Occupant kinematics and shoulder belt retention in far-side lateral and oblique collisions: a parametric study.

In far-side impacts, head contact with interior components is a key injury mechanism. Restraint characteristics have a pronounced influence on head motion and injury risk. This study performed a parametric examination of restraint, positioning, and collision factors affecting shoulder belt retention and occupant kinematics in far-side lateral and oblique sled tests with post mortem human subjects (PMHS). Seven PMHS were subjected to repeated tests varying the D-ring position, arm position, pelvis restraint, pre-tensioning, and impact severity. Each PMHS was subjected to four low-severity tests (6.6 g sled acceleration pulse) in which the restraint or position parameters were varied and then a single higher-severity test (14 g) with a chosen restraint configuration (total of 36 tests). Three PMHS were tested in a purely lateral (90° from frontal) impact direction; 4 were tested in an oblique impact (60° from frontal). All subjects were restrained by a 3-point seatbelt. Occupant motion was tracked with a 3D optoelectric high speed motion capture system. For all restraint configurations, the 60° oblique impact angle was associated with greater lateral head excursion than the 90° impact angle. This unexpected result reflects the increased axial rotation of the torso in the oblique impacts, which allowed the shoulder to displace more relative to the shoulder belt and thus the head to displace more relative to the sled buck. Restraint engagement of the torso and shoulder was actually greater in the purely lateral impacts than in the oblique impacts. Pretensioning significantly reduced lateral head excursion (175 mm average in the low-severity tests across all restraint configurations).

Practical experience of telehealth between an Antarctic station and Japan.

The Japanese Antarctic Research Expedition (JARE) has had a presence in Antarctica since 1956. The Syowa station is 15,000 km from Japan and evacuation of patients is impossible during the winter months. From 1956 to 2003, a total of 4932 telemedical consultations were undertaken, i.e. every member of the station needed an average of 4 medical consultations each winter. Forty five percent of the consultations were surgical or orthopaedic cases, 23% were for internal medicine and 12% were for dental problems. In the early 1980s, satellite radio-telephony was found to be useful for consultations, but did not have the ability to transmit medical pictures. Email was transmitted by the International Mobile Satellite Organization (INMARSAT) but the connection was only available every 2 hours and the maximum message size was 100 kByte. In 2004, the International Telecommunications Satellite (INTELSAT) system made a connection constantly available, and increased the maximum message size to 10 MByte. Transmission of still and moving pictures became possible. Scheduled consultations are performed monthly. A doctor in Japan can ask the patient questions and perform a proxy examination with the assistance of the Antarctic doctor. Real-time telemedicine is very effective in orthopaedic and surgical cases, skin, eye and dental troubles. Still pictures are more effective for understanding in detail skin and eye problems. Emergency consultations are effective if adequate consulting staff are available.

A methodology to estimate the kinematics of pediatric occupants in frontal impacts.

OBJECTIVE: The goal of this article is to propose a new methodology to estimate the sagittal plane displacement of the head, spine, and pelvis of a 6-year-old (6YO) occupant during a high-speed frontal impact. Research has shown major discrepancies between the spinal kinematics of current pediatric anthropomorphic test devices and humans during frontal impacts. This article provides an estimation of the kinematics of a pediatric subject that may assist in the development of physical and computational models of a 6YO occupant in high-speed frontal impacts. METHODS: This article presents data on 4 different experimental data sets corresponding to noninjurious low-speed (nominally 9 km/h) frontal impacts involving pediatric and adult volunteers and to low-speed (9 km/h) and high-speed (40 km/h) frontal impacts with postmortem human subjects (PMHS). Kinematic data from each subject were first normalized to the size of a 50th percentile within its age group. Two already published and commonly used scaling methods (mass scaling and the Society of Automotive Engineers [SAE] scaling methods) were assessed using volunteer data. A new scaling method based on energy considerations was developed. RESULTS: Both the mass scaling and the SAE scaling methods failed to predict the actual pediatric displacement at 9 km/h. The newly proposed method substantially improved the prediction of the pediatric kinematics at low speed and it was applied to the high-speed PMHS data to provide an approximation of the displacements of the head, thoracic spine, and pelvis of a 6YO occupant in a 40 km/h frontal impact. CONCLUSIONS: A new scaling method based on energy conservation improved the prediction of the displacement of the pediatric head, thoracic spine, and pelvis at 9 km/h. This method was then applied to the response of the PMHS in a high-speed impact to provide an approximation of the 6YO kinematics in a 40 km/h frontal impact. The article also discusses the limitations of the method, which failed to completely describe the kinematics of pediatric occupants.

