OBJECTIVETo 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.

METHODS87 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.

RESULTSWhen 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.

CONCLUSIONThere 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.

Accidents, Traffic ; Adult ; Aged ; Biomechanical Phenomena ; Female ; Finite Element Analysis ; Humans ; Male ; Middle Aged ; Pedestrians ; Stress, Mechanical ; Thoracic Injuries ; etiology ; Trauma Severity Indices

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

METHODSIn 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.

RESULTSIn 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.

CONCLUSIONSThe 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.

Biomechanical Phenomena ; Brain Injuries ; etiology ; Finite Element Analysis ; Humans ; Intracranial Pressure ; Manikins

Objective:To observe the efficacy of apatinib combined with capecitabine in the treatment of advanced esophageal cancer.Methods:A total of 101 patients with advanced esophageal cancer in Taixing People's Hospital of Jiangsu Province from June 2017 to February 2018 were enrolled, and all the patients were divided into the control group (50 cases) and the observation group (51 cases) according to the random number table. The control group was treated with capecitabine combined with radiotherapy, and the observation group was treated with apatinib on the basis of the control group. The therapeutic effects, adverse reactions and progression-free survival (PFS) time of the two groups were compared.Results:The overall response rate in the observation group was higher than that in the control group [90.2% (46/51) vs. 72.0% (36/50)], and the difference was statistically significant ( χ2 = 5.473, P = 0.019). There were no significant differences in leukopenia, neutropenia, thrombocytopenia, anemia, proteinuria and hypertension between the two groups (all P > 0.05). The median PFS time in the observation group was 18.49 months (95% CI 15.35-25.03 months), and that in the control group was 13.33 months (95% CI 10.36-18.24 months), and the difference between the two groups was statistically significant ( χ2 = 5.995, P < 0.01). Conclusions:The therapeutic effect of apatinib combined with capecitabine in the treatment of advanced esophageal cancer is accurate. No obvious adverse reaction occurs, and the PFS time is prolonged.

In recent years, researchers have found that patients with nonalcoholic fatty liver disease (NAFLD) often have urolithiasis, and the incidence of urolithiasis increases gradually with the severity of NAFLD. Meanwhile, the detection rate of NAFLD was higher in patients with urolithiasis than in normal controls. In this paper, we reviewed the domestic and international studies on the correlation between urolithiasis and NAFLD and described the related pathogenesis, such as insulin resistance, oxidative stress, abnormal lipid metabolism and impaired glyoxalate detoxification. Meanwhile, this paper proposed preventive measures to reduce the risk of development and recurrence of NAFLD-associated urolithiasis by addressing the common risk factors of both diseases, including metabolism-related diseases, lifestyle and diet.

Objective:To investigate the effects of pre-treatment Naples prognostic score (NPS), including inflammation-related and nutrition-related indicators, on the treatment efficacy and prognosis of patients with thoracic esophageal squamous cell carcinoma (ESCC) receiving chemoradiotherapy.Methods:A retrospective analysis was conducted for 123 patients diagnosed with thoracic ESCC. These patients were treated either with standard curative radiotherapy (RT) alone or with concurrent chemoradiotherapy (CCRT) in the Affiliated Taixing People's Hospital of Yangzhou University between January 2014 and December 2017. The patients were divided into NPS 0 group (18 cases), NPS 1 or 2 group (60 cases), and NPS 3 or 4 group (45 cases). The responsiveness to treatment was analyzed using logistic regression analysis. The Kaplan-Meier method and log-rank test were adopted to calculate and compare the progression-free survival (PFS) and overall survival (OS) rates. Meanwhile, Cox proportional hazards models were used for the multivariate analyses.Results:The overall effective rate across the entire cohort was 65.0%, and the effective rates of the NPS 0 group, NPS 1 or 2 group, and NPS 3 or 4 group were 88.9%, 73.3%, and 44.4%, respectively. As indicated by the univariate logistic analysis, the treatment responses in patients with ESCC were highly associated with TNM stage, treatment method, neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and NPS (1 or 2 group and 3 or 4 group) ( HR =1.633, 0.225, 4.002, 0.320, 2.909, 6.591, P<0.05). Subsequently, multivariate logistic regression analysis showed that treatment strategy alone ( HR =0.214, 95% CI 0.105-0.436, P=0.001), NLR ( HR =2.547, 95% CI 1.248-5.199, P=0.010), and NPS (1 or 2 group: HR=1.193, 95% CI 1.377-9.691, P=0.033; 3 or 4 group: HR =3.349, 95% CI 1.548-10.499, P=0.003) were independent risk factors for tumour response. In addition, the univariate analysis indicates that TNM stage, treatment modality, NLR, LMR, and NPS were significantly associated with PFS and OS( HRPFS=1.480, 0.364, 2.129, 0.635, 3.316, 6.599, P < 0.05; HROS=1.149, 0.308, 2.306, 0.609, 3.316, 6.599, P < 0.05). Furthermore, multivariate Cox proportional hazard regression model analysis showed that TNM stage ( HR =1.408, 95% CI 1.069-1.854, P=0.015), treatment modality ( HR =0.367, 95% CI 0.261-0.516, P=0.015), NLR ( HR =1.518, 95% CI 1.078-2.139, P=0.017), and NPS (1 or 2 group: HR=3.279, 95% CI 1.405-7.653, P=0.006; 3 or 4 group: HR =6.233, 95% CI 2.439-15.875, P < 0.001) were considered independent prognostic factors for PFS. Additionally, these parameters were also independent prognostic factors for OS. Conclusions:Using inflammation-related and nutrition-related biomarkers, this study demonstrated that NPS is promising as a predictive indicator for the therapeutic effects and survival prognosis in patients with ESCC receiving CRT or RT alone.

Objective:To explore the practical effect of multi-disciplinary treatment learning (MDT-L) combined with PBL+CBL teaching on the clinical clerkship of neurosurgery.Methods:In the study, 30 neurosurgery clinical interns accepted by Wuhan Third Hospital from January 2019 to December 2019 were set as the control group, and 30 neurosurgery clinical interns from January 2020 to December 2020 were set as the research group. The control group implemented conventional teaching, and the research group used MDT-L combined with PBL+CBL teaching. After the clerkship, the two groups' clinical clerkship results, changes of comprehensive abilities before and after clerkship, professional quality after clerkship, and satisfaction with teaching methods were compared. SPSS 26.0 was used for t test and chi-square test. Results:After the clerkship, the theoretical knowledge and operational skills assessment scores of the research group were significantly higher than those of the control group ( P<0.05). There was no statistically significant difference in the scores of the two groups in learning interest, analytical ability, communication skills, innovation ability and file management ability before the clerkship ( P>0.05). While, after the clerkship, the comprehensive ability scores of the above dimensions of the two groups increased, and the comprehensive ability scores of the study group were all higher than those of the control group ( P<0.05). After the clerkship, the scores of professional ability, problem analysis and solving ability, mastery of diagnosis and treatment procedures, scoring of medical documents writing and total scoring of professional quality in the study group were all higher than those in the control group ( P<0.05). The satisfaction scores of the study group on the attractiveness, effectiveness and practicality of the teaching method were higher than those of the control group ( P<0.05). Conclusion:The application of MDT-L combined with PBL+CBL teaching in neurosurgery clinical clerkship can not only improve the performance of internship, but also enhance the comprehensive ability of interns and improve their professional quality and satisfaction.