Genomic and transcriptomic comparison of Aspergillus oryzae strains: a case study in soy sauce koji fermentation.

The filamentous fungus Aspergillus oryzae is used in soy sauce koji making due to its high productivity of hydrolytic enzymes. In this study, we compared the genomes and transcriptomes of an industrial strain RD2 and a strain with decreased fermentation performance TS2, aiming to explain their phenotypic differences at the molecular level. Under the regulation of conidiation and fermentation conditions, the enhanced hydrolytic enzyme production and flavor precursor formation in RD2 described a complete expression profile necessary to maintain desirable fermentation performance. By contrast, central carbon metabolism was up-regulated in TS2 for fast growth, suggesting a conflicting relationship between mycelium growth and fermentation performance. Accumulation of mutations also lowered the fermentation performance of TS2. Our study has deepened the understanding of the metabolism and related regulatory mechanisms in desirable koji fermentation. A list of potential molecular markers identified here could facilitate targeted strain maintenance and improvement for better koji fermentation.

Liver fatty acid-binding protein binds monoacylglycerol in vitro and in mouse liver cytosol.

Liver fatty acid-binding protein (LFABP; FABP1) is expressed both in liver and intestinal mucosa. Mice null for LFABP were recently shown to have altered metabolism of not only fatty acids but also monoacylglycerol, the two major products of dietary triacylglycerol hydrolysis (Lagakos, W. S., Gajda, A. M., Agellon, L., Binas, B., Choi, V., Mandap, B., Russnak, T., Zhou, Y. X., and Storch, J. (2011) Am. J. Physiol. Gastrointest. Liver Physiol. 300, G803-G814). Nevertheless, the binding and transport of monoacylglycerol (MG) by LFABP are uncertain, with conflicting reports in the literature as to whether this single chain amphiphile is in fact bound by LFABP. In the present studies, gel filtration chromatography of liver cytosol from LFABP(-/-) mice shows the absence of the low molecular weight peak of radiolabeled monoolein present in the fractions that contain LFABP in cytosol from wild type mice, indicating that LFABP binds sn-2 MG in vivo. Furthermore, solution-state NMR spectroscopy demonstrates two molecules of sn-2 monoolein bound in the LFABP binding pocket in positions similar to those found for oleate binding. Equilibrium binding affinities are ∼2-fold lower for MG compared with fatty acid. Finally, kinetic studies examining the transfer of a fluorescent MG analog show that the rate of transfer of MG is 7-fold faster from LFABP to phospholipid membranes than from membranes to membranes and occurs by an aqueous diffusion mechanism. These results provide strong support for monoacylglycerol as a physiological ligand for LFABP and further suggest that LFABP functions in the efficient intracellular transport of MG.

The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services.

BACKGROUND: In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. METHODS: An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. RESULTS: No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. CONCLUSIONS: We demonstrated that the implementation of a revised statewide prehospital pain management protocol based on an EBG developed using the National Prehospital Evidence-based Guideline Model Process was associated with an increase in dosing of narcotic pain medication consistent with that recommended by the EBG. No differences were seen in the percentage of patients receiving opiate analgesia or in the documentation of pain scores.

Zebrafish fat-free is required for intestinal lipid absorption and Golgi apparatus structure.

The zebrafish fat-free (ffr) mutation was identified in a physiological screen for genes that regulate lipid metabolism. ffr mutant larvae are morphologically indistinguishable from wild-type sibling larvae, but their absorption of fluorescent lipids is severely impaired. Through positional cloning, we have identified a causative mutation in a highly conserved and ubiquitously expressed gene within the ffr locus. The Ffr protein contains a Dor-1 like domain typical of oligomeric Golgi complex (COG) gene, cog8. Golgi complex ultrastructure is disrupted in the ffr digestive tract. Consistent with a possible role in COG-mediated Golgi function, wild-type Ffr-GFP and COG8-mRFP fusion proteins partially colocalize in zebrafish blastomeres. Enterocyte retention of an endosomal lipid marker in ffr larvae support the idea that altered vesicle trafficking contributes to the ffr mutant defect. These data indicate that ffr is required for both Golgi structure and vesicular trafficking, and ultimately lipid transport.

