Category: Injury & Trauma

Categories : Injury & TraumaTags :

Stopping Fatal Blood Loss With an Ancient Remedy – Clay

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Researchers are developing emergency injectable bandages that could decrease bleeding time by as much as 70% and revolutionise the future of trauma care.

Photo by Mat Napo on Unsplash

A massive number of traumatic injury deaths are the result of uncontrolled bleeding.

“Severe blood loss can rapidly lead to haemorrhagic shock,” said Dr Akhilesh Gaharwar, a biomedical engineering professor at Texas A&M University. “Many patients die within one to two hours of injury. This critical period is often referred to as the ‘golden hour.'”

Thanks to funding from the U.S. Department of Defense and the National Science Foundation, Gaharwar and his fellow researchers in the biomedical engineering department have found a way to extend this golden hour – using clay.

Gaharwar, Dr Duncan Maitland and Dr Taylor Ware are developing a suite of injectable haemostatic bandages – biomedical materials that stop bleeding and promote blood to clot faster. Their research is specifically targeting deep internal bleeding where traditional methods like compression are not possible.

Two papers, recently published in Advanced Science and Advanced Functional Materials demonstrate that these dressings can reduce bleeding time by almost 70%.

“Under normal circumstances, human blood clots within six to seven minutes,” said Gaharwar. “Using these haemostatic dressings, we are able to reduce the clotting time to one to two minutes.”

The goal is a lifesaving device simple enough that a critically injured person could apply it to themselves immediately after injury.

“For a self-applied or in-the-field-applied device, you can’t use the fancy mechanics and apparatus that you would have in the operating room,” said Ware. “There can’t be any special tools. You have to have something that just works and works quickly.”

The research hinges on a class of materials that have been used for wound treatment for thousands of years. Certain naturally occurring clay minerals contain silicate-based particles that can accelerate blood coagulation. The exact mechanics of this effect are still an active area of investigation.

“These clay particles were being used as a haemostat in ancient civilisations in China, Mesopotamia, Egypt, India, Greece and Rome, likely owing to their absorbency and tissue adherent properties” said Gaharwar. “Ancient peoples would make a paste out of water and clay particles and apply it to wounds to stop bleeding faster.”

Fascinated by the particle’s blood clotting properties, Gaharwar began to explore the potential uses of a synthetic particle, which would avoid the potential risk of infection that comes with natural clays.

The challenge is getting this particle to the injury site and keeping it there. High blood flow washes powders and pastes away. Not only does this fail to stop the bleeding, it risks killing the patient in another way. The nanosilicate particles are small enough to easily travel through blood vessels to non-injured areas of the body, causing life-threatening blood clots and embolism.

With the help of Maitland’s lab, the researchers combined the nanosilicate particles with an expanding foam. While completely stable in its applicator device, the particle-laced foam reacts to body heat. Once injected into a wound site, it expands to fill up the entire space, sealing severed blood vessels and holding the blood-clotting nanosilicate exactly where it needs to be. Since the foam forms a single piece, there is no risk of particles breaking away and traveling to form dangerous blood clots in other areas of the body.

In Ware’s lab, the researchers took an entirely different approach: micro-ribbons. This biomaterial is delivered in the form of multiple ribbon-like structures, each covered in coagulation-promoting nanosilicate particles.

Like the foam, the micro-ribbons exploit the patient’s body heat to trigger a reaction once in place. Each ribbon is made of two different materials, only one of which reacts to body temperature. Once in contact with the patient’s body, one side of the ribbon contracts, causing it to curl. As multiple ribbons curl at the injury site, they tangle together to form a single foam-like structure. Even if a single ribbon were able to escape, its size prevents it from traveling through blood vessels, keeping the blood-clotting nanosilicate exactly where it needs to be.

The combined expertise of all three research labs may be responsible for the future of trauma care.

“If these materials get into the first aid kits in an ambulance as well as a soldier’s backpack, they can save a lot of lives,” said Gaharwar. “If you can save 30-40% of haemorrhagic shock victims, that is a big achievement.”

Source: University of Texas

Categories : Emergency Medicine Injury & TraumaTags :

Intubation Before Hospital Admission for Major Trauma Saves Lives

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Photo by Mikhail Nilov

Trauma patients urgently requiring a breathing tube are more likely to survive if the tube is inserted before arriving at hospital compared to insertion afterwards, suggests a modelling study led by researchers at University College London and the Severn Major Trauma Network.

The researchers found that prehospital emergency intubation of high-risk trauma patients could improve 30-day survival by 10.3%, and could save 170 lives each year in the UK.

