Analysis of child-vehicle collision injuries by vehicle type.

PURPOSE: This study aimed to determine the severity of injuries to each body region of child pedestrians struck by different types of vehicles. METHODS: We collected in-depth data from the Institute for Traffic Accident Research and Data Analysis on pedestrians younger than 13 years with any bodily injuries from collisions with vehicles between 1993 and 2004. RESULTS: Sixty-eight patients with a mean age of 6.9 ± 2.4 years were included in the study. In collisions, vehicles caused higher Abbreviated Injury Scale (AIS) scores than those from impact with the road. Injury Severity Score and AIS values were higher with one-box or sports utility vehicles compared with those in sedan vehicles, but the differences were not statistically significant. The mean AIS score of head injuries was significantly higher with one-box or sports utility vehicles than that with sedans (1.6 ± 2.1 vs 0.5 ± 1.1, P < .05). The mean AIS score of the lower extremities was significantly higher with sedans than that with one-box or sports utility vehicles (1.2 ± 1.0 vs 0.5 ± 0.9, P < .05). CONCLUSIONS: The type and severity of injuries in child-car collisions vary by type of vehicle and pedestrian kinematics.

Severity of child pedestrian injuries due to bonnet-type-vehicle collision.

BACKGROUND: The aim of this study was to clarify the pattern of child pedestrian injury, injury severity, and its relation to collision velocity in bonnet-type-vehicle collision. METHODS: In-depth data were retrospectively collected from the Institute for Traffic Accident Research and Data Analysis on pedestrians younger than 13 years old with any bodily injuries from collisions with bonnet-type vehicles between 1993 and 2004. RESULTS: Forty-seven patients from 43 collisions with a mean age of 6.9 ± 2.5 years were included in the study. Injury severity was not significantly different between patients who were hit by the front of the vehicle and those who were hit by the side of the vehicle. In front collisions, impact with the vehicle was associated with significantly higher Abbreviated Injury Scale (AIS) scores than those for impact with the road, especially for the lower extremities (mean: 1.2 vs 0.2, P < 0.001). Injury severity of the lower extremities and collision velocity were examined. The estimated collision velocity of the vehicle was not significantly different between patients with lower extremity AIS scores of 0 or 1 and those of 2 or 3. CONCLUSIONS: Some pediatric pedestrians suffer from collisions with bonnet-type vehicles without lower extremity fractures owing to the characteristics of child pedestrians. Providing injury prevention programs for children in communities and schools, developing active safety devices in the vehicle, and modifying the vehicle body to a pediatric pedestrian-friendly structure may increase pedestrian protection.

Multiple-type dynamic culture of highly oriented fiber scaffold for ligament regeneration.

The ruptured anterior cruciate ligament does not heal spontaneously as it has a low capacity for healing. Therefore, the development of new healing techniques employing tissue engineering is vital. As a potentially new approach for ligament regeneration, this study used a highly oriented fiber scaffold made of elastin and collagen (the mean diameters were 1.7 ± 0.4 µm and 0.5 ± 1.4 µm, respectively), which comprise the extracellular matrix of the ligament. In addition, a multiple-type dynamic culture consisting of a combination of pressure and twist stimulation was performed to examine the influence of mechanical force on the functional maintenance of ligament cells and on the differentiation of ligament cells to osteoblast-like cells. Our results show that a pressure stimulation and elastin A upregulated the expression of alkaline phosphatase (ALP) (a marker of osteogenic differentiation) and promoted the osteogenic differentiation of ligament cells. In addition, the twist stimulation upregulated the expression of type III collagen (the main component of ligament tissue). Furthermore, the combination of pressure and twist stimulation promoted the expression of type III collagen and ALP protein depending on the portion of scaffold.

Experimental analysis of the relationship between simulated low-velocity rear-end collisions and fetal outcomes of pregnant rats.

Our study aimed to define the risk for a human fetus of rear-end vehicle collisions. We therefore performed drop tests using pregnant SLC Wistar rats. Pressure applied to the rat uterus and rectum at various stages of acceleration was measured. After being dropped, rats were observed throughout pregnancy. At birth, the numbers, weight and the occurrence of physical anomalies among pups were followed-up for 28 days. Uterine pressure increased exponentially from 2.1 +/- 0.3 kPa at 19-fold gravity (G) to 13.9 +/- 0.8 kPa at 92-fold G. These values are much lower than the mechanical failure level of human fetal membrane tissue or of those at risk of adverse fetal outcomes. Neither the average number of offspring per pregnant rat nor the average body weight of newborn pups differed significantly between control pregnant rats and those which had been exposed to acceleration of 46-fold or 92-fold G. Other variables such as maternal mental distress, motion effects of amniotic fluid or seatbelt-induced uterine injuries might contribute to fetal loss.

Analysis of cervical injuries in persons with head injuries.

To determine which clinical factors are useful for predicting concomitant injuries of the cervical spine and cervical spinal cord in persons with head injuries, we examined the nature and mechanisms of cervical injuries. For 109 forensic autopsies of persons with head injuries, the cause of injury, mechanism of cervical injury, survival time, and anatomic injury severity (1990 revision of the abbreviated injury scale [AIS] and injury severity score) were determined. Traffic accidents were the most common cause of injuries (41.3%), followed by slips and falls (24.8%), assaults (17.4%), and falls from height (9.2%). The mean maximum AIS scores and the AIS scores of the head or neck were similar in the 4 groups. Cervical spine injuries and epidural or subdural hemorrhages of the cervical spinal cord were more common in persons dying in traffic accidents and falls from height than in persons dying in slips and falls or assaults. Cervical injuries were significantly more common in persons sustaining frontal impacts than lateral or rear impacts. The most common cervical hyperextension injuries were atlanto-occipital and atlantoaxial dislocation and injuries of the 5th intervertebral disc. Our results suggest that persons with injuries of the head due to high-energy frontal impacts should be carefully examined for concomitant cervical injuries. These findings should be helpful for decreasing preventable deaths from undiagnosed cervical injuries in head-injured persons.

