How would increasing seat belt use affect the number of killed or seriously injured light vehicle occupants?

The expected effects of increasing seat belt use on the number of killed or seriously injured (KSI) light vehicle occupants have been estimated for three scenarios of increased seat belt use in Norway, taking into account current seat belt use, the effects of seat belts and differences in crash risk between belted and unbelted drivers. The effects of seat belts on fatality and injury risk were investigated in a meta-analysis that is based on 24 studies from 2000 or later. The results indicate that seat belts reduce both fatal and non-fatal injuries by 60% among front seat occupants and by 44% among rear seat occupants. Both results are statistically significant. Seat belt use among rear seat occupants was additionally found to about halve fatality risk among belted front seat occupants in a meta-analysis that is based on six studies. Based on an analysis of seat belt wearing rates among crash involved and non-crash involved drivers in Norway it is estimated that unbelted drivers have 8.3 times the fatal crash risk and 5.2 times the serious injury crash risk of belted drivers. The large differences in crash risk are likely to be due to other risk factors that are common among unbelted drivers such as drunk driving and speeding. Without taking into account differences in crash risk between belted and unbelted drivers, the estimated effects of increasing seat belt use are likely to be biased. When differences in crash risk are taken into account, it is estimated that the annual numbers of KSI front seat occupants in light vehicles in Norway could be reduced by 11.3% if all vehicles had seat belt reminders (assumed seat belt wearing rate 98.9%), by 17.5% if all light vehicles had seat belt interlocks (assumed seat belt wearing rate 99.7%) and by 19.9% if all front seat occupants of light vehicles were belted. Currently 96.6% of all (non-crash involved) front seat occupants are belted. The effect on KSI per percentage increase of seat belt use increases with increasing initial levels of seat belt use. Had all rear seat occupants been belted, the number of KSI front seat occupants could additionally be reduced by about 0.6%. The reduction of the number of KSI rear seat occupants would be about the same in terms of numbers of prevented KSI.     

Pressure Combined with Ischemia/Reperfusion Injury Induces Deep Tissue Injury via Endoplasmic Reticulum Stress in a Rat Pressure Ulcer Model

Pressure ulcer is a complex and significant health problem in long-term bedridden patients, and there is currently no effective treatment or efficient prevention method. Furthermore, the molecular mechanisms and pathogenesis contributing to the deep injury of pressure ulcers are unclear. The aim of the study was to explore the role of endoplasmic reticulum (ER) stress and Akt/GSK3β signaling in pressure ulcers. A model of pressure-induced deep tissue injury in adult Sprague-Dawley rats was established. Rats were treated with 2-h compression and subsequent 0.5-h release for various cycles. After recovery, the tissue in the compressed regions was collected for further analysis. The compressed muscle tissues showed clear cellular degenerative features. First, the expression levels of ER stress proteins GRP78, CHOP, and caspase-12 were generally increased compared to those in the control. Phosphorylated Akt and phosphorylated GSK3β were upregulated in the beginning of muscle compression, and immediately significantly decreased at the initiation of ischemia-reperfusion injury in compressed muscles tissue. These data show that ER stress may be involved in the underlying mechanisms of cell degeneration after pressure ulcers and that the Akt/GSK3β signal pathway may play an important role in deep tissue injury induced by pressure and ischemia/reperfusion.     

Investigating driver injury severity patterns in rollover crashes using support vector machine models

Rollover crash is one of the major types of traffic crashes that induce fatal injuries. It is important to investigate the factors that affect rollover crashes and their influence on driver injury severity outcomes. This study employs support vector machine (SVM) models to investigate driver injury severity patterns in rollover crashes based on two-year crash data gathered in New Mexico. The impacts of various explanatory variables are examined in terms of crash and environmental information, vehicle features, and driver demographics and behavior characteristics. A classification and regression tree (CART) model is utilized to identify significant variables and SVM models with polynomial and Gaussian radius basis function (RBF) kernels are used for model performance evaluation. It is shown that the SVM models produce reasonable prediction performance and the polynomial kernel outperforms the Gaussian RBF kernel. Variable impact analysis reveals that factors including comfortable driving environment conditions, driver alcohol or drug involvement, seatbelt use, number of travel lanes, driver demographic features, maximum vehicle damages in crashes, crash time, and crash location are significantly associated with driver incapacitating injuries and fatalities. These findings provide insights for better understanding rollover crash causes and the impacts of various explanatory factors on driver injury severity patterns.     