The findings of the new artificial intelligence (AI)-supported analysis, published in The Lancet Respiratory Medicine, provide\s the strongest evidence yet that prehospital emergency anaesthesia with intubation saves lives when delivered to those who need it most.

Trauma is a leading cause of death worldwide, with rates in South Africa 5–9 times higher than the global average. But there is a lack of high-quality evidence on the best time to start certain types of care for major trauma patients, such as the insertion of breathing tubes.

Prehospital intubation needs to be administered by an advanced critical care team, specially trained and equipped to administer the anaesthesia required to facilitate the insertion of breathing tubes. In the UK, that is currently provided only by the air ambulance services.

The researchers say their findings could inform policy discussions on funding specialist prehospital critical care teams, which could include public funding for air ambulances or funding additional training for ground ambulance teams, so that more high-risk major trauma patients can have breathing tubes inserted before arrival at hospital.

Joint first author Dr Amy Nelson (UCL Queen Square Institute of Neurology and King’s College London) said: “The airway is a top priority in major trauma, but the question of whether we should intubate before hospital arrival is unsettled because we cannot ethically conduct a randomised trial.

“Emergency care decisions made before hospital admission depend on the combination of many measurements taken under pressure. We used these measurements to answer the question in steps: we first built a machine learning model to identify high-risk patients, then we modelled the impact of early intubation in this group, which showed us that prehospital intubation saves lives.”

For the study, researchers analysed data from 6467 trauma patients treated at Southmead Hospital Major Trauma Centre, Bristol.

The researchers used AI-assisted modelling to predict both who would need intubation and who would likely survive – to isolate the impact that intubation had from other factors such as the injury severity. To facilitate their analysis, they developed a new machine learning model, called ‘Intub-8’, which predicted outcomes based on eight routinely collected prehospital measurements.

The researchers found that among high-risk patients who were identified by the model as needing intubation (229 patients), those who received it before arriving at hospital were 10.3% more likely to survive (within a 30-day period) compared with those who did not.

By scaling up their findings relative to national trauma incidence, the researchers estimate that if every trauma patient who needed prehospital intubation was given it, 170 lives could be saved each year in the UK – roughly one life saved every other day. 

Additionally, they conducted a cost-effectiveness analysis, finding that cost savings would be in the range of £101 million annually for the UK, due to reduced costs of further care and lives saved.

Professor Parashkev Nachev (UCL Queen Square Institute of Neurology), joint senior author, said: “In medicine, action and inaction are not morally asymmetric. When we cannot have randomised controlled trial evidence for an intervention, we must use the best available alternative: causal inference from real-world data, assisted by artificial intelligence, the only technology with the power to address the complexity of biological systems.”

Associate Professor Julian Thompson, joint senior author and Clinical Director of the Severn Major Trauma Network, said: “Until now, advanced air ambulance services across the world who respond to critically injured patients have struggled to conduct studies that assess the benefit and cost effectiveness of their life-saving interventions. The use of AI in this study has allowed us to analyse existing data in a totally new way. This reveals the huge impact that advanced care provides when delivered before arrival in hospital.

“These findings may have a huge impact on how UK and international health services look after the most severely injured patients in our societies.”

The authors note that the findings are specific to a mixed rural-urban UK setting where highly trained physician-paramedic teams perform all prehospital intubation. The survival benefit may differ in other healthcare systems or national contexts, and further research is needed to examine long-term outcomes and potential complications.

Source: University College London

Categories : Antibiotics Injury & TraumaTags :

New Device Sprays Antibiotics Deep into Wounds

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The new device sprays mist to treat deep wound infections without causing kidney damage

Hongmin Sun demonstrating the new device.

A University of Missouri researcher has unveiled a safer, smarter way to fight drug-resistant infections. Hongmin Sun, an associate professor in the School of Medicine, demonstrated that a spray-mist device can deliver last-resort antibiotics directly into infected tissue without the harmful side effects often caused by delivery via the bloodstream.

In a recent study, researchers worked with an industry partner to use a needle-free device to treat methicillin-resistant Staphylococcus aureus (MRSA), a dangerous bacterium that has become resistant to many common antibiotics.

The device successfully delivered the common last-resort antibiotic vancomycin deep into infected tissue without typical side effects such as kidney damage. Unlike topical creams or ointments that are easily wiped away or bloodstream delivery that risks organ damage, the spray-mist technology pushed the medicine through the skin to successfully treat the infection.