Combination PEG-IFN a-2b/ribavirin therapy following treatment of hepatitis C virus-associated hepatocellular carcinoma is capable of improving hepatic functional reserve and survival.

BACKGROUND/AIMS: Hepatitis C virus (HCV) associated HCC shows a high rate of recurrence even after curative treatment. Outcomes of pegylated interferon PEGIFN a-2b/ribavirin (RBV) therapy for HCV-associated HCC have yet to be elucidated. We investigated therapeutic response and hepatic functional reserve improvement in patients receiving PEG-IFN a-2b/RBV after curative HCC treatment. METHODOLOGY: We investigated survival rate, metachronous recurrence and hepatic functional reserve in 54 patients with initial HCV-associated Stage I/II HCC; 29 patients were administered a preparation of PEG-IFN a-2b/RBV after HCC treatment (Secondary IFN group) and 25 were not (Non-secondary IFN group). RESULTS: A significant difference was observed in cumulative survival rates among HCV-associated HCC patients with rates of 100% after 1 year and 90.2% after 3 years in the secondary IFN group compared to 96.0% and 61.2%, respectively, in the non-secondary IFN group. Univariate analysis identified secondary IFN treatment, alanine aminotransferase and albumin levels as factors contributing to survival. Serum albumin level decreased temporarily but subsequently increased and improved hepatic functional reserve was observed in PEG-IFN a-2b/RBV therapy. CONCLUSIONS: PEG-IFN a-2b/RBV therapy after HCC treatment can improve hepatic functional reserve and may therefore represent a therapeutic option in the event of recurrence. PEG-IFN a-2b/ RBV therapy following HCC treatment shows promise for improving the prognosis of HCC.

Kinetics of the cervical spine in pediatric and adult volunteers during low speed frontal impacts.

Previous research has quantified differences in head and spinal kinematics between children and adults restrained in an automotive-like configuration subjected to low speed dynamic loading. The forces and moments that the cervical spine imposes on the head contribute directly to these age-based kinematic variations. To provide further explanation of the kinematic results, this study compared the upper neck kinetics - including the relative contribution of shear and tension as well as flexion moment - between children (n=20, 6-14 yr) and adults (n=10, 18-30 yr) during low-speed (<4 g, 2.5 m/s) frontal sled tests. The subjects were restrained by a lap and shoulder belt and photo-reflective targets were attached to skeletal landmarks on the head, spine, shoulders, sternum, and legs. A 3D infrared tracking system quantified the position of the targets. Shear force (F(x)), axial force (F(z)), bending moment (M(y)), and head angular acceleration (θ(head)) were computed using inverse dynamics. The method was validated against ATD measured loads. Peak F(z) and θ(head) significantly decreased with increasing age while M(y) significantly increased with increasing age. F(x) significantly increased with age when age was considered as a univariate variable; however when variations in head-to-neck girth ratio and change in velocity were accounted for, this difference as a function of age was not significant. These results provide insight into the relationship between age-based differences in head kinematics and the kinetics of the cervical spine. Such information is valuable for pediatric cervical spine models and when scaling adult-based upper cervical spine tolerance and injury metrics to children.

The effect of pretensioning and age on torso rollout in restrained human volunteers in far-side lateral and oblique loading.

