury.
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Traumatic brain injury (TBI) is the most significant cause of death and disability resulting from major trauma. The aim of this study is to describe the demographics of TBI patients, the current pathways of care and outcomes in the Republic of Ireland from 2014 to 2019. ⋯ This population-based study bench marks the 'as is' for patients with TBI in Ireland. We found that presently in Ireland, the mortality rate from severe TBI appears to be higher than that reported in international literature, and only a minority of severe TBI patients are brought directly from the incident to a neurosurgical centre. The new major trauma system should focus on providing effective and efficient access to neurosurgical, neuro-critical and neuro-rehabilitative care for patients who sustain TBI.
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Randomized Controlled Trial
Clinical evaluation of automated segmentation for body composition analysis on abdominal L3 CT slices in polytrauma patients.
Sarcopenia is a muscle disease that involves loss of muscle strength and physical function and is associated with adverse health effects. Even though sarcopenia has attracted increasing attention in the literature, many research findings have not yet been translated into clinical practice. In this article, we aim to validate a deep learning neural network for automated segmentation of L3 CT slices and aim to explore the potential for clinical utilization of such a tool for clinical practice. ⋯ A deep learning method for automatic segmentation of truncal muscle, visceral and subcutaneous adipose tissue on individual L3 CT slices has been independently validated against expert human-generated results for an enlarged polytrauma registry dataset. Time efficiency, consistency and high accuracy relative to human experts suggest that quantitative body composition analysis with deep learning should is a promising tool for clinical application in a hospital setting.