Purpose:With the increasing level of automation in automobiles,the advent of autonomous vehicles hasreduced the tendency of drivers and passengers to focus on the task of driving.The increasing automation in automobil...Purpose:With the increasing level of automation in automobiles,the advent of autonomous vehicles hasreduced the tendency of drivers and passengers to focus on the task of driving.The increasing automation in automobiles reduced the drivers'and passengers'focus on driving,which allowed occupants tochoose a more relaxed and comfortable sitting position.Meanwhile,the occupant's sitting position wentfrom a frontal,upright position to a more relaxed and reclined one,which resulted in the existing restraint systems cannot to keep occupants safe and secure.This study aimed to determine the effects ofdifferent reclining states on occupants'lumbar and neck injuries.Methods:This is an original research on the field of automotive safety engineering.Occupants indifferent initial sitting positions(25°,35°,45°,and 55°)were adapted to changes in seat back angle andrestraint systems and placed in the same frontal impact environment.Neck injury indexes,lumbar axialcompression force and acceleration,as well as occupant dynamic response during the impact,werecompared in different sitting positions.The injury response and kinematic characteristics of occupants indifferent reclining positions were analyzed by the control variable method.Results:As the sitting angle increased,the occupant's head acceleration decreased,and the forward-leanangle decreased.Occupants in the standard sitting position had the greatest neck injury,with an Nij of0.95,and were susceptible to abbreviated injury scale 2+cervical medullary injuries.As the seatbackangle increased,the geometric position of the lumbar spine tended to be horizontal,and the impact loadtransmitted greater forces to the lumbar spine.The occupant's lumbar injury was greatest in the lyingposition,with a peak axial compression force on the lumbar region of 5.5 KN,which was 2.3 KN greaterthan in the standard sitting position.Conclusion:The study of occupant lumbar and neck injuries based on different recline states can providea theoretical basis for optimizing lumbar evaluation indexes,which is conducive to the understanding ofthe lumbar injury mechanism and the comprehensive consideration of occupant safety protection.展开更多
Background: Cut-throat injury is a potentially fatal condition that may be associated with serious morbidity and mortality. The neck region is particularly at risk of serious injuries due to the location of vital stru...Background: Cut-throat injury is a potentially fatal condition that may be associated with serious morbidity and mortality. The neck region is particularly at risk of serious injuries due to the location of vital structures, including nerves, viscera, and major vessels. Although cut-throat injury is said to be rare in children, its occurrence has been reported in some series. Management of this condition requires a multidisciplinary approach for a better outcome. Aim: The aim of this report is to highlight the successful management of an alarming case of severe cut-throat injury with associated laryngeal injury in a child. Case presentation: A 12-year-old boy presented with a cut-throat following an assault by an unknown person. Examination revealed an acutely ill child, conscious but pale. He sustained a deep transverse laceration that transected the thyroid cartilage, exposing the laryngeal cavity. An assessment of Zone II penetrating neck injury was made. He was resuscitated, and had emergency neck exploration, tracheostomy, and repair of the injuries. The patient was followed up for 6 months, and had a good voice outcome, with no significant complication. Conclusion: Cut-throat injury is rare in children. But it is a potentially life-threatening condition. It is therefore important to recognize this entity and develop effective protocol of management in our environment.展开更多
Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies...Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies for eight different complex PFUI scenarios.Methods:Our centre is a tertiary referral centre for complex PFUI cases.We maintain a prospective database(1995e2016),which we retrospectively analysed.All patients with PFUI managed at our institute were included.Results:Over two decades 1062 cases of PFUI were managed at our institute(521 primary and 541 redo cases).Most redo cases were referred to us from other centres.Redo cases had up to five prior attempts at urethroplasty.We managed complex cases,which included bulbar ischemia,young boys and girls with PFUI,PFUI with double block,concomitant PFUI and iatrogenic anterior urethral strictures.Bulbar ischemia merits substitution urethroplasty,most commonly,using pedicled preputial tube.PFUI in young girls is usually associated with urethrovaginal fistula.Young boys with PFUI commonly have a long gap necessitating trans-abdominal approach.Our success rate with individualised management is 85.60%in primary cases,79.13%in redo cases and 82.40%in cases of bulbar ischemia.Conclusion:The definition of complex PFUI is ever expanding.The best chance of success is at the first attempt.Anastomotic urethroplasty for PFUI should be performed in experienced hands at high volume centres.展开更多