Zebrafish fat-free, a novel Arf effector, regulates phospholipase D to mediate lipid and glucose metabolism.

Zebrafish fat-free mutants (ffr) exhibit defective intestinal lipid metabolism and fat-free protein (Ffr) is involved in Golgi-related vesicular trafficking. In this study, we show that ffr mutants also display defective glucose metabolism. Using microarray and real-time PCR, we found that a ffr mutant with a nonsense mutation exhibits increased transcript level of ADP-ribosylation factor gene (arfs). Further analysis indicated that Ffr contains a putative Arf binding motif and can bind GTP-bound Arfs. In addition, ffr exhibited increased transcript and activity levels of the Arf downstream effector phospholipase D (PLD). Inhibition of PLD partially restored lipid and glucose metabolism in ffr, suggesting that Ffr is involved in a pathway regulating PLD activity by regulating Arfs. We propose that local over-production of phosphatidic acid (PA) by excess PLD promotes membrane curvature, which affects Golgi membrane structure and secretory processes, contributing to impairment of lipid and glucose metabolism.

Occupant and crash characteristics for case occupants with cervical spine injuries sustained in motor vehicle collisions.

BACKGROUND: Motor vehicle collisions (MVCs) are the leading cause of spine and spinal cord injuries in the United States. Traumatic cervical spine injuries (CSIs) result in significant morbidity and mortality. This study was designed to evaluate both the epidemiologic and biomechanical risk factors associated with CSI in MVCs by using a population-based database and to describe occupant and crashes characteristics for a subset of severe crashes in which a CSI was sustained as represented by the Crash Injury Research Engineering Network (CIREN) database. METHODS: Prospectively collected CIREN data from the eight centers were used to identify all case occupants between 1996 and November 2009. Case occupants older than 14 years and case vehicles of the four most common vehicle types were included. The National Automotive Sampling System's Crashworthiness Data System, a probability sample of all police-reported MVCs in the United States, was queried using the same inclusion criteria between 1997 and 2008. Cervical spinal cord and spinal column injuries were identified using Abbreviated Injury Scale (AIS) score codes. Data were abstracted on all case occupants, biomechanical crash characteristics, and injuries sustained. Univariate analysis was performed using a χ analysis. Logistic regression was used to identify significant risk factors in a multivariate analysis to control for confounding associations. RESULTS: CSIs were identified in 11.5% of CIREN case occupants. Case occupants aged 65 years or older and those occupants involved in rollover crashes were more likely to sustain a CSI. In univariate analysis of the subset of severe crashes represented by CIREN, the use of airbag and seat belt together (reference) were more protective than seat belt alone (odds ratio [OR]=1.73, 95% confidence interval [CI]=1.32-2.27) or the use of neither restraint system (OR=1.45, 95% CI=1.02-2.07). The most frequent injury sources in CIREN crashes were roof and its components (24.8%) and noncontact sources (15.5%). In multivariate analysis, age, rollover impact, and airbag-only restraint systems were associated with an increased odds of CSI. Using the population-based National Automotive Sampling System's Crashworthiness Data System data, 0.35% of occupants sustained a CSI. In univariate analysis, older age was noted to be a significant risk factor for CSI. Airbag-only restraint systems and both rollover and lateral crashes were also identified as risk factors for CSI. In addition, increasing delta v was highly associated with CSIs. In multivariate analysis, similar risk factors were noted. Of all the restraint systems, seat belt use without airbag deployment was found to be the most protective restraint system (OR=0.29, 95% CI=0.16-0.50), whereas airbag-only restraint was associated with the highest risk of CSI (OR=3.54, 95% CI=2.29-5.46). CONCLUSIONS: Despite advances in automotive safety, CSIs sustained in MVC continue to occur too often. Older case occupants are at an increased risk of CSI. Rollover crashes and severe crashes led to a much higher risk of CSI than other types and severity of MVCs. Seat belt use is very effective in preventing CSI, whereas airbag deployment may increase the risk of occupants sustaining a CSI. More protection for older occupants is needed and protection in both rollover and lateral crashes should remain a focus of the automotive industry. The design of airbag restraint systems should be evaluated so that they are not causative of serious injury. In addition, engineers should continue to focus on improving automotive design to minimize the risk of spinal injury to occupants in high severity crashes.