Idiosyncratic Drug-Induced Liver Injury: Mechanistic and Clinical Challenges

Idiosyncratic drug-induced liver injury (IDILI) remains a significant problem for patients and drug development. The idiosyncratic nature of IDILI makes mechanistic studies difficult, and little is known of its pathogenesis for certain. Circumstantial evidence suggests that most, but not all, IDILI is caused by reactive metabolites of drugs that are bioactivated by cytochromes P450 and other enzymes in the liver. Additionally, there is overwhelming evidence that most IDILI is mediated by the adaptive immune system; one example being the association of IDILI caused by specific drugs with specific human leukocyte antigen (HLA) haplotypes, and this may in part explain the idiosyncratic nature of these reactions. The T cell receptor repertoire likely also contributes to the idiosyncratic nature. Although most of the liver injury is likely mediated by the adaptive immune system, specifically cytotoxic CD8+ T cells, adaptive immune activation first requires an innate immune response to activate antigen presenting cells and produce cytokines required for T cell proliferation. This innate response is likely caused by either a reactive metabolite or some form of cell stress that is clinically silent but not idiosyncratic. If this is true it would make it possible to study the early steps in the immune response that in some patients can lead to IDILI. Other hypotheses have been proposed, such as mitochondrial injury, inhibition of the bile salt export pump, unfolded protein response, and oxidative stress although, in most cases, it is likely that they are also involved in the initiation of an immune response rather than representing a completely separate mechanism. Using the clinical manifestations of liver injury from a number of examples of IDILI-associated drugs, this review aims to summarize and illustrate these mechanistic hypotheses.     

橄榄油与椰子油混油基对类蛋黄酱乳液流变及冻融稳定性的影响

以类蛋黄酱体系为研究对象，运用Turbiscan、流变仪、粒度仪、显微镜研究在pH 3条件下橄榄油与椰子油不同比例复配（10∶ 0、9∶ 1、8∶ 2、7∶ 3）的混油基对于乳清分离蛋白-蛋黄卵磷脂稳定的乳液体系流变性质及冻融稳定性的影响。结果表明：随着椰子油比例增加，乳液黏度增加，弹性模量增加，橄榄油与椰子油质量比7∶ 3复配混油基制得的乳液具有最大的黏度和最高的弹性模量；所有乳液在4~40 ℃弹性模量下降，说明乳液在贮存、冷藏运输过程中内部结构完整，乳液具有良好的稳定性;蛋黄卵磷脂能够提高含椰子油（饱和脂肪酸含量高）乳液的冻融稳定性，并且椰子油比例越大（饱和程度越高），冻融稳定性提高效果越好;乳液冻融稳定性从高到低依次为橄榄油与椰子油质量比为7∶ 3>8∶ 2>9∶ 1>10∶ 0。     

Fluoro-Photoacoustic Polymeric Renal Reporter for Real-Time Dual Imaging of Acute Kidney Injury

Photoacoustic (PA) imaging agents detect disease tissues and biomarkers with increased penetration depth and enhanced spatial resolution relative to traditional optical imaging, and thus hold great promise for clinical applications. However, existing PA imaging agents often encounter the issues of slow body excretion and low-signal specificity, which compromise their capability for in vivo detection. Herein, a fluoro-photoacoustic polymeric renal reporter (FPRR) is synthesized for real-time imaging of drug-induced acute kidney injury (AKI). FPRR simultaneously turns on both near-infrared fluorescence (NIRF) and PA signals in response to an AKI biomarker (γ-glutamyl transferase) with high sensitivity and specificity. In association with its high renal clearance efficiency (78% at 24 h post-injection), FPRR can detect cisplatin-induced AKI at 24 h post-drug treatment through both real-time imaging and optical urinalysis, which is 48 h earlier than serum biomarker elevation and histological changes. More importantly, the deep-tissue penetration capability of PA imaging results in a signal-to-background ratio that is 2.3-fold higher than NIRF imaging. Thus, the study not only demonstrates the first activatable PA probe for real-time sensitive imaging of kidney function at molecular level, but also highlights the polymeric probe structure with high renal clearance.     