Sun collaborated with former Mizzou researcher Lakshmi Pulakat, now a professor of medicine at Tufts University, and Droplette Inc. to use the patented device for antibiotic delivery. The findings pave the way for future clinical trials as researchers seek FDA approval.

The team is hopeful the spray-mist device might one day be used in wound care in challenging settings.

“Whether it’s people with diabetic foot ulcers or soldiers hurt in battle, we wanted to come up with a new approach to treat these severely infected wounds in a more targeted way,” Sun said. “This can be a game-changing therapy for treating those with severely infected wounds.”

Pulakat said the technology is an example of compassionate care.

“This method of delivering last-resort antibiotics could prevent countless amputations and help save lives,” she said. “Dr. Sun is an internationally recognized expert in the field of pathogenic microbiology, and our collaboration with an industry partner has helped make this translational research possible.”

The study, “Preventing nephrotoxicity of vancomycin and attenuating deep tissue infections by methicillin-resistant Staphylococcus aureus via needle-free drug delivery by the Droplette micromist technology device” was published in Military Medicine.

By Brian Consiglio

Source: University of Missouri

Categories : Injury & TraumaTags :

Exposure to Burn Injuries may have Played Key role in Shaping Human Evolution

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Photo by sena keçicioğlu

Humans’ exposure to high temperature burn injuries may have played an important role in our evolutionary development, shaping how our bodies heal, fight infection, and sometimes fail under extreme injury, according to new research.

For more than one million years, the control of fire has powered human success, from cooking and heating to technology and industry, driving genetic and cultural evolution and setting us apart from all other species. But this relationship has also exposed humans to high temperature injuries at a scale unmatched in the natural world. 

Humans burn themselves – and survive burns – with a frequency likely much greater than any other animal. Most animals avoid fire completely, while in contrast, humans live alongside fire and most humans will experience minor burns throughout their lives. 

A new study published in BioEssays, led by Imperial College London researchers, suggests that this increased exposure to burn injuries may have driven notable genetic adaptations which differentiated humans from other primates and mammals. This may also explain both beneficial and maladaptive responses to severe burn injury. 

Burn injuries exist on a spectrum of severity, with most small injuries healing on their own while severe burns can lead to lifelong disability or death. Burns damage the skin, the body’s main protective barrier against infection, sometimes over large areas of the body. The longer the skin is damaged, the greater the risk that bacteria can enter the body and cause overwhelming infection. 

The researchers argue that natural selection would have favoured traits that helped humans survive small to moderate burns. These may include faster inflammation, faster wound closure (to prevent infection) and stronger pain signals. 

However, while these traits are helpful for less severe injuries, they can become harmful for large burns, which may explain why modern humans can experience extreme inflammation, scarring, and organ failure from major burns. 

Using comparative genomic data across primates, the researchers found examples of genes associated with burn injury responses which show signs of accelerated evolution in humans. These genes are involved in wound closure, inflammation and immune system response – likely helping to rapidly close wounds and fight infection; a major complication after burn injury, particularly before the widespread use of antibiotics. 

These findings support the theory that exposure to burn injuries may have been a notable force on the evolution of humans. 

Dr Joshua Cuddihy, lead author for the study, and Honorary Clinical Lecturer in Imperial’s Department of Surgery and Cancer, said: “Burns are a uniquely human injury. No other species lives alongside high temperatures and the regular risk of burning in the way humans do.  

“The control of fire is deeply embedded in human life — from a preference for hot food and boiled liquids to the technologies that shape the modern world. As a result, unlike any other species, most humans will burn themselves repeatedly over their lifetime, a pattern that likely extends back over a million years to our earliest use of fire.

“Our research suggests that natural selection favoured traits that improved survival after smaller, more frequent burn injuries. However, those same adaptations may have come with evolutionary trade-offs, helping to explain why humans remain particularly vulnerable to the complications of severe burns.”

The control of fire has powered human success for more than one million years

The research was developed through a collaboration between burn injury experts, evolutionary biologists, and genetics experts at Imperial, Chelsea and Westminster Hospital NHS Foundation Trust, and Queen Mary University of London.

The study’s novel perspective on human evolution, which could reshape our understanding of modern burn care and human biology, was made possible through interdisciplinary collaboration between clinicians and researchers. 

Professor Armand Leroi, Professor of Evolutionary Developmental Biology in Imperial’s Department of Life Sciences, said: “What makes this theory of burn selection so exciting to an evolutionary biologist is that it presents a new form of natural selection – one, moreover, that depends on culture. It is part of the story of what makes us human, and a part that we really did not have any inkling of before.”