Far-side side impact loading of a seat belt restrained occupant has been shown to lead to torso slip out of the shoulder belt. A pretensioned seat belt may provide an effective countermeasure to torso rollout; however the effectiveness may vary with age due to increased flexibility of the pediatric spine compared to adults. To explore this effect, low-speed lateral (90°) and oblique (60°) sled tests were conducted using male human volunteers (20 subjects: 9-14 years old, 10 subjects: 18-30 years old), in which the crash pulse safety envelope was defined from an amusement park bumper-car impact. Each subject was restrained by a lap and shoulder belt system equipped with an electromechanical motorized seat belt retractor (EMSR) and photo- reflective targets were attached to a tight-fitting headpiece or adhered to the skin overlying key skeletal landmarks. Each subject was randomly assigned to either the 60° or 90° direction and was exposed to 4 test conditions - arms up (with hands on their knees) with EMSR on, arms down (with hands low on the hips) with EMSR on, arms up with EMSR off, arms down with EMSR off. The effect of age and pretensioning on the following outcomes was quantified: 1) lateral and forward displacement of the torso, 2) torso rollout angle projected onto three orthogonal planes, and 3) resultant belt-sternal distance. The effect of pretensioning on torso containment within the shoulder belt was strong in both impact directions across all metrics evaluated. EMSR activation significantly reduced lateral displacement of the suprasternal notch (~100 mm, p<0.0001), coronal projection of the torso rollout angle (~15°, p<0.0001), and belt sternal distance when the arms were down (~50 mm, p<0.05). The benefit of pretensioning was achieved by early engagement of the torso by the shoulder belt. An added benefit of pretensioning was the ability to make similar the torso kinematics across a range of anthropometries as assessed within and across age groups. These results can serve as a data set for validating the responses of restrained ATDs and computational human models to low severity far side collisions, in particular the interaction between the torso and the shoulder belt.

Complete early virological response was highly achieved by double filtration plasmapheresis plus IFN-beta induction therapy for HCV-1b patients with relapse or no response after previous IFN therapy.

The efficacy of double filtration plasmapheresis (DFPP) plus interferon (IFN)-ß induction therapy was preliminarily investigated in re-treated patients with chronic genotype 1b hepatitis C and high viral load (patients with relapse or non-response to previous IFN therapies). In eight patients with chronic hepatitis C, DFPP was performed five times over 2 weeks during IFN-ß therapy, and 3 MU of IFN-ß was administered twice a day for 2 weeks. Combination therapies with ribavirin and pegylated IFN-α2b (PEG-IFN-α2b) or pegylated IFN-α2a (PEG-IFN-α2a) were subsequently used. After 4 weeks, hepatitis C virus (HCV)-RNA tended to be more greatly decreased with DFPP combination therapy than with previous IFN therapy (4.5 ± 2.0 log(10) IU/mL vs. 2.9 ± 1.2 log(10) IU/mL). Rates of both rapid virological response and complete early virological response were significantly higher with DFPP and IFN-ß induction therapy than with previous IFN therapy. DFPP plus IFN-ß induction therapy produced a great reduction of viral load during the early stage of treatment and achieved a high early virological response, suggesting that this combination therapy may be useful as a new treatment modality for chronic hepatitis C patients in difficult-to-treat states. This combination may contribute to sustained virological response (SVR). The effects of DFPP on SVR and its significance remain to be clarified.

Prevention of intrahepatic distant recurrence by transcatheter arterial infusion chemotherapy with platinum agents for stage I/II hepatocellular carcinoma.

