Marine biological injuries and their medical management: A narrative review

The marine environment can be extremely dangerous, and the harm caused by marine organisms when they contact the human body can be especially harmful, even deadly. Contact includes stings, bites, wounds, and consumption as food. In this article, the characteristics of the common marine biological injuries are summarized, the major marine organisms causing damage in China’s marine waters are described, and injury prevention and treatment methods are discussed.     

Health risks for marine mammal workers

Marine mammals can be infected with zoonotic pathogens and show clinical signs of disease, or be asymptomatic carriers of such disease agents. While isolated cases of human disease from contact with marine mammals have been reported, no evaluation of the risks associated with marine mammal work has been attempted. Therefore, we designed a survey to estimate the risk of work-related injuries and illnesses in marine mammal workers and volunteers. The 17-question survey asked respondents to describe their contact with marine mammals, injuries sustained, and/or illnesses acquired during their period of marine mammal exposure. Most respondents, 88% (423/483), were researchers and rehabilitators. Of all respondents, 50% (243/483) reported suffering an injury caused by a marine mammal, and 23% (110/483) reported having a skin rash or reaction. Marine mammal work-related illnesses commonly reported included: 'seal finger' (Mycoplasma spp. or Erysipelothrix rhusiopathiae), conjunctivitis, viral dermatitis, bacterial dermatitis, and non-specific contact dermatitis. Although specific diagnoses could not be confirmed by a physician through this study, severe illnesses were reported and included tuberculosis, leptospirosis, brucellosis, and serious sequelae to seal finger. Risk factors associated with increased odds of injury and illness included prolonged and frequent exposure to marine mammals; direct contact with live marine mammals; and contact with tissue, blood, and excretions. Diagnosis of zoonotic disease was often aided by veterinarians; therefore, workers at risk should be encouraged to consult with a marine mammal veterinarian as well as a physician, especially if obtaining a definitive diagnosis for an illness becomes problematic.     

Injuries from antipersonnel mines: the experience of the International Committee of the Red Cross.

OBJECTIVE--To describe and quantify patterns of injury from antipersonnel mines in terms of distribution of injury, drain on surgical resources, and residual disability. DESIGN--Retrospective analysis. SETTING--Two hospitals for patients injured in war. SUBJECTS--757 patients with injuries from antipersonnel mines. MAIN OUTCOME MEASURES--Distribution and number of injuries; number of blood transfusions; number of operations; disability. RESULTS--Pattern 1 injury results from standing on a buried mine. These patients usually sustain traumatic amputation of the foot or leg; they use most surgical time and blood and invariably require surgical amputation of one or both lower limbs. Pattern 2 injury is a more random collection of penetrating injuries caused by multiple fragments from a mine triggered near the victim. The lower limb is injured but there is less chance of traumatic amputation or subsequent surgical amputation. Injuries to the head, neck, chest, or abdomen are common. Pattern 3 injury results from handling a mine: the victim sustains severe upper limb injuries with associated face injuries. Eye injuries are common in all groups. CONCLUSIONS--Patients who survive standing on a buried mine have greatest disability. Non-combatants are at risk from these weapons; in developing countries their social and economic prospects after recovery from amputation are poor.     

Separation and analysis of different types of nematocysts from <Emphasis Type="Italic">Cyanea capillata</Emphasis> (L.) medusae