Yuemin Li, PhD student at Queen Mary University of London, said: “Our study provides compelling evidence that humans have unique adaptive mutations in several key genes associated with burn injury response. 

“These findings could allow us to explore in future research how genetic variations in different groups impact burn injury response, potentially explaining why some patients heal well or poorly after a burn.” 

Unlike other wounds from cuts or bites which would have also led to infections, the increased lifetime risk of burns experienced by humans and their hominin ancestors is unique as they are the only species to regularly experience burn injuries and survive them. 

The researchers’ findings could change how we study burn injuries, design treatments, and interpret complications of burns. It may also explain why translating results on burn injuries from animal models to humans is often ineffective. 

Declan Collins, Consultant in Plastic and Reconstructive Surgery at Chelsea and Westminster Hospital NHS Foundation Trust, said: “Understanding the evolutionary drivers that cause genetic change is an important step in burn research that will influence the way in which we look at scar formation and wound healing. 

“The genetic basis for scarring variation in humans and response to tissue injury is still poorly understood, and this work will provide new angles for future research.” 

‘Burn Selection: How Fire Injury Shaped Human Evolution’ by Joshua Cuddihy et al. is published in Bioessays.

By Conrad Duncan

Source: Imperial College London

Categories : Dermatology Injury & TraumaTags :

The Face Scars Less than the Body – New Study Explains Why

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Photo by Tom Jur on Unsplash

The face is privileged when it comes to scarring after injury. A Stanford Medicine study in mice not only discovers why but also finds a drug that helps skin from other sites regenerate.

Tweaking a pattern of wound healing established millions of years ago may enable scar-free injury repair after surgery or trauma, Stanford Medicine researchers have found. If results from their study, which was conducted in mice, translate to humans, it may be possible to avoid or even treat the formation of scars anywhere on or within the body.

Scarring is more than a cosmetic problem. Scars can interfere with normal tissue function and cause chronic pain, disease and even death. It’s estimated that about 45% of deaths in the United States are due to some type of fibrosis – usually of vital organs like the lungs, liver or heart.

Scars on the skin’s surface, while rarely fatal, are stiffer and weaker than normal skin and they lack sweat glands or hair follicles, making it difficult to compensate for temperature changes.

Surgeons have known for decades that facial wounds heal with less scarring than injuries on other parts of the body. This phenomenon makes evolutionary sense: Rapid healing of body wounds prevents death from blood loss, infection or impaired mobility, but healing of the face requires that the skin maintain its ability to function well.

“The face is the prime real estate of the body,” said professor of surgery Michael Longaker, MD. “We need to see and hear and breathe and eat. In contrast, injuries on the body must heal quickly. The resulting scar may not look or function like normal tissue, but you will likely still survive to procreate.”

Exactly how this discrepancy happens has remained a mystery, although there were some clues.

“The face and scalp are developmentally unique,” said professor of surgery Derrick Wan, MD. “Tissue from the neck up is derived from a type of cell in the early embryo called a neural crest cell. In this study we identified specific healing pathways in scar-forming cells called fibroblasts that originate from the neural crest and found that they drive a more regenerative type of healing.”

Activating this pathway in even a subset of fibroblasts around small wounds on the abdomen or backs of mice caused them to heal with much less scarring – similar to untreated facial or scalp wounds.

Longaker, the Deane P. and Louise Mitchell Professor in the School of Medicine, and Wan, the Johnson & Johnson Distinguished Professor in Surgery II, are the senior authors of the study, which was published January 22 in Cell. Plastic surgery resident Michelle Griffin, MD, PhD, and clinical and postdoctoral scholar Dayan Li, MD, PhD, are the lead authors of the research.

“Many of the authors on this paper are fellow physician scientists,” said Li, who is board certified in dermatology. “This project was inspired by what we’ve observed in our patients – facial wounds in general heal with less scarring. We wanted to understand, mechanistically, why this is.”

Proteins determine scarring

Li and his colleagues used laboratory mice to investigate differences in wound healing at various sites on the animals’ bodies. They anesthetised the mice before creating small skin wounds on the face, scalp, back and abdomen. The wounds were stabilised by suturing small plastic rings around them to prevent differences in mechanical forces as the animals moved. Mice were given pain relief during the healing process.

After 14 days, the wounds on the face and scalp expressed lower levels of proteins known to be involved in scar formation as compared with those on the abdomen or back of the animals. The sizes of the scars were also smaller.

The researchers then transplanted skin from the face, scalp, back and abdomen of mice onto the backs of control mice. After the transplants had engrafted, they repeated the experiment on the transplanted skin. As before, wounds in the skin transplanted from the faces of the donor mice expressed lower levels of scarring-associated proteins.