Crash test ratings and real-world frontal crash outcomes: a CIREN study.

OBJECTIVE: To establish whether the Insurance Institute for Highway Safety (IIHS) offset crash test ratings are linked to different mortality rates in real world frontal crashes. METHODS: The study used Crash Injury Research Engineering Network drivers of age older than 15 years who were involved in frontal crashes. The Crash Injury Research Engineering Network is a convenience sample of persons injured in crashes with at least one Abbreviated Injury Scale score of 3+ injury or two Abbreviated Injury Scale score of 2+ injuries who were either treated at a Level I trauma center or died. Cases were grouped by IIHS crash test ratings (i.e., good, acceptable, marginal, poor, and not rated). Those rated marginal were excluded because of their small numbers. Mortality rates experienced by these ratings-based groups were compared using the Mantel-Haenszel chi test. Multiple logistic regression models were built to adjust for confounders (i.e., occupant, vehicular, and crash factors). RESULTS: A total of 1,226 cases were distributed within not rated (59%), poor (12%), average (16%), and good (14%) categories. Those rated good and average experienced a lower unadjusted mortality rate. After adjustment by confounders, those in vehicles rated good experienced a lower risk of death (adjusted OR 0.38 [0.16-0.90]) than those in vehicles rated poor. There was no significant effect for "acceptable" rating. Other factors influencing the occurrence of death were age, DeltaV >or=70 km/h, high body mass index, and lack of restraint use. CONCLUSION: After adjusting for occupant, vehicular, and crash factors, drivers of vehicles rated good by the IIHS experienced a lower risk of death in frontal crashes.

Germ cell migration in zebrafish is dependent on HMGCoA reductase activity and prenylation.

Hydroxymethylglutaryl coenzyme A reductase (HMGCoAR) is required for isoprenoid and cholesterol biosynthesis. In Drosophila, reduced HMGCoAR activity results in germ cell migration defects. We show that pharmacological HMGCoAR inhibition alters zebrafish development and germ cell migration. Embryos treated with atorvastatin (Lipitor) exhibited germ cell migration defects and mild morphologic abnormalities. The effects induced by atorvastatin were completely rescued by prior injection of mevalonate, the product of HMGCoAR activity, or the prenylation precursors farnesol and geranylgeraniol. In contrast, squalene, a cholesterol intermediate further down the pathway, failed to rescue statin-induced defects. Moreover, pharmacologic inhibition of geranylgeranyl transferase 1 (GGT1) protein prenylation activity also resulted in abnormal germ cell migration. Thus, our pharmacological inhibition-and-rescue approach provided detailed information about the elements of isoprenoid biosynthesis that contribute to germ cell migration. Together with data from Drosophila (Santos and Lehmann, this issue), our results highlight a conserved role for protein geranylgeranylation in this context.

Expected differences and unexpected commonalities in mortality, injury severity, and injury patterns between near versus far occupants of side impact crashes.

