Volume 18 · Issue 02 · 2015

自1896年8月17日伦敦发生第一起致命车祸以来，¹超过3200万人死于车祸，超过了战争或自然灾害造成的死亡总数。

To study the biomechanical mechanism of head injuries beaten with sticks, which is common in the battery or assaultive cases.

In this study, the Hybrid-III anthropomorphic test device and finite element model (FEM) of the total human model for safety (THUMS) head were used to determine the biomechanical response of head while being beaten with different sticks. Total eight Hybrid-III tests and four finite element simulations were conducted. The contact force, resultant acceleration of head center of gravity, intracranial pressure and von Mises stress were calculated to determine the different biomechanical behavior of head with beaten by different sticks.

In Hybrid-III tests, the stick in each group demonstrated the similar kinematic behavior under the same loading condition. The peak values of the resultant acceleration for thick iron stick group, thin iron stick group, thick wooden stick group and thin wooden stick group were 203.4 g, 221.1 g, 170.5 g and 122.2 g respectively. In finite element simulations, positive intracranial pressure was initially observed in the frontal comparing with negative intracranial pressure in the contra-coup site. Subsequently the intracranial pressure in the coup site was decreasing toward negative value while the contra-coup intracranial pressure increasing toward positive values.

The results illustrated that the stiffer and larger the stick was, the higher the von Mises stress, contact force and intracranial pressure were. We believed that the results in the Hybrid-III tests and THUMS head simulations for brain injury beaten with sticks could be reliable and useful for better understanding the injury mechanism.

To explore the relationship between the collision parameters of vehicle and the pedestrian thorax injury by establishing the chest simulation models in car-pedestrian collision at different velocities and angles.

87 cases of vehicle-to-pedestrian accidents, with detailed injury information and determined vehicle impact parameters, were included. The severity of injury was scaled in line with the Abbreviated Injury Scale (AIS). The chest biomechanical response parameters and change characteristics were obtained by using Hyperworks and LS-DYNA computing. Simulation analysis was applied to compare the characteristics of injuries.

When impact velocities at 25, 40 and 55 km/h, respectively, 1) the maximum values of thorax velocity criterion (VC) were for 0.29, 0.83 and 2.58 m/s; and at the same collision velocity, the thorax VC from the impact on pedestrian's front was successively greater than on his back and on his side; 2) the maximum values of peak stress on ribs were 154, 177 and 209 MPa; and at the same velocity, peak stress values on ribs from the impact on pedestrian's side were greater than on his front and his back.

There is a positive correlation between the severity and risk of thorax injury and the collision velocity and angle of car-thorax crashes. At the same velocity, it is of greater damage risk when the soft tissue of thorax under a front impact; and there is also a greater risk of ribs fracture under a side impact of the thorax. This result is of vital significance for diagnosis and protection of thorax collision injuries.

To discuss the characteristics and risk factors for intracranial infection post traumatic brain injury to prevent and better the clinical care.

Retrospective study of 520 patients with traumatic brain injury were included, 308 male and 212 female. The risky factors of intracranial infection were identified.

Thirty two cases (6.54%, 32/520) of intracranial infection were diagnosed. Intracranial infection most likely happened 4-10 days after injury. Cerebrospinal fluid leakage, drainage, multiple craniotomies were significant related to intracranial infection. Logistic regression predicted cerebrospinal fluid leakage and drainage as independent factors.

Intracranial infection is a serious complication after traumatic brain injury. Patients with drainage or cerebrospinal fluid leakage are more risky for intracranial infection. Aggressive precaution should be taken to better outcome.

To investigate and analyze the clinical and etiological characteristics of community-acquired intraabdominal infections (CIAIs) and hospital-acquired or nosocomial intraabdominal infections (NIAIs) in a comprehensive hospital, to understand the characteristics, pathogen composition, and drug resistance of CIAIs as well as NIAIs, and to provide a reference for clinical treatment.

We collected the clinical data of patients with intraabdominal infections admitted to our hospital from June 2013 to June 2014. In vitro drug sensitivity tests were conducted to separate pathogens, and the data were analyzed using the WHONET 5.4 software and SPSS 13.0 software.

A total of 221 patients were enrolled in the study, including 144 with CIAIs (55 mild-moderate and 89 severe) and 77 with NIAIs. We isolated 322 pathogenic strains, including 234 strains of gram-negative bacteria, 82 strains of gram-positive bacteria, and 6 strains of fungi. Based on clinical features, NIAIs and severe CIAIs presented significantly higher values in age, length of hospital stay, mortality, and the incidence of severe intra-abdominal infection than mild-moderate CIAIs (p < 0.05). There was no significant difference in the prognosis between NIAIs and severe CIAIs. Primary diseases leading to CIAIs and NIAIs mostly were hepatobiliary diseases and gastrointestinal diseases respectively. Bacteria isolated from various types of IAIs mainly were Enterobacteriaceae; mild-moderate CIAIs mostly were mono-infection of gram-negative bacteria; NIAIs mostly were mixed infections of gram-negative and gram-positive bacteria; and severe CIAIs were from either type of infection. The rate of Extended Spectrum β-Lactamase-producing Escherichia coli and Klebsiella pneumoniae was much higher in NIAIs than in CIAIs (p < 0.05). The antimicrobial drug sensitivity of gram-negative bacteria isolated from NIAIs was significantly lower than that of CIAIs.

CIAIs and NIAIs have their own unique clinical features and epidemiological features of pathogens which should be considered during the initial empiric therapy for the rational use of anti-microbial drugs. Regional IAIs pathogenic bacteria have their own features in drug resistance, slightly different from some recommendations of 2010 Infectious Diseases Society of America guidelines.

To investigate the changes of cerebral hemodynamics pre- and post-ventricular drainage in patients with posttraumatic acute diffuse brain swelling.

Twenty-four cases of traumatic diffuse brain swelling were analyzed retrospectively. Patients in nonsurgical group were treated by medicine therapy. Patients in surgical group were treated by external ventricular drainage plus medicine therapy. The first CT perfusion scan was completed within 4-5 h after trauma and scanned again after 7 days. The changes of perfusion parameters in area-of-interest in two groups were analyzed and compared before and after treatment.

Compared with the nonsurgical group, the value of cerebral blood volume, cerebral blood flow and mean transit time in bilateral frontal temporoparietal grey matter, basal ganglia, cerebellum, and brain stem at pre- and post-therapy were increased significantly (p < 0.05) in surgical group, and consequently the prognosis of patients undergoing surgery was also better than that of nonsurgical group.

External ventricular drainage can improve cerebral perfusion and increase survival quality for the patients with posttraumatic acute diffuse brain swelling.

关于题为“跑酷运动（自由跑步）中的脊髓损伤：一例罕见病例报告”的病例介绍。¹通过Nima Derakhshan等人，我收到了一些批评信，要求修改跑酷和自由跑这两个实体之间的区别。