Accidental strangulation of a mentally retarded patient by a clothing collar: a case report.

A 40-year-old mentally retarded woman died of accidental strangulation in a nursing home. She was found in a kneeling position with her hands on her knees and the collar of her clothing compressing the front and sides of the neck. Before the accident, a nurse had dressed the patient in one-piece overall-style pyjamas put on back to front so that she could not remove the garment herself. The post-mortem findings and reconstruction of the scene of death suggested that the patient had been strangled by the collar of her backward-facing clothing while in a kneeling position. Because patients with psychiatric illnesses may have a limited ability to recognize or communicate symptoms of physical danger, they must be closely monitored by knowledgeable medical and nursing staff. This case highlights the importance of preventing the accidental deaths of mentally retarded patients in nursing homes.

Traffic injuries of the pregnant women and fetal or neonatal outcomes.

OBJECTIVE: To investigate the relationship between pregnancy outcome and injury severity of pregnant woman in traffic accidents. METHOD: We reviewed insurance reports of traffic accidents and collected data on injuries of pregnant women and outcomes of their pregnancies. RESULT: A total of 135 pregnant women, with a mean injury severity score of 1.8+/-4.0, were involved in traffic accidents from 1994 through 2003. Injury severity score, abdominal abbreviated injury scale score were significantly higher in women whose neonates died than in women with healthy newborns. However, neither the likelihood of having been subjected to direct external forces during the accident nor injury severity differed between women with spontaneous abortions and woman with healthy newborns. CONCLUSION: Predicting abortion on the basis of maternal injury severity is difficult. Because unknown variables may contribute to fetal loss, further studies of traffic injuries are needed.

Accidental choking in a patient with Treacher Collins syndrome.

A 3-year-old boy with Treacher Collins syndrome had undergone tracheostomy and placement of a secured cannula at the age of 4 months. When he was 3 years old, he manually extracted the secured cannula by himself and choked to death. Autopsy revealed upper airway obstruction with posterior deviation and mucosal hyperplasia of the radix linguae, mandibular hyperplasia, and occlusion of the artifical airway owing to intratracheal granuloma due to the long-standing tracheotomy. For safe, long-term use of a tracheostomy to maintain the airway, children with craniofacial abnormalities should be carefully supervised by their families to prevent accidental decannulation.

An autopsy case of sudden death in a boy with primary pulmonary hypertension: a case report.

We report a rare autopsy case of sudden death due to primary pulmonary hypertension. A seven-year-old boy, who had been diagnosed with primary pulmonary hypertension at the age of four years, died suddenly. Forensic autopsy and histopathologic examination revealed extensive obstruction of small muscular pulmonary arteries by plexiform lesions and concentric intimal thickenings, compatible with primary pulmonary hypertension. We concluded that plexiform lesions of pulmonary arteries produced right ventricular hypertrophy and dilatation, decreased the preload of the left ventricle and subsequently led to biventricular failure. This autopsy and histopathologic examination suggested a possible pathophysiologic mechanism of sudden death due to primary pulmonary hypertension in a child.

Changes in blood viscosity with heavy and light exercise.

To clarify the relationship of the intensity of acute exercise to sudden cardiac death, we examined the effects of short-term heavy and light exercise on whole blood viscosity. Nine healthy sedentary male volunteers performed ten minutes of heavy (more than 95% of maximum oxygen consumption) or light (60% to 65% of maximum oxygen consumption) exercise. Blood samples were obtained before, immediately after, and one hour after exercise. The whole blood viscosity was immediately examined with an oscillation-type viscometer and was found to increase significantly after exercise and subsequently return to baseline levels within one hour after exercise. The whole blood viscosity increased by a similar degree after heavy or light exercise. Therefore, our results suggest that there is a similar risk of sudden cardiac death, due to increased whole blood viscosity, after short-term heavy or light exercise.

An autopsy case of fatal anaphylactic shock following fluorescein angiography: a case report.

We present a rare autopsy case of fatal anaphylactic shock following fluorescein angiography. A 71-year-old Japanese woman undergoing retinal angiography to evaluate diabetic retinopathy died immediately after an injection of sodium fluorescein. Forensic autopsy and post-mortem biochemical analyses revealed an elevated serum level of tryptase which, in the absence of morphologic changes suggesting injury or disease, confirmed the diagnosis of fatal anaphylactic shock. Although serious adverse effects are rare after fluorescein angiography, patients should be observed, with appropriate resuscitation equipment available, for several hours after the administration of fluorescein.

Changes in blood viscosity with mucopolysaccharide polysulfate.

We examined the dose-dependent effects of mucopolysaccharide polysulfate (MPS) on coagulation variables and whole-blood viscosity in human blood. Both 0.01% and 0.1% MPS significantly reduced levels of both fibrin monomer and thrombin-antithrombin III complex in a manner similar to that of 2.0 IU/ml heparin sodium. Furthermore, MPS dose-dependently decreased whole-blood viscosity, as measured with an oscillation viscometer. Because MPS can be applied in creams and gels, percutaneous application of MPS may effectively reduce whole-blood viscosity in local veins.