OBJECTIVE: To compare injury patterns and outcomes of near- and far-side collisions. METHODS: Near- and far-side occupants in the Crash Injury Research and Engineering Network (CIREN) were compared for mortality and the occurrence of severe injuries (maximum abbreviated injury scale [MAIS] 3+). Regression models, adjusting for confounders, examined death and MAIS 3+ injuries as outcomes and near- or far-side position as an independent variable. CIREN findings were compared with those of the Crash Outcome Data Evaluation System (CODES), and the Maryland Automated Accident Reporting System. RESULTS: Of the 380 cases, 72% were in the near and 28% in the far position. Mortality was similar between groups within CIREN. Near-side occupants experienced a higher frequency of MAIS 3+ injuries for the thorax, abdomen, and lower extremities, and fewer MAIS 3+ head injuries than far-side occupants (35% vs. 46%, p = 0.06). Regression models revealed similar risk of MAIS 3+ head injuries among near- and far-side occupants. The most common structures contacting the head in far-side crashes (N = 62) were opposite side structures (52%) and other occupants (13%). Similar risks of head injuries among near- and far-side occupants were observed for the CODES data; however, lower risks of death were present among far-side drivers involved in crashes, based on CODES and Maryland Automated Accident Reporting System. CONCLUSIONS: Despite a lower incidence of thoracic, abdominal, and lower extremity injuries, far-side occupants experienced a similar risk of head injuries to that of near-side occupants. Contact patterns suggest that restraint systems fail to keep far-side occupants' heads from striking opposite side structures or other occupants.

Crash and occupant predictors of pulmonary contusion.

OBJECTIVES: Pulmonary contusions (PCs) are a common injury sustained in motor vehicle collisions. The crash and occupant characteristics of PC in motor vehicle collisions are currently unknown. Additionally, the clinical significance and the impact on mortality have not been determined. METHODS: A retrospective review of the Crash Injury Research and Engineering Network database with inclusion criteria of frontal (F) and near-side lateral (L) crashes involving occupants older than 15 years, yielded 2,184 case occupants. Pearson's chi and multivariate logistic regression were used with a p < 0.05 conferring statistical significance. RESULTS: Median age was 38 years, 80% were drivers and mortality was 16%. Forty-nine percent of case occupants were not wearing lap-shoulder belts. Chest trauma was sustained by 1,131 (52%), of whom 379 had PC. Crash characteristics included: 38 kph median change in velocity (delta V), 72% frontal deformation, and 35% struck a fixed object. Injury characteristics included median Injury Severity Score 17 with the following Abbreviated Injury Score (AIS) >2 injuries: thoracic 40%, abdominal 19%, and head 24%. Univariate predictors of PC included: age <25, male, higher Injury Severity Score, fatality, delta V >45 kph, L impacts, and collision with fixed object. PC was significantly associated with occupant compartment intrusion in F but not L crashes. In multivariate analysis, significant predictors of PC included: age <25 (odds ratios [OR] = 1.5), delta V >45 kph (OR = 1.9), and fixed object (frontal crash only) (OR = 1.8). Controlling for head, spine, abdominal, and extremity injuries AIS >2, PC was not a statistically significant risk factor for mortality. This was consistent whether or not another AIS >2 thoracic injury was present. The effectiveness of side-impact airbags was not evaluated due to the small sample size. CONCLUSIONS: Crash severity as demonstrated by higher delta V was strongly associated with PC in all crashes. Frontal crashes with a fixed object or intrusion are more likely to result in a PC. The risk of PC is greatly increased in near-side lateral impacts regardless of intrusion or object struck; suggesting occupant proximity may be the most important factor. Further investigations of the efficacy of side airbags as a counter measure should be considered and continued public education of the efficacy of lap-shoulder restrains should continue. Unexpectedly, although a marker for crash severity, PC is not an independent marker of mortality.

A web based resource characterizing the zebrafish developmental profile of over 16,000 transcripts.

