A Review of Cold Atmospheric Pressure Plasmas for Trauma and Acute Care

Despite the high overall survival rates of severely injured military and civilian personnel requiring trauma and acute care, the challenges of treating infections and healing-resistant wounds have grown. Exposure to unknown environmental pathogens at the wound, including parasites and antibiotic resistant microorganisms, hinders timely and effective treatment using traditional techniques. Cold atmospheric pressure plasma (CAPP) provides a promising biophysical tool to address these issues by applying physically created modalities that cannot be circumvented by bioresistance to inactivate microorganisms and enhance wound healing. CAPPs generate charged particles and numerous reactive oxygen species (ROS) and reactive nitrogen species (RNS) that act on biological cells and tissues, often through plasma membrane interactions. This review fills a gap in the plasma medicine literature by specifically focusing on applying CAPPs for acute trauma, such as surgery, wound treatment, and disinfection. After briefly highlighting the areas of opportunity for improving acute trauma treatment and the fundamentals of CAPP generation, this review details emerging applications of CAPPs for enhanced wound healing, burn treatment, transdermal delivery, and surgical applications. We also discuss CAPP optimization through novel device design and synergistic combination with traditional treatment technologies to transition this biophysical technology to the battlefield and acute care settings.

Evaluating the Diagnostic Pathway for Acute ACL Injuries in Trauma Centres: A Systematic Review

Objective: This review sought to evaluate the literature on the initial assessment and diagnostic pathway for patients with a suspected Anterior Cruciate Ligament (ACL) tear.Methods: MEDLINE, EMBASE, and CINAHL were systematically searched for eligible studies. Studies were included if they used at least one assessment method to assess for ACL injury and participants were assessed at an acute trauma centre within 6-weeks of injury. Article quality was evaluated using the QUADAS-2 checklist. Results: A total of 353 studies were assessed for eligibility, 347 were excluded for the following reasons: injuries were not assessed in an acute trauma setting, injuries were not acute, participants had previous ACL injuries or chronic joint deformities affecting the knee, participants were under 18, or participants included animals or cadavers. A total of six studies were included in the review. Common assessment methods included: laxity tests, joint effusion, inability to continue activity, and a history of a ‘pop’ and ‘giving way’ at the time of injury. Diagnostic accuracy varied greatly between the assessment method and the assessing clinician. Gold standard diagnostics were MRI and arthroscopy. A weighted meta-mean calculated the time to reach diagnosis to be 68.60 days [CI 23.94, 113.24]. The mean number of appointments to reach diagnosis varied from 2-5. Delay to surgery or surgical consultation ranged from 61 to 328 days. Conclusion: Clinicians in the Emergency Department are not proficient in performing the assessment methods that are used for diagnosis in acute ACL injury. Reliance on specialist assessments or radiological methods inevitably increases the time to reach a diagnosis, which has repercussions on management options. There is an ever-growing demand to improve diagnostic accuracy and efficiency, innovation into new diagnostic methods that require less specialist training would help improve patient care.

Role of Innate Immunity in Initiation and Progression of Osteoarthritis, with Emphasis on Horses

Osteoarthritis (OA) is a common condition with diverse etiologies, affecting horses, humans, and companion animals. Importantly, OA is not a single disease, but rather a disease process initiated by different events, including acute trauma, irregular or repetitive overload of articular structures, and spontaneous development with aging. Our understanding of the pathogenesis of OA is still evolving, and OA is increasingly considered a multifactorial disease in which the innate immune system plays a key role in regulating and perpetuating low-grade inflammation, resulting in sustained cartilage injury and destruction. Macrophages within the synovium and synovial fluid are considered the key regulators of immune processes in OA and are capable of both stimulating and suppressing joint inflammation, by responding to local and systemic cues. The purpose of this review is to examine the role of the innate immune system in the overall pathogenesis of OA, drawing on insights from studies in humans, animal models of OA, and from clinical and research studies in horses. This review also discusses the various therapeutic immune modulatory options currently available for managing OA and their mechanisms of action.

Neuroimaging

Neuroimaging is commonly used in the clinical setting to aid in determining a diagnosis and prognosis and in making therapeutic decisions. This chapter reviews indications, pitfalls, underlying physics, safety issues, and examples of select neuroimaging methods. Computed tomography (CT) is the most frequently used cross-sectional technique for the initial evaluation of a patient with acute neurologic symptoms because of its availability, speed, and reliability. CT is also invaluable for patients with acute trauma because of its high spatial resolution and bone–soft tissue contrast.

Three-dimensional biomodel in the treatment of bilateral mandibular fracture sequelae: a case report

Mandibular fractures lead to changes in occlusion, aesthetic deformities and functional alterations, when untreated, their sequelae may cause permanent problems, leading to a more complex treatment than the acute trauma. The treatment offers challenges that can be minimized with the aid of biomodels, printed by 3D technology. This article aims to report a biomodel-assisted surgical procedure for mandibular reconstruction, arguing how these prototypes may help to achieve better outcomes. The patient was involved in an automobile accident and sought treatment for the sequelae of mandibular fractures two years after the initial trauma. The biomodel printing of her mandible allowed for the execution of surgery on the model, reestablishing correct occlusion and facial aesthetics, and helping shorten the surgical time through the pre-bending of reconstruction plates. The patient improved uneventfully. The use of biomodels must be encouraged, especially in cases where the patient shows sequelae, when the anatomical landmarks are compromised, they offer more predictability for treatment outcomes, as described on this case report.