Medusae play an important role in marine ecosystems, as competitors of many invertebrate and fish species. Additionally, jellyfish stings can cause severe pain, inflammation of the affected skin, and allergic reactions in human. Climate and environmental changes are likely to affect the medusae, but it is not yet clear whether these will affect their distribution, physiology, and their toxicity. Very little is known about the effect of biotic and abiotic factors on the proliferation and the distribution of medusan nematocysts. In this study, we compared three types of nematocysts (euryteles and A- and O-isorhizas) and venoms of Cyanea capillata medusae (Scyphozoa) obtained from the North Sea and the Baltic Sea, which have different salinity and temperature ranges. Different types of nematocysts were separated by laser microdissection and pressure catapulting (LMPC), and the proteinaceous contents of the nematocysts were analyzed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Medusae from the brackish Baltic Sea possessed more euryteles than those from the North Sea. The O-isorhizas and A-isorhizas were smaller in the Baltic Sea sample compared to the North Sea samples and the length-to-width ratios were larger in the Baltic Sea sample. Moreover, the pattern of proteins (potential toxins) obtained from the separated nematocysts showed differences among samples and nematocyst types, but no clear pattern was observable. This study displays the novel LMPC/MALDI-TOF MS approach as a useful tool to investigate the function and venom of cnidarian nematocysts types.     

Clinical Features of Severe Wasp Sting Patients with Dominantly Toxic Reaction: Analysis of 1091 Cases

Background

Massive wasp stings have been greatly underestimated and have not been systematically studied. The aim of this study was to identify the clinical features and treatment strategies of severe wasp stings.

Methods and Findings

A multicenter retrospective study was undertaken in 35 hospitals and medical centers including 12 tertiary care hospitals and 23 secondary care hospitals in the Hubei Province, China. The detailed clinical data of 1091 hospitalized wasp sting patients were investigated. Over three-fourths (76.9%) of the cases had 10 or more stings and the in-hospital mortality of patients was 5.1%. Forty-eight patients died of organ injury following toxic reactions to the stings, whereas six died from anaphylactic shock. The in-hospital mortality in patients with >10 stings was higher than that of ≤10 stings (5.2% vs. 1.0%, p = 0.02). Acute kidney injury (AKI) was seen in 21.0% patients and most patients required blood purification therapy. Rhabdomyolysis was seen in 24.1% patients, hemolysis in 19.2% patients, liver injury in 30.1% patients, and coagulopathy in 22.5% patients. Regression analysis revealed that high creatinine level, shock, oliguria, and anemia were risk factors for death. Blood purification therapy was beneficial for patients with ≥20 stings and delayed hospital admission of patients (≥4 hours after sting).

Conclusions

In China, most patients with multiple wasp stings presented with toxic reactions and multiple organ dysfunction caused by the venom rather than an anaphylactic reaction. AKI is the prominent clinical manifestation of wasp stings with toxic reaction. High creatinine levels, shock, oliguria, and anemia were risk factors for death.     

Spinal injuries due to front-end bale loaders.

Of 22 patients admitted to Plains Health Centre, Regina, from January 1979 to April 1986 with spinal injuries due to farming accidents, 7 had injuries related to tractor-mounted front-end bale loaders. In contrast, none of the 12 patients admitted with farm-related spinal injuries from 1974 through 1978 had injuries related to bale loaders. All seven injuries occurred when a front-end loader was used to move a large, round hay bale. In each case when the loader arms were raised past the horizontal plane the bale rolled back onto the unprotected tractor operator. There were five thoracic injuries, one cervical injury and one lumbar injury. All seven bony injuries healed. Four of the patients had permanent neurologic sequelae; two of the four had paraplegia. All seven patients suffered disability that impaired work performance; all five farmers suffered some loss of income. None of these injuries would have occurred if available safety equipment had been in place.     

The isolated burned palm in children: epidemiology and long-term sequelae

The isolated burn of the palm is a typical injury in young children. Positioning and splinting in small hands is difficult, and long-term sequelae of these injuries are not uncommon. The objective of the present study was to assess the outcome of palm burns and to identify the risk factors for long-term sequelae. All patients admitted to our hospital affected with isolated palm injuries between January of 1988 and January of 1998 were reviewed. In total, 120 pediatric patients were admitted with isolated palm burns; 110 patients (91.7 percent) had partial-thickness burns, and 10 patients (8.3 percent) had full-thickness burns. Only four patients (3.3 percent) required excision and skin autografting, but all patients whose palms were operated on in the acute phase developed burn contractures. Sixteen patients (13.3 percent) developed palmar contractures, and more than half of them (56 percent) required reconstructive procedures. All palm burns that healed in more than 3 weeks developed scarring and sequelae (p<0.05 compared with no sequelae). Pediatric palmar burns are benign injuries with a low incidence of late sequelae. However, flame and contact burns are more prone to develop scarring. Excision and autografting should be performed on wounds that take over 3 weeks to heal, but it does not prevent late sequelae.     