Using a spotted 65-mer oligonucleotide microarray, we have characterized the developmental expression profile from mid-gastrulation (75% epiboly) to 5 days post-fertilization (dpf) for >16,000 unique transcripts in the zebrafish genome. Microarray profiling data sets are often immense, and one challenge is validating the results and prioritizing genes for further study. The purpose of the current study was to address such issues, as well as to generate a publicly available resource for investigators to examine the developmental expression profile of any of the over 16,000 zebrafish genes on the array. On the chips, there are 16,459 printed spots corresponding to 16,288 unique transcripts and 172 beta-actin (AF025305) spots spatially distributed throughout the chip as a positive control. We have collected 55 microarray gene expression profiling results from various zebrafish laboratories and created a Perl/CGI-based software tool (http://serine.umdnj.edu/approximately ouyangmi/cgi-bin/zebrafish/profile.htm) for researchers to look for the expression patterns of their gene of interest. Users can search for their genes of interest by entering the accession numbers or the nucleotide sequences and the expression profiling will be reported in the form of expression intensities versus time-course graphical displays. In order to validate this web tool, we compared 74 genes' expression results between our web tool and the in situ hybridization results from Thisse et al. [Thisse, B., Heyer, V., Lux, A., Alunni, A., Degrave, A., Seiliez, I., Kirchner, J., Parkhill, J.-P., Thisse, C., 2004. Spatial and temporal expression of the zebrafish genome by large-scale in situ hybridization screening. Meth. Cell. Biol. 77, 505-519] as well as those reported by Mathavan et al. [Mathavan, S., Lee, S.G., mark, A., Miller, L.D., Murthy, K.R., Tong, Y., Wu, Y.L., Lam, S.H., Yang, H., Ruan, Y., Korzh, V., Gong, Z., Liu, E.T., Lufkin, T., 2005. Transcriptome analysis of zebrafish embryogenesis using microarrays. PLoS Genet. 1, 260-276]. The comparison indicates that our microarray-derived expression patterns are 80% and 75% in agreement with the in situ database (Thisse et al., 2004) and previously published microarray data (Mathavan et al., 2005), respectively. Those genes that conflict between our web tool and the in situ database either have high sequence similarity with other genes or the in situ probes are not reliable. Among those genes that disagree between our web tool and those reported by Mathavan et al. (2005), 93% of the genes are in agreement between our web tool and the in situ database, indicating our web tool results are quite reliable. Thus, this resource provides a user-friendly web based platform for researchers to determine the developmental profile of their gene of interest and to prioritize genes identified in microarray analyses by their developmental expression profile.

Sociodemographic characteristics associated with substance use status in a trauma inpatient population.

Substance use is significantly associated with physical injury, yet relatively little is known about the prevalence of specific substance use disorders among trauma patients, or their associated sociodemographic characteristics. We evaluated these issues in an unselected sample of 1,118 adult inpatients at the University of Maryland Shock Trauma Center, Baltimore, MD, who were interviewed with the psychoactive substance use disorder section of the Structured Clinical Interview for DSM-III-R. Among trauma inpatients, lifetime alcohol users (71.8% of subjects) were more likely male; users of illegal drugs (45.3%) were also more likely to be younger, unmarried, and poor. Patients with current drug abuse/dependence (18.8%) were more likely to be non-white, less educated, and poor; those with current alcohol abuse/dependence (32.1%) were also more likely male, unmarried, and older. These findings highlight the need for screening for substance use disorders in trauma settings and referral of patients to substance abuse treatment programs.

Risk of psychoactive substance dependence among substance users in a trauma inpatient population.

One measure of a substance's addictive risk is the proportion of users who become dependent. This study evaluates the lifetime and current risk of substance dependence among lifetime substance users' among trauma inpatients and provides a relative ranking of addictive risk among the substances. Data on use of 8 substance groups (alcohol, opiates, marijuana, cocaine, other stimulants, sedative-hypnotics, hallucinogens, other drugs) were obtained by interview (Structured Clinical Interview for the DSM-III-R) from 1,118 adult trauma inpatients. Prevalence of lifetime dependence among lifetime users ranged from 80.7% for opiates and 70.9% for cocaine to 33.3% for hallucinogens and 26.6% for sedative-hypnotics. The rank order of addictive risk was similar to that found in the general population. Trauma inpatients had a higher absolute addictive risk than the general population, comparable to the risk found in patients in treatment for substance use disorders, suggesting the importance of screening trauma inpatients for substance dependence.