BACKGROUND: The effectiveness of additional chemotherapy in preventing intrahepatic distant tumor recurrence of hepatocellular carcinoma (HCC) has not been fully established. The authors compared the efficacy of 2 platinum-based chemotherapeutic agents in combination with radical local treatment for preventing intrahepatic distant recurrence (IDR). METHODS: Seventy-eight patients with stage I/II HCC aged 45 to 85 years underwent transcatheter arterial chemoembolization and/or radiofrequency ablation after they received hepatic arterial infusion (HAI) of platinum compounds. The HAI consisted of cis-diammine(1,1-cyclobutanedicarboxylato)platinum(II) (carboplatin) in 25 patients and cis-diamminedichloroplatinum (II) (cisplatin) in 53 patients. Multivariate analysis was used to identify independent factors that were associated with IDR. RESULTS: Cumulative IDR rates at 1 year, 2 years, and 3 years were 21.7%, 52.2% and 75.7%, respectively, in the carboplatin group and 8.1%, 22.7%, and 36.9%, respectively, in the cisplatin group. The cisplatin group had a significantly lower IDR rate compared with the carboplatin group. The selection of a platinum agent was 1 of the independent factors for IDR in a multivariate Cox proportional hazards model. CONCLUSIONS: HAI chemotherapy with cisplatin before radical local treatment was effective in patients with HCC. The authors concluded that radical local treatment with concurrent HAI using cisplatin may contribute to a longer progression-free period, which could be predicted with intrahepatic imaging in patients with stage I/II HCC.

Assessment of a three-point restraint system with a pre-tensioned lap belt and an inflatable, force-limited shoulder belt.

This study investigates the performance of a 3-point restraint system incorporating an inflatable shoulder belt with a nominal 2.5-kN load limiter and a non-inflatable lap belt with a pretensioner (the "Airbelt"). Frontal impacts with PMHS in a rear seat environment are presented and the Airbelt system is contrasted with an earlier 3-point system with inflatable lap and shoulder belts but no load-limiter or pretensioners, which was evaluated with human volunteers in the 1970s but not fully reported in the open literature (the "Inflataband"). Key differences between the systems include downward pelvic motion and torso recline with the Inflataband, while the pelvis moved almost horizontally and the torso pitched forward with the Airbelt. One result of these kinematic differences was an overall more biomechanically favorable restraint loading but greater maximum forward head excursion with the Airbelt. The Airbelt is shown to generate generally lower head, neck, and thoracic injury metrics and PMHS trauma than other, non-inflatable rear-seat restraint concepts (viz., a standard 3-point belt and a pre-tensioned shoulder belt with a progressive load limiter). Further study is needed to evaluate the Airbelt system for different size occupants (e.g., children), non-frontal impact vectors, and for out-of-position occupants and to allow the results with this particular system to be generalized to a broader range of Airbelt designs.

Analysis of spinal motion and loads during frontal impacts. Comparison between PMHS and ATD.

Quantifying the kinematics of the human spine during a frontal impact is a challenge due to the multi-degree-of-freedom structure of the vertebral column. This papers reports on a series of six frontal impacts sled tests performed on three Post Mortem Human Surrogates (PMHS). Each subject was exposed first to a low-speed, non-injurious frontal impact (9 km/h) and then to a high-speed one (40 km/h). Five additional tests were performed using the Hybrid III 50(th) percentile male ATD for comparison with the PMHS. A 3D motion capture system was used to record the 6-degree-of-freedom motion of body segments (head, T1, T8, L2, L4 and pelvis). The 3D trajectories of individual bony structures in the PMHS were determined using bone-mounted marker arrays, thus avoiding skin-attached markers and their potential measurements artifacts. The PMHS spines showed different behavior between low and high speed. While at low speed the head and upper spinal segments lagged the lower portion of the spine and pelvis in reaching their maximum forward displacement (time for maximum forward head excursion was 254.3±31.9 ms and 140.3±9 ms for the pelvis), these differences were minimal at high speed (127±2.6 ms for the head vs. 116.7±3.5 ms for the pelvis). The ATD did not exhibit this speed-dependant behavior. Furthermore, the ATD's forward displacements were consistently less than those exhibited by the PMHS, regardless of the speed. Neck loads at the atlanto-occipital joint were estimated for the PMHS using inverse dynamics techniques and compared to those measured in the ATD. It was found that the axial and shear forces and the flexion moment at the upper neck of the PMHS were higher than those measured in the ATD.

Kinematic Comparison of Pediatric Human Volunteers and the Hybrid III 6-Year-Old Anthropomorphic Test Device.