Additionally, Li and his colleagues isolated fibroblasts from skin samples from the four body sites in the donor mice and injected them into the backs of control mice. They observed reduced levels of scarring-associated proteins on the recipient animals’ backs injected with fibroblasts from the donor animals’ faces as compared with fibroblasts from the scalp, back or abdomen.

Now that we understand this pathway and the implications of the differences among fibroblasts that arise from different types of stem cells, we may be able to improve wound healing after surgeries or trauma.”

–Derrick Wan

“We found you don’t need to change or manipulate all fibroblasts within the tissue to have a positive outcome,” Li said. “When we injected fibroblasts that we had genetically altered to more closely resemble facial fibroblasts, we saw that the back incisions healed very much like facial incisions, with reduced scarring, even when the transplanted fibroblasts made up only 10% to 15% of the total number of surrounding fibroblasts. Changing just a few cells can trigger a cascade of events that can cause big changes in healing.”

A less-fibrotic wound healing

Digging deeper, the researchers identified changes in gene expression between facial fibroblasts and those from other parts of the body and followed these clues to identify a signaling pathway involving a protein called ROBO2 that maintains facial fibroblasts in a less-fibrotic state. They also saw something interesting in the genomes of fibroblasts making ROBO2.

“In general, the DNA of the ROBO2-positive cells is less transcriptionally active, or less available for binding by proteins required for gene expression,” Li said. “These fibroblasts more closely resemble their progenitors, the neural crest cells, and they might be more able to become the many cell types required for skin regeneration.”

In contrast, the DNA in fibroblasts from other sites of the body allows free access to genes like collagen that are involved in the creation of scar tissue.

“It seems that, in order to scar, the cells must be able to express these pro-fibrotic genes,” Longaker said. “And this is the default pathway for much of the body.”

ROBO2 doesn’t act alone. It triggers a signalling pathway that results in the inhibition of another protein called EP300 that facilitates gene expression. EP300 plays an important role in some cancers, and clinical trials of a small drug molecule that can inhibit its activity are underway. Li and his colleagues found that using this pre-existing small molecule to block EP300 activity in fibroblasts prone to scarring caused back wounds to heal like facial wounds.

“Now that we understand this pathway and the implications of the differences among fibroblasts that arise from different types of stem cells, we may be able to improve wound healing after surgeries or trauma,” Wan said.

The findings are likely to extend to internal scarring as well, Longaker said. “There’s not a million ways to form a scar,” he said. “This and previous other findings in my lab suggest there are common mechanisms and culprits regardless of the tissue type, and they strongly suggest there is a unifying way to treat or prevent scarring.”

By Krista Conger

Source: Stanford University Medical Center

Categories : Injury & TraumaTags :

First Responders Could Soon Use a New Autoinjector to Control Severe Bleeding

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Photo by Mat Napo on Unsplash

A new study shows that a TXA autoinjector delivers lifesaving treatment for severe bleeding as effectively as traditional IV methods – but in under five minutes and without the need for medical expertise. This breakthrough could transform trauma care in emergencies, making rapid, easy-to-administer treatment available in settings ranging from battlefields to roadside accidents, where every second counts.

In a major breakthrough for emergency and trauma medicine, a group of researchers led by Prof Arik Eisenkraft and Prof David Gertz of the Institute for Research in Military Medicine (IRMM), Faculty of Medicine at The Hebrew University of Jerusalem, partnered with the IDF Medical Corps, have demonstrated that a simple autoinjector device can rapidly deliver Tranexamic Acid (TXA), an antifibrinolytic drug that helps stabilise blood clots and reduce blood loss, with the same effectiveness as traditional intravenous (IV) administration.

The study, recently published in the peer-reviewed journal Injury, highlights the potential for this technology to save lives in pre-hospital and battlefield settings, where timely intervention is critical and IV access may be delayed or impossible.

In Trauma, Every Second Counts

Severe bleeding is the leading cause of preventable death in trauma situations, from combat zones to highway accidents. TXA is already widely used in hospitals and dedicated trauma centres and by pre-hospital emergency responders. However, the standard IV method of administration can be difficult to perform in chaotic, high-stress environments, leading to dangerous delays in treatment.

Research has shown that for every 15-minute delay in administering TXA, its effectiveness drops by 10%, underscoring the need for a faster, simpler solution.

In the new study, the researchers found that TXA delivered via autoinjector reached effective therapeutic levels in less than five minutes and remained active throughout the treatment window.

