INTRODUCTION: Falls from heights contribute to 34% of fatal accidents in Singapore. Of these, 51% of the accidents occur in the construction industry. This retrospective review, of all persons falling from heights in the construction industry from 2006 to 2012 and attending a major hospital, analysed injury patterns and related them to mechanisms and contributory factors. METHODS: Information collected included injury and casualty characteristics, safety measures, pre-existing medical conditions and clinical outcomes. RESULTS: Of 1,085 patients, 951 were male with a mean age of 39.8 years, mean height of 165.9 cm and mean weight of 69.7 kg. Most of the casualties fell between 0800 and 2000 hours. Among the severely injured patients, 2.4% had head injuries, 54.9% had chest injuries and 39.2% had abdominal and pelvic injuries. For these casualties, the mortality rate was 60.8%. For patients with less than major trauma, the commonest injuries were in the lower limbs (41.8%), upper limbs (40.8%) and spine (22.2%). All the casualties survived. Falls from scaffolding, formwork and platforms were the most common causes of severe injuries (41.1%). Safety helmets and harnesses were reported to be used in 1.8% and 4.1% of instances of falls, respectively. CONCLUSION Studying the patterns of injuries following falls at construction sites has the potential for injury prevention through safe practices, use of safety equipment and targeted training.
Humans ; Male ; Adult ; Female ; Construction Industry ; Craniocerebral Trauma/etiology* ; Protective Devices ; Head Protective Devices ; Retrospective Studies ; Wounds and Injuries/etiology* ; Injury Severity Score

Objective Based on the theory of biomechanics, the finite element method was used to study the injury characteristics of different parts of brain hit by fist with different force and to predict the risk of craniocerebral injury, in order to provide reference for actual medical protection and forensic identification. Methods The finite element model of fist was constructed by using DICOM data modeling method and related software, and the effective mass and speed of fist were used to represent the kinetic energy of fist, and combined with human finite element model THUMS 4.02, the characteristics of craniocerebral injury caused by frontal and lateral blows were parametrically simulated. Results The probability of direct death from a blow to the head was low, but as fist power increased, so did the risk of craniocerebral injury. The characteristics of craniocerebral injury were also significantly different with the different fist hitting head locations. When the frontal area was attacked, the maximum equivalent stress of skull was 122.40 MPa, while that of brain tissue was 4.31 kPa. When the temporal area was attacked, the maximum equivalent stress of skull was 71.53 MPa, while that of brain tissue was 7.09 kPa. Conclusion The characteristics and risks of skull fracture and brain tissue injury are different when different parts of the brain are hit by fist. When the frontal area is hit, the risk of skull fracture is significantly higher than when the temporal area is hit. The risk of brain tissue injury is the opposite. The position with the highest probability of skull fracture is generally the place where the skull is directly impacted, and with the conduction of stress waves, it will spread to other parts of the skull, while the position with the highest risk of brain tissue injury is not the place where the brain is directly impacted.
Biomechanical Phenomena ; Craniocerebral Trauma/etiology* ; Finite Element Analysis ; Head ; Humans ; Skull ; Skull Fractures/etiology*

Hemorrhage of the basal ganglia is common in hypertensive patients, and most of the cases are spon- taneous unilateral hemorrhage. Traumatic basal ganglia hemorrhage is uncommon, while bilateral hemorrhage of the basal ganglia after trauma is an extremely rare entity. This report described a rare case of bilateral hemorrhage of the basal ganglia after head trauma. We also analyzed the mechanisms and reviewed relative literatures.
Basal Ganglia Hemorrhage ; diagnostic imaging ; etiology ; Craniocerebral Trauma ; complications ; Female ; Humans ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVETo observe the clinical effect of hyperbaric oxygen (HBO) therapy at different pressure levels on aphasia after craniocerebral injury and assess the patient adherence to the therapies.

METHODSThirty-one patients with aphasia after craniocerebral injury receiving 30 sessions of HBO therapy at the pressure level of 0.175 MPa and another 31 patients receiving 0.2 MPa therapy were recruited as the treatment groups 1 and 2, respectively; 31 patients who refused to have HBO therapy served as the control group. All the patients received routine therapy. The therapeutic effects were assessed using Western Aphasia Battery (WAB) before and after the therapy. The WAB item and AQ scores, curative effect, and recovery time of aphasia were compared between the 3 groups.

RESULTSThe total response rate was significantly lower in the control group as compared with those in treatment groups 1 and 2 (58.06% vs 83.87% and 87.1%). WAB item scores and AQ scores, curative effect, and recovery time of aphasia all showed significant differences between the control group and the two treatment groups (P<0.05), but not between the latter 2 groups (P>0.05). Compared with 0.20 MPa HBO therapy, 0.175 MPa HBO therapy showed a better patient adherence with a significantly lowered non-adherence rate (by 31.37%) an increased partial and total adherence rates (by 13.86% and 17.51%, respectively).

CONCLUSIONHBO therapy at the pressure level of 0.175 MPa is more appropriate for treatment of aphasia after craniocerebral injury to ensure the safety, efficacy and patient compliance.

Aphasia ; etiology ; therapy ; Craniocerebral Trauma ; complications ; therapy ; Humans ; Hyperbaric Oxygenation ; Patient Compliance ; Pressure

OBJECTIVETo compare the clinical therapeutic effects differences between acupuncture at Suliao (GV 25) and Shuigou (GV 26) on promoting regain of consciousness from coma in severe craniocerebral injury.