The Hybrid III 6-year-old ATD has been benchmarked against adult-scaled component level tests but the lack of biomechanical data hinders the effectiveness of the procedures used to scale the adult data to the child. Whole body kinematic validation of the pediatric ATD through limited comparison to post mortem human subjects (PMHS) of similar age and size has revealed key differences attributed to the rigidity of the thoracic spine. As restraint systems continue to advance, they may become more effective at limiting peak loads applied to occupants, leading to lower impact environments for which the biofidelity of the ATD is not well established. Consequently, there is a growing need to further enhance the assessment of the pediatric ATD by evaluating its biofidelity at lower crash speeds. To this end, this study compared the kinematic response of the Hybrid III 6 year old ATD against size-matched male pediatric volunteers (PVs) (6-9 yrs) in low-speed frontal sled tests. A 3-D near-infrared target tracking system quantified the position of markers at seven locations on the ATD and PVs (head top, opisthocranion, nasion, external auditory meatus, C4, T1, and pelvis). Angular velocity of the head, seat belt forces, and reaction forces on the seat pan and foot rest were also measured. The ATD exhibited significantly greater shoulder and lap belt, foot rest, and seat pan normal reaction loads compared to the PVs. Contrarily, PVs exhibited significantly greater seat pan shear. The ATD experienced significantly greater head angular velocity (11.4 ± 1.7 rad/s vs. 8.1 ± 1.4 rad/s), resulting in a quicker time to maximum head rotation (280.4 ± 2.5 ms vs 334.2 ± 21.7 ms). The ATD exhibited significantly less forward excursions of the nasion (171.7 ± 7.8 mm vs. 199.5 ± 12.3 mm), external auditory meatus (194.5 ± 11.8 mm vs. 205.7 ± 10.3 mm), C4 (127.0 ± 5.2 mm vs. 183.3 ± 12.8 mm) and T1 (111.1 ± 6.5 mm vs. 153.8 ± 10.5 mm) compared to the PVs. These analyses provide insight into aspects of ATD biofidelity in low-speed crash environments.

An inflatable belt system in the rear seat occupant environment: investigating feasibility and benefit in frontal impact sled tests with a 50(th) percentile male ATD.

Frontal-impact airbag systems have the potential to provide a benefit to rear seat occupants by distributing restraining forces over the body in a manner not possible using belts alone. This study sought to investigate the effects of incorporating a belt-integrated airbag ("airbelt") into a rear seat occupant restraint system. Frontal impact sled tests were performed with a Hybrid III 50th percentile male anthropomorphic test device (ATD) seated in the right-rear passenger position of a 2004 mid-sized sedan buck. Tests were performed at 48 km/h (20 g, 100 ms acceleration pulse) and 29 km/h (11 g, 100 ms). The restraints consisted of a 3-point belt system with a cylindrical airbag integrated into the upper portion of the shoulder belt. The airbag was tapered in shape, with a maximum diameter of 16 cm (at the shoulder) that decreased to 4 cm at the mid-chest. A 2.5 kN force-limiter was integrated into the shoulder-belt retractor, and a 2.3 kN pretensioner was present in the out-board anchor of the lap belt. Six ATD tests (three 48 km/h and three 29 km/h) were performed with the airbelt system. These were compared to previous frontal-impact, rear seat ATD tests with a standard (not-force-limited, not-pretensioned) 3-point belt system and a progressive force-limiting (peak 4.4 kN), pretensioning (FL+PT) 3-point belt system. In the 48 km/h tests, the airbelt resulted in significantly less (p<0.05, two-tailed Student's t-test) posterior displacement of the sternum towards the spine (chest deflection) than both the standard and FL+PT belt systems (airbelt: average 13±1.1 mm standard deviation; standard belt: 33±2.3 mm; FL+PT belt: 23±2.6 mm). This was consistent with a significant reduction in the peak upper shoulder belt force (airbelt: 2.7±0.1 kN; standard belt: 8.7±0.3 kN; FL+PT belt: 4.4±0.1 kN), and was accompanied by a small increase in forward motion of the head (airbelt: 54±0.4 cm; standard belt: 45±1.3 cm; FL+PT belt: 47±1.1 cm) The airbelt system also significantly reduced the flexion moment in the lower neck (airbelt: 169±3.3 Nm; standard belt: 655±26 Nm; FL+PT belt: 308±19 Nm). Similar results were observed in the 29 km/h tests. These results suggest that this airbelt system may provide some benefit for adult rear seat occupants in frontal collisions, even in relatively low-speed impacts. Further study is needed to evaluate this type of restraint system for different size occupants (e.g., children), for out-of-position occupants, and with other occupant models (e.g., cadavers).