岩石冻融循环试验建议性方案探讨

岩石冻融循环试验是低温岩石力学基础性试验,其主要涉及冻融循环温度、冻融时长、循环次数等3个指标。但目前关于指标的选取,国内外的试验规程或相关学者研究成果,均未给出明确参考依据,对岩石冻融循环试验方案的确定造成较大困扰。本研究旨在明确各指标的确定办法,提出建议性岩石冻融循环试验方案。首先,展开国内外冻融循环试验方案的全面综述,指出目前冻融循环试验方案确定时所存在问题,并藉此明确冻融循环试验方案思路;接着,针对以上三大影响指标,通过设计室内岩石冻融循环试验,详细探讨冻融循环温度、冻融时长、循环次数对岩石物理、力学参数的影响,最终根据试验结果,明确出针对不同岩性、孔隙率所对应的建议性试验方案。本研究将为后期冻融循环指标选取及标准化试验方案建立提供技术借鉴。     

Assessment of the static fit of automobile lap-belt systems on front-seat passengers

While automobile seat belts are recognized as reducing injury in frontal collisions, the lap belt can cause injury to the abdominal contents during impact. A lap belt which is malpositioned, i.e., above the anterior superior iliac spines (ASIS) of the pelvis before impact, is suggested as a causative factor in many of these injuries. A questionnaire was completed by 198 adult passengers on lap-belt fit as well as vehicle, anthropometric and behavioural factors. All measures were self-reported. The fit of automobile seat belts was also investigated in the laboratory to determine some of the factors thought important in the pre-impact position of the lap belt. Seven factors, subject size, subject sitting posture, clothing thickness, vehicle configuration, vehicle seat position, seat back angle and the handling of the belt by the occupant, were assessed on 51 subjects sitting in six simulated vehicles. The sample purposely included a disproportionate number of tall, short, heavy and thin subjects.

The questionnaire responses indicated that a high proportion (49%) of lap belts were found to be malpositioned in a normal sitting posture. Moving around in the seat, especially slouching, greatly increased the proportion of malpositions. It was noteworthy that wearing a heavy winter coat did not cause belt malposition. A high incidence of malpositioned lap belts was also found in the laboratory study with 42% of the belts having their centre-lines above the ASIS and 89% having part of the belt overlying the ASIS in a normal upright seated position with the seat in the middle of its fore/aft movement. Slouching in the seat significantly increased this proportion. The malposition rate was adversely affected by a forward seat position in a significant manner. There was a large increase in the malposition rate when the occupant attached the belt compared to when the experimenter attached it, with malposition rates of 43% and 19% respectively in the rearmost seat position. There was no statistically significant effect of clothing thickness on belt fit. Although statistically significant correlations between belt inclination and malposition were found, no clear-cut belt-angle existed above which satisfactory fit existed.     

Transfer of the horizontal patient: The effect of a friction reducing assistive device on low back mechanics

Recognizing that the transfer of bedridden patients is associated with a high rate of low back injuries, various devices have been developed to assist with sparing the patient handlers. The purpose of this study was to quantify the friction-reducing ability of three different ‘sliding’ patient transfer devices together with the subsequent consequences on the low back loads of people performing the transfers. Coefficients of friction of the devices were determined by ‘transferring’ a standard object and a ‘patient’ over several surfaces common to a hospital setting. Then three participants performed controlled transfers with the various devices. Electromyography to measure muscle activation levels together with external forces and kinematic positional data were collected during push, pull and twist transfers. Spine loads were estimated with a three-dimensional biomechanical static link-segment model of the human body. Simply sliding a patient on a cotton sheet (control condition) produced a coefficient of friction of 0.45. The assistive devices substantially reduced friction by well over one-half (coefficients of 0.18?–?0.21). However, when using the devices the subjects adopted a variety of postures and techniques, such that there were no consistent influences on trunk inclination, low back compression or muscle activation profiles. Direct measurement of reduced friction between the bed and the patient with a friction-reducing device together with measurement of the back loads when actually transferring a patient formed a proof of principle. Specifically, while the device lowers friction, the transfer technique adopted by the lifter must be proper to reduce low back loading and any subsequent risks of back troubles associated with patient transfers. The direction of hand forces and torso position remains important.