New insights into metabolic properties of marine bacteria encoding proteorhodopsins

Proteorhodopsin phototrophy was recently discovered in oceanic surface waters. In an effort to characterize uncultured proteorhodopsin-exploiting bacteria, large-insert bacterial artificial chromosome (BAC) libraries from the Mediterranean Sea and Red Sea were analyzed. Fifty-five BACs carried diverse proteorhodopsin genes, and we confirmed the function of five. We calculate that proteorhodopsin-exploiting bacteria account for 13% of microorganisms in the photic zone. We further show that some proteorhodopsin-containing bacteria possess a retinal biosynthetic pathway and a reverse sulfite reductase operon, employed by prokaryotes oxidizing sulfur compounds. Thus, these novel phototrophs are an unexpectedly large and metabolically diverse component of the marine microbial surface water.     

Microenvironment at tissue injury, a key focus for efficient stem cell therapy: A discussion of mesenchymal stem cells

Stem cell therapy is not a new field, as indicated by the success of hematopoietic stem cell reconstitution for various hematological malignancies and immune-mediated disorders. In the case of tissue repair, the major issue is whether stem cells should be implanted, regardless of the type and degree of injury. Mesenchymal stem cells have thus far shown evidence of safety, based on numerous clinical trials, particularly for immune-mediated disorders. The premise behind these trials is to regulate the stimulatory immune responses negatively. To apply stem cells for other disorders, such as acute injuries caused by insults from surgical trauma and myocardial infarction, would require other scientific considerations. This does not imply that such injuries are not accompanied by immune responses. Indeed, acute injuries could accompany infiltration of immune cells to the sites of injuries. The implantation of stem cells within a milieu of inflammation will establish an immediate crosstalk among the stem cells, microenvironmental molecules, and resident and infiltrating immune cells. The responses at the microenvironment of tissue injury could affect distant and nearby organs. This editorial argues that the microenvironment of any tissue injury is a key consideration for effective stem cell therapy.     

Identification of Bacterial Strains Isolated from the Mediterranean Sea Exhibiting Different Abilities of Biofilm Formation

The Mediterranean Sea has rarely been investigated for the characterization of marine bacteria as compared to other marine environments such as the Atlantic or Pacific Ocean. Bacteria recovered from inert surfaces are poorly studied in these environments, when it has been shown that the community structure of attached bacteria can be dissimilar from that of planktonic bacteria present in the water column. The objectives of this study were to identify and characterize marine bacteria isolated from biofilms developed on inert surfaces immersed in the Mediterranean Sea and to evaluate their capacity to form a biofilm in vitro. Here, 13 marine bacterial strains have been isolated from different supports immersed in seawater in the Bay of Toulon (France). Phylogenetic analysis and different biological and physico-chemical properties have been investigated. Among the 13 strains recovered, 8 different genera and 12 different species were identified including 2 isolates of a novel bacterial species that we named Persicivirga mediterranea and whose genus had never been isolated from the Mediterranean Sea. Shewanella sp. and Pseudoalteromonas sp. were the most preponderant genera recovered in our conditions. The phenotypical characterization revealed that one isolate belonging to the Polaribacter genus differed from all the other ones by its hydrophobic properties and poor ability to form biofilms in vitro. Identifying and characterizing species isolated from seawater including from Mediterranean ecosystems could be helpful for example, to understand some aspects of bacterial biodiversity and to further study the mechanisms of biofilm (and biofouling) development in conditions approaching those of the marine environment.     