Gemcitabine in arterial injection chemotherapy for pancreatic cancer does not cause catheter obstruction or any other complication.

BACKGROUND/AIMS: Intra-arterial injection therapy is performed to ensure more localized administration; however, this approach has led to more cases of catheter obstruction during the course of treatment for pancreatic cancer than in any other type of cancer. Therefore, the purpose of this study was to verify the resistance of catheters to gemcitabine. METHODOLOGY: The catheters were prepared by injecting gemcitabine into the lumen, which was subsequently closed by clipping both ends. After incubation, the gemcitabine in the lumen of the catheter was removed, the breaking strength was measured by pulling 1 side of the catheter at a speed of 500 mm/min to test the tensile strength. To verify the surface of the lumen, the lumen was observed with an electron microscope. RESULTS: Soaking the lumen revealed no significant differences in breaking strength due to abusive treatment conditions. Electron microscopy revealed residual microscopic amounts of gemcitabine in the lumen but with no marked deterioration or alteration in the quality of the tube surface. CONCLUSIONS: Gemcitabine had no chemical effect on the intra-arterial injection catheter. It is possible that a thrombotic tendency in pancreatic cancer patients may be responsible for the high frequency of catheter occlusion in patients with this disease.

Usefulness of Y-shaped sheaths in CT angiography for examination of liver tumors.

AIM: To conduct a single-stage, combined computed tomography (CT) arterial portography (CTAP) and CT arteriography (CTA) imaging operation, we used Y-shaped sheaths with 2 valves, which allowed the insertion of 2 catheters simultaneously. METHODS: Of 1254 patients who underwent abdominal angiography for transarterial embolization and/or intraarterial chemotherapy in our department from May 2002 to November 2009, 664 patients in whom Y-shaped sheaths with 2 valves were used underwent CT angiography using a combination of CTA and CTAP. The Seldinger method was used to insert a 10 cm Y-shaped short sheath with 2 valves into the femoral artery. Under radiographic guidance, a 3.2 French (Fr) catheter was placed in the celiac artery or proper hepatic artery, and a second 3.2 Fr catheter was then placed distal to the inferior pancreaticoduodenal artery of the superior mesenteric artery. CTAP was then performed followed by CTA 10 min later. Photographs were taken during the early and late phases of the procedure. RESULTS: Insertion of 3.2 Fr catheters was not possible in 6 of 664 (0.9%) patients with strong curvature of the femoral artery and 4 of 664 (0.6%) patients with strong curvature of the abdominal aorta. In addition, performing CTAP and CTA as a single-stage combined intervention was not possible in 14 of 664 (2.1%) patients whose right hepatic artery originated from the superior mesenteric artery and in 8 of 664 (1.2%) patients whose left hepatic artery branched from the left gastric artery. There were no sheath-related complications such as those related to arterial dissection or hemostasis. CONCLUSION: Although transfers to and from the CT room were necessary for anatomically variant patients, CT angiography using the Y-shaped sheath for combined CTAP and CTA was considered useful.

[Multiple liver metastases due to sigmoid colon cancer successfully treated by degradable starch microspheres (DSM)-TAE, radiofrequency ablation therapy, and Uzel/UFT].