Importantly, outcomes were comparable to intravenous delivery, with stable haemodynamic parameters and effective clot formation observed across all test subjects.

“When someone is bleeding heavily, every minute matters,” said Dr Eisenkraft. “With this autoinjector, even non-medical responders can administer lifesaving treatment almost instantly – and that can mean the difference between life and death.”

“This innovation could transform trauma response in the field,” added Dr Gertz. “From combat zones to roadside accidents and natural disasters, the ability to deliver a proven treatment quickly and easily has the potential to save countless lives.”

The simplicity and portability of the autoinjector device allow it to be used widely by paramedics, first responders, and military medics, ensuring that TXA can be administered within the critical early minutes following severe injury.

This research builds on ongoing efforts by Hebrew University and IDF scientists to improve emergency medical care in high-risk environments, ensuring that patients receive fast, effective interventions when and where they need them most.

Source: Hebrew University of Jerusalem

Categories : Injury & TraumaTags :

Study Sheds Light on Why Tendons Are Prone to Injury

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Achilles tendon injury. Credit: Scientific Animations CC0

Scientists at the University of Portsmouth have created the first detailed 3D map of how a crucial piece of connective tissue in our bodies responds to the stresses of movement and exercise. This tissue, called calcified fibrocartilage (CFC), acts like a biological shock absorber where tendons attach to bone.

Damage to the CFC tissue – common in sport-related injuries – does not mend well. To improve healing treatments, scientists need to better understand the structure of this tissue and how it reacts to varying types of pressure.

Research by Atousa Moayedi, a PhD student at the University of Portsmouth’s School of Electrical and Mechanical Engineering, has been able to demonstrate that the centre of the CFC tissue changes shape more than the surrounding areas, when stressed at different angles. 

In areas where the microscopic cavities within the tissue (the lacunae) were more densely packed, the distortion was greater. This means that the way the tissue layers are arranged, and how thick they are, strongly influences how stretching (strain) is dispersed where the tendon meets the bone.

The study, published in the Nature journal Communications Materials, is the first to measure how differently tiny regions inside this tissue stretch or deform when forces are applied.

Until now, scientists couldn’t see exactly how this tissue behaves when put under pressure, making it nearly impossible to design effective treatments. The research team used high resolution 3D scanning and AI powered image reconstruction to map the way in which CFC tissue behaves under pressure in a mouse model, as well as how and where it might fail. Importantly, they were also able to identify the features that would be important for healing.

Better understanding of how these attachments fail under stress could help prevent common sports injuries. Tennis champion Andy Murray has battled hip tendon problems, England cricket captain Ben Stokes has dealt with recurring knee tendon issues, and footballer Harry Kane has faced ankle tendon injuries that kept him off the pitch.

Atousa said: “Once you know which parts experience the most stress and why, you can design better treatments and implants that actually replicate how the natural attachment works.”

Overseeing the study, was Professor Gordon Blunn from the University of Portsmouth’s School of Medicine, Pharmacy and Biomedical Sciences. Professor Blunn said: “The weak link in the way that load is transferred from muscle to the skeleton is where the tendon joins with the bone. After injury this region is slow to heal and difficult to repair. Importantly, Atousa’s work identifies the way that load is naturally transferred in this region and serves as a model for the repair and regeneration of tissues at this site.”

Source: University of Portsmouth

Categories : Injury & Trauma Lab Tests and ImagingTags :

New Method Noninvasively Assesses Achilles Tendon in Dancers

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Photo by Nihal Demirci on Unsplash

A study in the Journal of Orthopaedic Research uses a noninvasive, nonradioactive imaging-based method to measure the structure and function of the Achilles tendon in professional ballet dancers. The method could potentially be developed to help prevent injuries and improve rehabilitation efforts in athletes, as well as in the general public.

The study involved what is called multi-echo ultrashort echo time (UTE) magnetic resonance imaging (MRI) to assess collagen and other components of the Achilles tendon. These structural UTE MRI assessments were combined with functional assessments of the Achilles tendon based on sheer wave elastography (SWE) ultrasound, which measures tendon stiffness.

Professional dancers tended to have more tendon stiffness compared with non-dancers, consistent with prior observations of a training effect from repeated loading with exercise. UTE MRI measures corresponded with the degree of stiffness from SWE ultrasound.

“These findings highlight the potential of integrating UTE and SWE imaging to investigate tendon structure‐function relationships and adaptations to mechanical loading,” the authors write. “Enhanced structure‐function assessment of tendon health and injury status could improve rehabilitation protocols or injury prevention strategies for athletes, including professional dancers.”