Lambdoid synostosis: surgical considerations

Premature closure of the lambdoid suture may result in abnormalities in skull shape not only in the parieto-occipital region, but also in the frontal region and at the vertex of the skull. Although most of these abnormalities are mild, some constitute significant abnormalities in shape and therefore require specific surgical correction. In this report, we describe our approach from five patients we have treated and followed for 6 to 24 months with abnormalities characteristic of unilateral and bilateral lambdoid synostosis. We describe our approach to the simultaneous correction of frontal, occipital, and abnormal vertical height skeletal abnormalities in one operative procedure. To date, no negative neurologic sequelae have resulted from this operative approach, but significant improvement in skull form has been appreciated.     

Injuries associated with mandible fractures sustained in motor vehicle collisions

Motor vehicle collisions are second only to altercations as the most common cause of mandible fractures. This article details in a retrospectively studied group the incidence of isolated mandible fractures and associated injuries in patients who were involved in motor vehicle collisions. This group consisted of 148 patients with mandible fractures listed in the University of Mississippi's trauma registry during the past 5 years. In almost all patients, associated injuries occurred with mandible fractures that were caused by motor vehicle collisions, with an incidence of 99.3 percent. Facial and head lacerations and facial fractures were the leading associated injuries, occurring in more than half of the patients who had a mandible fracture. Closed head injury is the major life-threatening associated injury and cause of mortality. The life-threatening injuries occurred in 64.8 percent of patients in this study. The mortality rate in this group of patients was 8.1 percent. These data suggest that mandible fractures from motor vehicle collisions should never be viewed as an isolated injury but rather as part of a spectrum of significant and sometimes life-threatening injuries that require thorough trauma evaluation at the time of presentation.     

Disability in young people and adults one year after head injury: prospective cohort study

ObjectiveTo determine the frequency of disability in young people and adults admitted to hospital with a head injury and to estimate the annual incidence in the community.DesignProspective, hospital based cohort study, with one year follow up of sample stratified by coma score.SettingFive acute hospitals in Glasgow.Subjects2962 patients (aged 14 years or more) with head injury; 549 (71%) of the 769 patients selected for follow up participated.ResultsSurvival with moderate or severe disability was common after mild head injury (47%, 95% confidence interval 42% to 52%) and similar to that after moderate (45%, 35% to 56%) or severe injury (48%, 36% to 60%). By extrapolation from the population identified (90% of whom had mild injuries), it was estimated that annually in Glasgow (population 909 498) 1400 young people and adults are still disabled one year after head injury.ConclusionThe incidence of disability in young people and adults admitted with a head injury is higher than expected. This reflects the high rate of sequelae previously unrecognised in the large number of patients admitted to hospital with an apparently mild head injury.     

Microbial diversity of cultivatable bacteria associated with the North Sea bryozoan Flustra foliacea

The microbial diversity of cultivatable bacteria associated with the bryozoan species Flustra foliacea from the North Sea was investigated by a molecular approach. Amplified ribosomal RNA restriction analyses (ARDRA) and 16S rDNA partial sequence analysis revealed differences in the composition of cultivatable bacteria populations from single bryozoan colonies collected from two different sampling sites in the North Sea as well from one site taken at different points in time. Whereas gamma-Proteobacteria identified as Shewanella frigidimarina, Pseudoalteromonas ssp. and Psycbrobacter ssp. were predominant on samples of Flustra I (taken near the island of Helgoland), most bacteria isolated from Flustra II, originating from the Steingrund, could be affiliated to Gram-positive taxa. Survey of the bryozoan samples from the latter site in February 2000 led to the detection of a phylogenetically mixed bacterial population, consisting of gamma-, and alpha-Proteobacteria and Gram-positive bacteria with low and high GC-content (Flustra III). As these bacteria are among the most widely isolated organisms from the marine environment, it may be concluded that the bryozoan Flustra foliacea accepts colonization of surfaces by bacteria which are common inhabitants of the marine environment and which may have been transferred into this environment from terrestrial sites.     