A69-year-old man was diagnosed with sigmoid colon cancer and underwent resection of the sigmoid colon. He was later diagnosed with multiple liver metastases 11 months after resection of the sigmoid colon cancer. He was treated by intraarterial chemoembolization using degradable starch microspheres (DSM) and radiofrequency ablation therapy. As a systemic therapy, combined oral administration of tegafur/uracil (UFT) and Leucovorin(Uzel) was started (UFT 450 mg/day, Leucovorin 75 mg/day, 4 weeks of therapy followed by a 1-week treatment break). Two months after 4 courses, the liver metastases had markedly diminished and CEA was within the normal range. The metastases had almost disappeared and tumor markers decreased to within normal limits. This treatment was very safe and effective. Such a strategic multidisciplinary treatment can lead to a better prognosis for colorectal cancer with liver metastases.

Oral branched-chain amino acids administration improves impaired liver dysfunction after radiofrequency ablation therapy for hepatocellular carcinoma.

BACKGROUND/AIMS: Radiofrequency ablation (RFA) is a new modality for hepatocellular carcinoma (HCC). However, the effects of RFA on hepatic reserve have not yet been thoroughly studied. In the present study, it was evaluated the effect of branched chain amino acid (BCAA) administration after RFA. METHODOLOGY: Fifty-seven patients with initial, single HCC lesions measuring not more than 30mm in whom RFA was selected in first-line therapy were enrolled. Twenty-eight patients with the Child-Pugh B/C grade who received RFA therapy were divided into two groups: 11 who received a BCAA-enriched nutrient mixture, and 17 who did not. Changes in serum albumin were evaluated before RFA and 1, 6 and 12 months after RFA. RESULTS: Multivariate analysis showed that the Child-Pugh grading is the most important factor related to intrahepatic distant recurrence following by RFA. Serum albumin levels decreased 1 month after RFA. Although a tendency toward recovery was noted 6 months after RFA, a decreasing tendency was noted again one year after RFA compared to the pre-RFA baseline. However, a tendency toward improvement was noted in Child-Pugh B grade patients who received BCAA mixture. CONCLUSIONS: BCAA mixture made it possible to maintain serum albumin levels and hepatic reserve.

Comparison of kinematic responses of the head and spine for children and adults in low-speed frontal sled tests.

Previous research has suggested that the pediatric ATD spine, developed from scaling the adult ATD spine, may not adequately represent a child's spine and thus may lead to important differences in the ATD head trajectory relative to a human. To gain further insight into this issue, the objectives of this study were, through non-injurious frontal sled tests on human volunteers, to 1) quantify the kinematic responses of the restrained child's head and spine and 2) compare pediatric kinematic responses to those of the adult. Low-speed frontal sled tests were conducted using male human volunteers (20 subjects: 6-14 years old, 10 subjects: 18-40 years old), in which the safety envelope was defined from an amusement park bumper-car impact. Each subject was restrained by a custom-fit lap and shoulder belt system and photo-reflective targets were attached to a tight-fitting cap worn on the head or adhered to the skin overlying skeletal landmarks on the head, spine, shoulders, sternum, and legs. A 3-D near-infrared target tracking system quantified the position of the following markers: head top, external auditory meatus, nasion, opisthocranion, C4, T1, T4, and T8. Trajectory data were normalized by subject seated height and head and spine rotations were calculated. The Generalized Estimating Equations method was used to determine the effect of age and key anthropometric measures on marker excursion. For all markers, the normalized forward excursion significantly decreased with age and all spinal markers moved upward due to a combination of rigid body rotation and spinal flexion with lesser upward movement with age. The majority of the spine flexion occurred at the base of the neck not in the upper cervical spine and the magnitude of flexion was greatest for the youngest subjects. Additional flexion occurred in the thoracic spine as well. Our findings indicate that the primary factor governing the differences in normalized head and spinal trajectories between the various age groups was decreasing head-to-neck girth ratio with increasing age. Other factors, such as muscle response and cervical vertebral structural properties, may also contribute to the differences, but were not evaluated in this paper. These results can serve as a data set for validating the responses of restrained ATDs and computational human models to low severity frontal collisions.

Biomechanical response of the pediatric abdomen, Part 2: injuries and their correlation with engineering parameters.