The association between age, injury, and survival to hospital among a cohort of injured motorcyclists.

Despite the significant increase in mortality among older motorcyclists during the past decade, few studies have addressed specific injuries or mortality rates among all those injured. The purpose of this study is to describe the crash and injury characteristics among a cohort of motorcyclists injured in Maryland, and to determine the influence of age and crash type on mortality, injury patterns, and place of death (scene vs. hospital). Possible biases introduced by studying only those hospitalized are described. Based on the findings, specific injury prevention strategies for older vs. younger riders are proposed.

Injury patterns and severity among hospitalized motorcyclists: a comparison of younger and older riders.

In recent years there has been a significant increase in mortality among motorcyclists, especially older riders (40+ years). However, few studies have compared the nature and severity of injuries sustained by older vs. younger cyclists. The purpose of this analysis was to determine differences, if any, in injury patterns to older vs. younger motorcyclists and to explore rider, vehicle, and environmental factors associated with these differences. Older riders were found to have a significantly higher incidence of thoracic injury, especially multiple thoracic injuries, and specifically multiple rib fractures. Older motorcyclists were also more likely to ride larger motorcycles, and were more involved in collisions involving overturning or striking highway structures. Large engine sizes were associated with increased risk of head and thoracic injuries, but not abdominal injuries. The magnitude of increased risks related to 1000+ cc engine size was higher among older motorcyclists than younger motorcyclists.

Crash culpability and the role of driver blood alcohol levels.

Twenty years ago the American Medical Association reported the relationship between blood alcohol concentration (BAC) and crash causation. This study addresses culpability, age, gender and BAC in a population of drivers injured in motor vehicle crashes. Five years of hospital and crash data were linked, using probabilistic techniques. Trends in culpability were analyzed by BAC category. Given BAC level, the youngest and oldest drivers were more likely to have caused their crash. Women drivers had significantly higher odds of culpability at the highest BAC levels. Seatbelt use was also associated with culpability, perhaps as a marker for risk-taking among drinkers.

On equal footing: Trends in ankle/foot injuries for men vs. women.

OBJECTIVES: The objective of the current study was to examine trends in ankle/foot (A/F) injuries during the period 2001-2014, in order to determine whether the incidence of these injuries has changed and whether a previously identified difference in risk by gender still existed. In addition, other driver and crash-related risk factors were examined separately for men and women. METHODS: Passenger vehicle drivers aged 16+ were identified from NASS-CDS; weighted data were analyzed for model years 2001-2014. Model years (MY) were grouped as 2001-2004 (older) vs. 2005-2014 (newer), and drivers in frontal crashes were included. Ankle injuries included fractures and dislocations to the malleolus and distal tibia/fibula. Foot injuries included fractures and dislocations of the talus, calcaneus, and tarsal/metatarsal bones. Logistic regression models were constructed to identify risk factors, including MY, age, belt use, toepan/instrument panel intrusion, and body mass index (BMI) separately for each gender using odds ratios. RESULTS: The incidence of A/F injuries declined significantly between older and newer MY, especially for women. Whereas before MY 2005, ankle and foot injury risk was significantly higher for women than men, risks for ankle injury are now virtually the same for both genders, and women are only 1.2 times more likely than men to sustain a foot injury in a frontal crash. From multivariable regression models, however, it is apparent that there are different risk factors for A/F injuries for men vs. women. Body weight was a significant factor for both groups, but for men it was a risk only for those extremely obese, whereas for women those who were categorized as overweight were also at increased risk. Age greater than 55 was also found to be a risk factor for foot injuries among women but not men. For men and women, toepan intrusion remained the most important factor for both foot and ankle injuries, with significantly higher odds ratios noted for men. Foot pedals were a more likely injury source for women, whereas the toepan was more likely for men. In addition, belt use was protective for ankle injuries in women but not men. CONCLUSIONS: Significant declines in A/F injuries have been noted in recent years, especially for women, whose risks are now similar to those for men. However, significant risk factors remain for each gender, primarily related to body habitus (BMI) and toepan intrusion. Age was a risk factor for foot injuries among women, for whom the foot pedals were more likely to be an injury source. Toepan intrusion remains a major factor for both men and women, but, with the exception of 30+ cm of intrusion, odds ratios were primarily much higher for men in each category of intrusion.