Spiniferites cruciformis: a fresh water dinoflagellate cyst?

Palynological studies of cored lacustrine sediments from the late Quaternary of Lake Kastoria, northern Greece, revealed a Late Glacial interval with abundant dinoflagellate cysts. Cyst assemblages include two identifiable species, Spiniferites cruciformis and Gonyaulax apiculata. The presence of the fresh water species G. apiculata is consistent with the lacustrine setting of these deposits, but that of S. cruciformis is anomalous. Previously, this species has only been recorded in abundance from presumed brackish marine sediments from the Black Sea and Marmara Sea sediments where geochemical data clearly record brackish salinities. Therefore, it has been regarded as a low salinity cyst type with a wide range of morphological variation that some workers have suggested to reflect salinity fluctuations. Specimens from Greece display only part of the range of morphological variability previously described from these (brackish) marine settings. Encountered morphological variation includes ellipsoidal/pentameral and cruciform endocyst shapes with rare intermediate shapes, and highly variable septa development. Specimens characterized by extremely reduced ornamentation known from (brackish) marine environments have not been recorded. Our records of S. cruciformis indicate that: (1) it could thrive in fresh water conditions; and (2) that apparently most of the strong morphological variations of the cysts are an intrinsic phenomenon for this taxon, and may only partly be linked to salinity variations as suggested earlier. We suggest that S. cruciformis essentially is a fresh water taxon, and that its records in (brackish) marine environments, with the exception of specimens with strongly reduced ornamentation, may be due to transportation, to short-lived fresh water surface conditions in such environments, or to tolerance of the species to brackish conditions.     

Coding early naturalists' accounts into long-term fish community changes in the Adriatic Sea (1800-2000)

The understanding of fish communities' changes over the past centuries has important implications for conservation policy and marine resource management. However, reconstructing these changes is difficult because information on marine communities before the second half of the 20(th) century is, in most cases, anecdotal and merely qualitative. Therefore, historical qualitative records and modern quantitative data are not directly comparable, and their integration for long-term analyses is not straightforward. We developed a methodology that allows the coding of qualitative information provided by early naturalists into semi-quantitative information through an intercalibration with landing proportions. This approach allowed us to reconstruct and quantitatively analyze a 200-year-long time series of fish community structure indicators in the Northern Adriatic Sea (Mediterranean Sea). Our analysis provides evidence of long-term changes in fish community structure, including the decline of Chondrichthyes, large-sized and late-maturing species. This work highlights the importance of broadening the time-frame through which we look at marine ecosystem changes and provides a methodology to exploit, in a quantitative framework, historical qualitative sources. To the purpose, naturalists' eyewitness accounts proved to be useful for extending the analysis on fish community back in the past, well before the onset of field-based monitoring programs.     

Traumatisme de la verge et des organes génitaux

The most frequent cause of testicular injuries is blunt trauma (following sports injuries or road accidents). Penetrating injuries are rare. Increased scrotal volume and a painful testis are the main symptoms and require scrotal ultrasonography. Scrotal ultrasonography is very sensitive and specific for testicular rupture or intratesticular haematoma. Two out of three patients with testicular injuries require surgical exploration. Secondary complications due to delayed management of trauma are testicular atrophy, sterility or impotence. Penile fracture (rupture of corpus cavernosum) is due to direct trauma by an excessive force applied to an erect penis. Swelling, penile ecchymosis, penile curvature and pain are the usual symptoms of rupture of the tunica albuginea. Urethral injury must be ruled out. Cavernosography, ultrasonography or MRI are not considered mandatory to establish a diagnosis but can be prescribed in the absence of typical signs or symptoms. Early surgical exploration and repair ensure a better outcome. Secondary complications are penile curvature, chronic pain and impotence.     