This paper describes the injuries generated during dynamic belt loading to a porcine model of the 6-year-old human abdomen, and correlates injury outcomes with measurable parameters. The test fixture produced transverse, dynamic belt loading on the abdomen of 47 immediately post-mortem juvenile swine at two locations (upper/lower), with penetration magnitudes ranging from 23% - 65% of the undeformed abdominal depth, with and without muscle tensing, and over a belt penetration rate range of 2.9 m/s - 7.8 m/s. All thoracoabdominal injuries were documented in detail and then coded according to the Abbreviated Injury Scale (AIS). Observed injuries ranged from AIS 1 to AIS 4. The injury distribution matched well the pattern of injuries observed in a large sample of children exposed to seatbelt loading in the field, with most of the injuries in the lower abdomen. Univariate and multiple regression models were used to assess mechanical predictors as injury criteria for maximum AIS 2+ and 3+ outcomes, including peak belt tension and posterior reaction force, abdominal penetration, penetration rate, the viscous criterion, and a newly proposed criterion, FCmax, which is the maximum of the instantaneous product of loading rate and normalized penetration. The Goodman-Kruskal Gamma (gamma) was used to assess each parameter's ability to discriminate between injurious and non-injurious tests. Injury risk functions were generated for both outcomes by fitting a 2-parameter Weibull distribution to the injury data using survival analysis. The best discriminators were peak belt tension (gamma = 0.86 and 0.83, p < 0.01), the work done by the deforming thorax (gamma = 0.86 and 0.74, p < 0.01), and abdominal penetration (gamma = 0.89 and 0.66, p < 0.02). Penetration rate was not a good discriminator (gamma = 0.34 and 0.52), and the consideration of penetration rate decreased the discrimination of the viscous criterion (gamma = 0.67 and 0.58) relative to penetration alone. FCmax was a better discriminator of injury than the viscous criterion (gamma = 0.70 and 0.76, p < 0.01), indicating that the loading rate may be more related to injury outcome than the penetration rate.

[Hypogeusia in a 9-year-old girl with multiple sclerosis].

We reported a case of hypogeusia in a 9-year-old girl with multiple sclerosis (MS). She had two episodes of neurological disturbances resembling those associated with MS, and diagnosed by McDonald's criteria. She complained of gustatory disturbance on the first attack. A quantitative test with four fundamental tastes (measurements with a filter paper disc) suggested decreased gustatory sensitivity in the right anterior part of the tongue. Magnetic resonance imaging (MRI) revealed a right thalamic lesion involving the ventral posteromedial nucleus parvocellular part (VPMpc). The patient was successfully treated with steroid pulse therapy, and improvement of neurological abnormalities involving gustatory disturbances was seen. Some studies of monkeys have demonstrated that the secondary neurons in the gustatory part of the solitary nucleus project ipsilaterally to VPMpc in the brainstem. The gustatory pathway in humans has not yet been demonstrated, but is speculated to be present based on that of monkeys. In the present case, we considered that the thalamic lesion involving VPMpc caused a decreased sense of taste in the ipsilateral part of the tongue. Several neurological abnormalities caused by multifocal demyelinating lesions can be observed in MS, but gustatory disturbance is rare. We quantitatively investigated unilateral gustatory disturbance in our patient, and concluded that the ipsilateral thalamic lesion detected by MRI could be causative.

Antipyretics and delirious behavior during febrile illness.

BACKGROUND: The purpose of the present paper was to study the use of antipyretics in children with delirium associated with fever in order to clarify their possible adverse effects. METHODS: The use of antipyretics was investigated in 26 children with delirious behavior associated with fever. Temporal relation between delirious behavior and the use of antipyretics was recognized in six children. RESULTS: In four children, delirious behavior was observed soon after administration of antipyretics. The antipyretics used were acetaminophen in two children, mephenamate in one, and diclofenac in one. In the other two children, delirious behavior was observed when body temperature began to fall 1-2 h after administration of antipyretics. The antipyretics used were acetaminophen in one child and mephenamate in one. CONCLUSION: A temporal relationship between antipyretics and delirious behavior was observed in some patients with febrile delirium. This suggests that antipyretics can be a trigger of delirium.