Are frailty markers associated with serious thoracic and spinal injuries among motor vehicle crash occupants?

BACKGROUND: While age is a known risk factor in trauma, markers of frailty are growing in their use in the critically ill. Frailty markers may reflect underlying strength and function more than chronologic age, as many modern elderly patients are quite active. However, the optimal markers of frailty are unknown. METHODS: A retrospective review of The Crash Injury Research and Engineering Network (CIREN) database was performed over an 11-year period. Computed tomographic images were analyzed for multiple frailty markers, including sarcopenia determined by psoas muscle area, osteopenia determined by Hounsfield units (HU) of lumbar vertebrae, and vascular disease determined by aortic calcification. RESULTS: Overall, 202 patients were included in the review, with a mean age of 58.5 years. Median Injury Severity Score was 17. Sarcopenia was associated with severe thoracic injury (62.9% vs. 42.5%; p = 0.03). In multivariable analysis controlling for crash severity, sarcopenia remained associated with severe thoracic injury (p = 0.007) and osteopenia was associated with severe spine injury (p = 0.05). While age was not significant in either multivariable analysis, the association of sarcopenia and osteopenia with development of serious injury was more common with older age. CONCLUSIONS: Multiple markers of frailty were associated with severe injury. Frailty may more reflect underlying physiology and injury severity than age, although age is associated with frailty. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level IV.

Retained risk-taking behaviors among past alcohol dependent trauma patients.

Alcohol dependence has been associated with behavioral risk factors and risk-taking tendencies. We investigated whether past alcohol dependent trauma center patients (n=42) retain the characteristics of current alcohol dependent patients (n=67) or whether they resemble patients without history of alcohol dependence (n=262). We found that past alcohol dependence patients retain some of the risk-taking tendencies (impulsivity and sensation seeking) and risk-taking behaviors (drinking and driving, riding with a drunk driver, binge drinking, speeding for the thrill) common to current alcohol dependent patients and they remain at a higher injury risk than the non alcohol dependent population.

Crash culpability relative to age and sex for injured drivers using alcohol, marijuana or cocaine.

While there is a great deal of data documenting the etiologic role alcohol use plays in crash culpability, there is a dearth of data for other drugs. The purpose of this study was to assess crash culpability for single drug use among injured drivers admitted to a regional trauma center. This study is the largest of its kind involving trauma center patients. Clinical toxicology results obtained for patient care were linked to police crash reports containing a field attributing crash culpability. Drugs studied were alcohol, cocaine, and marijuana. As expected crash culpability was strongly associated with pre-crash alcohol use. In contrast, for both men and women, this study did not find an association between crash culpability and marijuana use. The data documents a significant association between cocaine use and crash culpability for both sexes and for drivers 21 to 40 years of age. This is the first large study to assess for crash culpability among injured drivers relative to cocaine use. Each year approximately 42 to 43,000 people die annually as the result of vehicular crashes. (NHTSA, 2005) For the decade 1994 through 2003, alcohol was a factor in 40-43% fatal injury crashes - the fatally injured person being either a vehicular occupant or pedestrian. Specifically 25 to 29% of drivers of cars and light trucks involved in those crashes were alcohol positive. Further, it is estimated that 80% or more of those drivers had blood alcohol concentrations (BAC) of 80 mg/dl or greater. (NHTSA, 2005).