Scenario simulations of future salinity and ecological consequences in the Baltic Sea and adjacent North Sea areas–implications for environmental monitoring

Substantial ecological changes occurred in the 1970s in the Northern Baltic during a temporary period of low salinity (S). This period was preceded by an episodic increase in the rainfall over the Baltic Sea watershed area. Several climate models, both global and regional, project an increase in the runoff of the Northern latitudes due to proceeding climate change. The aim of this study is to model, firstly, the effects on Baltic Sea salinity of increased runoff due to projected global change and, secondly, the effects of salinity change on the distribution of marine species. The results suggest a critical shift in the S range 5–7, which is a threshold for both freshwater and marine species distributions and diversity. We discuss several topics emphasizing future monitoring, modelling, and fisheries research. Environmental monitoring and modelling are investigated because the developing alternative ecosystems do not necessarily show the same relations to environment quality factors as the retiring ones. An important corollary is that the observed and modelled S changes considered together with species’ ranges indicate what may appear under a future climate. Consequences could include a shift in distribution areas of marine benthic foundation species and some 40–50 other species, affiliated to these. This change would extend over hundreds of kilometres, in the Baltic Sea and the adjacent North Sea areas. Potential cascading effects, in coastal ecology, fish ecology and fisheries would be extensive, and point out the necessity to develop further the “ecosystem approach in the environmental monitoring”.     

Complete-fosmid and fosmid-end sequences reveal frequent horizontal gene transfers in marine uncultured planktonic archaea

The extent of horizontal gene transfer (HGT) among marine pelagic prokaryotes and the role that HGT may have played in their adaptation to this particular environment remain open questions. This is partly due to the paucity of cultured species and genomic information for many widespread groups of marine bacteria and archaea. Molecular studies have revealed a large diversity and relative abundance of marine planktonic archaea, in particular of Thaumarchaeota (also known as group I Crenarchaeota) and Euryarchaeota of groups II and III, but only one species (the thaumarchaeote Candidatus Nitrosopumilus maritimus) has been isolated in pure culture so far. Therefore, metagenomics remains the most powerful approach to study these environmental groups. To investigate the impact of HGT in marine archaea, we carried out detailed phylogenetic analyses of all open reading frames of 21 archaeal 16S rRNA gene-containing fosmids and, to extend our analysis to other genomic regions, also of fosmid-end sequences of 12 774 fosmids from three different deep-sea locations (South Atlantic and Adriatic Sea at 1000 m depth, and Ionian Sea at 3000 m depth). We found high HGT rates in both marine planktonic Thaumarchaeota and Euryarchaeota, with remarkable converging values estimated from complete-fosmid and fosmid-end sequence analysis (25 and 21% of the genes, respectively). Most HGTs came from bacterial donors (mainly from Proteobacteria, Firmicutes and Chloroflexi) but also from other archaea and eukaryotes. Phylogenetic analyses showed that in most cases HGTs are shared by several representatives of the studied groups, implying that they are ancient and have been conserved over relatively long evolutionary periods. This, together with the functions carried out by these acquired genes (mostly related to energy metabolism and transport of metabolites across membranes), suggests that HGT has played an important role in the adaptation of these archaea to the cold and nutrient-depleted deep marine environment.     

Cervicothoracic spinal cord and pontomedullary injury secondary to high-voltage electrocution: a case report

ABSTRACT: INTRODUCTION: High-voltage electrical injuries are uncommonly reported and may predispose to both immediate and delayed neurologic complications. CASE PRESENTATION: We report the case of a 43-year-old Caucasian man who experienced a high-voltage electrocution injury resulting in ischemic myelopathy and secondary paraparesis. CONCLUSION: High-voltage electrocution injuries are a serious problem with potential for both immediate and delayed neurologic sequelae. The existing literature regarding effective treatment of neurologic complications is limited. Long-term follow-up and multidisciplinary management of these patients is required.