Source: Wiley

Categories : Injury & Trauma Pain ManagementTags :

Peri-neuronal Injection of Botulinum Eases Pain in Ukrainian Amputees

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Botulinum injection around neuromas may also be effective for other forms of pain

Photo by Raghavendra V Konkathi on Unsplash

Botulinum toxin injections provided greater short-term relief for phantom limb pain than standard medical and surgical care among Ukrainian war amputees, reports a new study led by Northwestern Medicine and Ukrainian physicians.

The study, which involved 160 amputees treated at two hospitals in western Ukraine between 2022 and 2024, could ultimately benefit millions worldwide, according to the research team.

Post-amputation pain affects most amputees. The condition limits prosthetic use, mobility and quality of life. In the US, more than 2 million people live with limb loss. In Ukraine, it is estimated that over 100 000 soldiers and civilians have lost limbs since Russia’s full-scale invasion, which began in 2022.

“Botulinum toxin injected into painful stumps of residual limbs and around neuromas was on some outcome measures more effective than comprehensive medical and surgical treatment at one month post-treatment,” said senior study author Dr Steven P. Cohen, a professor of anaesthesiology and the vice chair of research and pain medicine at Northwestern University Feinberg School of Medicine.

Dr. Steven Cohen is a retired U.S. Army colonel who traveled to Ukraine to collaborate with local doctors.

“Our results show that botulinum toxin potentially could be a powerful short-term tool for treating post-amputation pain when used alongside comprehensive medical and surgical care,” said co-author Dr. Roman Smolynets, an anesthesiologist and intensive care specialist at Multidisciplinary Clinical Hospital of Emergency and Intensive Care in Lviv, Ukraine.

“It could be another step toward helping amputees live with less pain and more dignity. But always as an additional point to comprehensive medical and surgical care, not as a monotherapy.”

The study was published in the journal Archives of Physical Medicine and Rehabilitation.

Assessing pain before and after treatments

All study participants were amputees treated at the First Medical Union of Lviv or Ivano-Frankivsk Regional Hospital. About one-fifth received botulinum toxin injections around painful nerve endings, called neuromas, in addition to standard medical and physical therapy. The other participants received comprehensive medical and surgical treatment, which included surgical revision, nerve blocks, physical and psychological therapy, medications and other interventional procedures.

The research team assessed pain levels at the start of treatment and after one and three months, focusing separately on phantom limb pain (pain in the missing limb) and residual limb pain (pain at the stump site).

At one month, the botulinum toxin group experienced an average reduction of four points in phantom limb pain on a 10-point scale, compared with just one point among patients in the comparison group. Also at one month, 69% of patients who received botulinum toxin achieved a meaningful improvement (defined as at least a 30% drop in pain) in phantom limb pain, versus only 43% in the other patient group.

However, the results shifted at three months: Patients who received comprehensive care showed more durable pain relief than the botulinum toxin group, consistent with previous research showing that botulinum toxin’s pain-relieving effects typically last about three months.

A novel way to inject botulinum toxin

While botulinum toxin injections, a non-surgical treatment that alleviates pain by blocking nerve signals, are most commonly known for their use in cosmetic procedures, they are also an established tool to treat chronic pain.

In the study, the substance was injected in a novel way. The research team used ultrasound guidance to inject botulinum toxin directly around painful nerve endings and surrounding soft tissues, rather than into muscle or skin. This targeted “peri-neuromal” approach, the scientists believe, may explain the strong short-term reduction in pain by quieting nerve activity and local inflammation. Previous studies have shown botulinum toxin to be effective for neuropathic pain, but none injected it around painful nerves.

The new findings suggest that botulinum toxin injections near nerves may also help relieve other types of nerve pain, such as shingles-related pain, carpal tunnel syndrome and pain following surgeries like mastectomy or thoracotomy.

Friendship with a Ukrainian anaesthesiologist

Cohen, who traveled to Ukraine in 2024 to help launch the study, is a retired U.S. Army colonel who served four overseas tours in support of military operations; his son currently serves with the infantry.

In Ukraine, he partnered with Smolynets, who has treated thousands of soldiers and civilians injured in the war by working in the country’s largest trauma and emergency center, and Dr. Nadiya Segin, who is pioneering the use of Botulinum toxin and nerve stimulation to treat war injuries.

Smolynets will visit Chicago the week of Oct. 19 with a Ukrainian delegation for an observership program, spending time with Cohen at his pain medicine clinic and at a Shirley Ryan AbilityLab in downtown Chicago. The two physicians, now close friends, are available for interviews during that week.