METHODSBased on regular emergency treatments of neurosurgery, eighty-two cases of craniocerebral injury who were under stable condition were randomly divided into an observation group (42 cases) and a control group (40 cases). Suliao (GV 25) was selected as main aupoint, while Laogong (PC 8) and Yongquan (KI 1), etc. were selected as adjuvant acupoints and Neiguan (PC 6), Sanyinjiao (SP 6), Yifeng (TE 17) and Wangu (GB 12), etc. were selected as matching acupoints in the observation group where a strong needle manipulation was applied to improve the regain of consciousness. The main acupoint of Shuigou (GV 26) along with identical adjuvant acupoints and matching acupoints in the observation group were selected in the control group with identical strong needle manipulation. The treatment was given once a day in both groups, five times per week and ten times were considered as one session. The immediate clinical symptoms after acupuncture at Suliao (GV 25) and Shuigou (GV 26) were observed as well as Glasgow coma scale (GCS) before the treatment, after 45 days and 90 days of treatment to assess the resuscitation time and rate. Also the clinical efficacy was compared between both groups.

RESULTSThe occurrence rate of sneezing reflex was 85.7% (36/42) in the observation group, which was higher than 25.0% (10/40) in the control group (P < 0.01). The average resuscitation time was (64.6 +/- 19.4) days in the observation group, which was obviously shorter than (73.8 +/- 14. 6) days in the control group (P < 0.05). The resuscitation rate was 88.1% (37/42) in the observation group, which was similar to 75.0% (30/40) in the control group (P > 0.05). Compared before the treatment, GCS were both improved after the treatment in two groups (both P < 0.01). The 90-day GCS was 9.52 +/- 2.32 in the observation group, which was superior to 8.47 +/-2.14 in the control group (P < 0.05). The curative and markedly effective rate was 45.2% (19/42) in the observation group, which was superior to 22.5% (9/40) in the control group (P < 0.05).

CONCLUSIONThe effect of acupuncture at Suliao (GV 25) on improving regain of consciousness from coma in severe craniocerebral injury is positive. It could specifically improve sneezing reflex and stimulate respiratory center, which has more obvious effect than acupuncture at Shuigou (GV 26).

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Coma ; etiology ; physiopathology ; psychology ; therapy ; Consciousness ; Craniocerebral Trauma ; complications ; Female ; Humans ; Male ; Middle Aged ; Young Adult

Acupuncture Therapy ; Adolescent ; Craniocerebral Trauma ; complications ; Humans ; Male ; Optic Nerve Injuries ; etiology ; physiopathology ; therapy ; Vision, Ocular

OBJECTIVE: To investigate the relation between the expression of tPA, MMP-2, MMP-9 and AEG-1 in the human brain tissue and the ethanol concentration under the acute alcohol poison, and to analyze the role of alcohol and trauma in the mechanism of death of subarachnoid hemorrhage. METHODS: Fifteen real cases were collected in this study. The brain tissues were researched by histological examination and the concentration of ethanol in heart blood were detected. The tPA, MMP-2, MMP-9 and AEG-1 in brainstem, brain and cerebellum were observed respectively by immunohistochemistry. RESULTS: In alcohol poisoning groups with or without trauma, the acute alcohol toxicity resulted in the swelling of brain tissues. The tPA, MMP-2, MMP-9 and AEG-1 of brainstem, brain and cerebellum showed high expression in alcohol victims, and the tPA in cerebellum showed no difference. The expression of the MMP-2, MMP-9 and AEG-1 showed good relation with the ethanol concentration in blood (P < 0.05, r > 0.6). CONCLUSION The expressions of tPA, MMP-2, MMP-9 and AEG-1 are significant higher in alcohol victims, and expressions of MMP-2 and MMP-9 and AEG-1 have positive correlation with the alcohol concentration. The alcohol has acute toxicity to brain cells.
Alcohol Drinking/adverse effects* ; Brain ; Cell Adhesion Molecules/metabolism* ; Craniocerebral Trauma/etiology* ; Death ; Ethanol/poisoning* ; Heart/drug effects* ; Humans ; Matrix Metalloproteinase 2/metabolism* ; Matrix Metalloproteinase 9/metabolism* ; Membrane Proteins ; RNA-Binding Proteins ; Subarachnoid Hemorrhage/complications*

Bacterial Infections ; epidemiology ; etiology ; Cerebral Hemorrhage ; diagnosis ; etiology ; therapy ; Craniocerebral Trauma ; diagnosis ; etiology ; therapy ; Female ; Fetal Membranes, Premature Rupture ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; diagnosis ; etiology ; therapy ; Pregnancy ; Risk Factors ; Tomography, X-Ray Computed

Acupuncture Points ; Adolescent ; Adult ; Aged ; Coma ; drug therapy ; etiology ; therapy ; Combined Modality Therapy ; Craniocerebral Trauma ; complications ; Drugs, Chinese Herbal ; administration & dosage ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Young Adult

Calcinosis ; complications ; Cerebral Infarction ; diagnosis ; etiology ; therapy ; Child ; Child, Preschool ; Craniocerebral Trauma ; complications ; Female ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Prognosis ; Tomography, X-Ray Computed