More research in Ukraine

Cohen and his colleagues stress the need for larger, randomized trials to confirm their findings, refine patient selection and optimize botulinum toxin dosing. Future research should also explore whether repeat botulinum toxin injections over time could produce sustained benefits for post-amputation pain, as they appear to do for migraine treatment.

Cohen and Smolynets, who published another study in February about using hydrodissection for post-amputation pain in Ukraine, are also researching more novel war treatments in Ukraine, at Walter Reed, and Northwestern, for traumatic brain injury and PTSD. These studies are underway. 

“As a retired colonel and the father of an infantry soldier who could be deployed in future conflicts and suffered from traumatic brain injury while at the U.S. Military Academy, this research carries special personal meaning for me,” Cohen said.

Source: Northwestern University

Categories : Injury & TraumaTags :

International Healthcare Workers Report on War Related Injuries Among Civilians in Gaza

On By ModernMedia

Findings suggest patterns of harm that exceed those reported in previous modern-day conflicts and provide critical insights to tailor humanitarian response

Photo by Mohammed Ibrahim on Unsplash

A British led study published by The BMJ provides detailed data on the pattern and severity of traumatic injuries and medical conditions seen by international healthcare workers deployed to Gaza during the ongoing military invasion.

Healthcare workers describe “unusually severe” traumatic injuries including complex blast injuries, firearm related injuries, and severe burns. Many respondents with previous experience of conflicts reported that the pattern and severity of injuries in Gaza were greater than those they had encountered in previous warzones.

It’s thought to be the first study to provide such detailed data from frontline clinicians during the conflict, which the authors say offers critical insights into the injuries and conditions most relevant to immediate management, rehabilitation, and long term health planning.

Since October 2023, Gaza has faced high intensity Israeli bombardment and ground military incursions. Publicly reported figures show that more than 59,000 Palestinians have been killed and over 143,000 wounded during the conflict, but other analyses suggest these figures may be higher.

To address this gap, healthcare workers were invited to take part in a survey about the nature and pattern of injuries and medical conditions they managed while in Gaza, ranging from explosive and firearm injuries to infections and chronic diseases.

A total of 78 doctors and nurses completed the survey using logbooks and shift records between August 2024 and February 2025, within 3 months of their deployment end date.

Participants represented 22 non-governmental organisations (NGOs) and were mainly from the US, Canada, the UK and European Union member states working in trauma surgery, emergency medicine, paediatrics, or critical care and anaesthesia.

Almost two thirds (65%) had prior experience working in an active conflict zone and their deployment to Gaza ranged from 2-12 weeks, contributing to a total of 322 weeks of frontline clinical care.

Overall, 23,726 trauma related injuries and 6,960 injuries related to weapons were reported. The most common traumas were burns (4,348, 18%), leg injuries (4,258, 18%), and arm injuries (3,534, 15%).

There were 742 obstetric cases reported, of which more than a third (36%) involved the death of the fetus, mother or both. Psychological trauma was also reported, with depression, acute stress reactions, and suicidal ideation being most common.

Some 70% of healthcare workers reported managing injuries across two or more anatomical regions and experiences of mass casualties were widespread, with 77% reporting exposure to 5-10 events and 18% managing more than 10 such scenarios.

Explosive injuries accounted for the majority of weapon related trauma (4,635, 67%), predominantly affecting the head (1,289, 28%) whereas firearm injuries targeted the legs (526, 23%).

The most common general medical conditions reported were malnutrition and dehydration, followed by sepsis and gastroenteritis. Healthcare workers also reported 4,188 people with chronic disease requiring long term treatment.

In free text responses, healthcare workers frequently described injuries as unusually severe, including multi-limb trauma, open skull fractures, and extensive injuries to internal organs. Severe burns were also emphasised, particularly in children.

Respondents with previous experience of deployment in other conflict zones commented that the severity and pattern of injuries encountered in Gaza were greater than those they had previously managed.

Despite the strength of this data, the authors acknowledge limitations. For instance, relying on logbooks and shift records inevitably introduces uncertainty, especially during periods of large influxes of injured people. Nor can they rule out the possibility of duplication, although further analyses indicated minimal impact on overall estimates.

However, they say the volume, distribution, and severity of injuries seem to indicate patterns of harm that exceed those reported in previous modern-day conflicts.

“These findings highlight the urgent need for resilient, context specific surveillance systems, designed to function amid sustained hostilities, resource scarcity, and intermittent telecommunications, to inform tailored surgical, medical, psychological, and rehabilitation interventions,” they conclude.

Source: BMJ Group