Neck injury is a severe problem in traffic accidents.While most studies are focused on the neck injury in rear and front impacts,few are conducted in side impact.This study focuses on the difference of neck injury und...Neck injury is a severe problem in traffic accidents.While most studies are focused on the neck injury in rear and front impacts,few are conducted in side impact.This study focuses on the difference of neck injury under different postures and the difference of 7 cervical vertebras under the same posture using the method of prescribed structure motion（PSM）.The analytical results show that the maximum changes of mean force and mean moment of 7 cervical vertebras under 8 different postures are 20% and 47% respectively.The variation of each cervical vertebra is different under different neck postures.Up cervical vertebras （C1-C4） and low cervical vertebras （C5-C7） suffer different forces and moments under the same neck posture.Generally speaking,No.6 （neck right leaning 40°） is the posture with lowest neck injury risk.展开更多
Introduction-The cervical spine is subjected to injury frequently,especially among pilots who are usually on the condition of high acceleration.Injuries of the cervical spine will be potential risk of damage to the sp...Introduction-The cervical spine is subjected to injury frequently,especially among pilots who are usually on the condition of high acceleration.Injuries of the cervical spine will be potential risk of damage to the spinal cord,which could be result in life threatening展开更多
BACKGROUND Penetrating neck injuries require prompt recognition,diagnosis and management of critical airways.This case demonstrates an emergent situation that a“medical negligence”was avoided with the aid of end-tid...BACKGROUND Penetrating neck injuries require prompt recognition,diagnosis and management of critical airways.This case demonstrates an emergent situation that a“medical negligence”was avoided with the aid of end-tidal carbon dioxide(ETCO2)waveform.CASE SUMMARY We report a case of malposition of the endotracheal tube into the right hemithoracic cavity for cervical knife trauma,resulting in pneumothorax.Tube placement was not confirmed during emergency airway management,and the patient was directly transferred to the emergency operation room.Assisted by ETCO2 and imaging examinations,the anesthetist timely noticed the absence of ETCO2 waveform and resolved this urgent situation before anesthesia induction.CONCLUSION This case emphasizes the necessity of ETCO2 waveform and/or X-ray confirmation of endotracheal intubation even in emergent situations.展开更多
Neck injuries are significant causes of morbidity and mortality, and their chronic forms due to repetitive or sustained physical acts(e.g., prolonged use of mobile phone with a dropped head) are becoming increasingly ...Neck injuries are significant causes of morbidity and mortality, and their chronic forms due to repetitive or sustained physical acts(e.g., prolonged use of mobile phone with a dropped head) are becoming increasingly more prevalent. Many injuries are preventable but the prevention and control requires a clear basic understanding of the neck biomechanics. In this paper, we describe a first-of-its-kind study that integrates a gamut of state-of-the-art imaging modalities(dynamic radiography, computed tomography(CT), and magnetic resonance imaging(MRI)) and biodynamic measurements(motion capture, electromyography(EMG), force sensing), thereby investigating holistically the in vivo responses of the neck and its various interconnected musculoskeletal components during functional activities. We present a sample of findings to illustrate how the integrations at multiple levels can enable creating truly subject-specific neck musculoskeletal models and attaining novel insights that otherwise would be unattainable by a singular or subset of approaches.展开更多
Neck injury is one of the most common types of injury in vehicle accidents.The mechanisms of neck injury remain controversial due to the complex structure of the cervical spine and various impact conditions.The aim of...Neck injury is one of the most common types of injury in vehicle accidents.The mechanisms of neck injury remain controversial due to the complex structure of the cervical spine and various impact conditions.The aim of the present study is to provide a summary of recent research on neck injury mechanisms,neck injury criteria and neck injury prevention measures.The main types of neck injury resulting from vehicle accidents,including whiplash injury,cervical bone fractures and spinal cord injury,are introduced.Neck injury mechanisms are summarized according to load directions,test or simulation methods,and thresholds by means of impact intensity,load intensity and stress/strain conditions.Neck injury criteria are introduced,including NIC,N_(ij),N_(km) and LNL.Passive and active technologies for neck injury prevention are described and the challenge of neck injury prevention for future intelligent vehicles is discussed.展开更多
Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause p...Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially, life-threatening hemorrhage but also need profound surgical expertise in man- agement. Development of collateral circulation in neck is well known： however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of pene- trating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient pre- sented ~ith no neurological or motor de~,cits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.展开更多
There is much material demonstrating the use of acupuncture and moxibustion as an effective method of treatment in a variety of neurological conditions involving both peripheral and central nervous system dysfunction....There is much material demonstrating the use of acupuncture and moxibustion as an effective method of treatment in a variety of neurological conditions involving both peripheral and central nervous system dysfunction. Acupuncture＇s effects are experienced throughout the body but specifically acupuncture can be seen to contribute significantly to nerve metabolism and rebuilding. However, very little is written on the mechanisms for this nerve recovery. This paper will reflect on these mechanisms in relation to the treatment of neck problems associated with nerve root impingement.展开更多
Active muscle response is a key factor in the motion and injury of the human head and neck.Due to the limitations of experimentation and the shortcomings of previous finite element models,the influence of material par...Active muscle response is a key factor in the motion and injury of the human head and neck.Due to the limitations of experimentation and the shortcomings of previous finite element models,the influence of material parameters of cervical muscle on motions of the head and neck during a car crash have not been comprehensively investigated.In the present work,a model of the cervical muscle in a 50th-percentile adult male was constructed.The muscles were modelled using solid finite elements,with a nonlinear-elastic and viscoelastic material and a Hill material modelling the passive and active parts of each muscle,respectively.The head dynamic responses of the model were validated using results obtained from volunteer sled tests.The influence of the material parameters of a muscle on head and neck motions were determined.Our key finding was that the greater the stiffness and the contraction strength of the neck muscles,the smaller the rotation angle of the head and the neck,and,hence,the lower the risk of head and neck injury to occupants in a car crash.展开更多
Purpose： Suicide becomes a serious problem in today＇s society and hanging is a common method of suicide. We want to find the factors which can predict the final functional outcomes of these cases. Methods： All pati...Purpose： Suicide becomes a serious problem in today＇s society and hanging is a common method of suicide. We want to find the factors which can predict the final functional outcomes of these cases. Methods： All patients who presented to Accident and Emergency Department （ED） of the National Cheng Kung University Hospital from 1st January 2005 to 31th December 2013 with a hanging injury were included in this study. All cases were divided into good outcome group and bad outcome group according to Glasgow Outcome Scale （GOS）. Data was analyzed by Mann-Whitney test and chi-square test. Results： Glasgow Coma Scale （GCS） 〈 3, pupil dilation and no pupillary light reflex both at the scene and ED were the factors to indicate poor functional outcome. Out-hospital cardiac arrest （OHCA）, acidosis （pH 〈 Z2） and the need for intubation once arriving at ED were also related to poor functional outcome. OHCA cases all had poor functional outcome, Conclusion： GCS, pupil size, pupiUary light reflex, OHCA and acidosis are useful as prognostic factors. GCS= 3 lead to a very poor outcome. However, the functional outcome seems good in patients with GCS〉3. There parameters can help to predict the outcome before treatment.展开更多
基金This study was supported by the National Natural ScienceFoundation of China(52175084 and 52175085)the NaturalScience Foundation of Hebei Province(E2020202017).
文摘Purpose:With the increasing level of automation in automobiles,the advent of autonomous vehicles hasreduced the tendency of drivers and passengers to focus on the task of driving.The increasing automation in automobiles reduced the drivers'and passengers'focus on driving,which allowed occupants tochoose a more relaxed and comfortable sitting position.Meanwhile,the occupant's sitting position wentfrom a frontal,upright position to a more relaxed and reclined one,which resulted in the existing restraint systems cannot to keep occupants safe and secure.This study aimed to determine the effects ofdifferent reclining states on occupants'lumbar and neck injuries.Methods:This is an original research on the field of automotive safety engineering.Occupants indifferent initial sitting positions(25°,35°,45°,and 55°)were adapted to changes in seat back angle andrestraint systems and placed in the same frontal impact environment.Neck injury indexes,lumbar axialcompression force and acceleration,as well as occupant dynamic response during the impact,werecompared in different sitting positions.The injury response and kinematic characteristics of occupants indifferent reclining positions were analyzed by the control variable method.Results:As the sitting angle increased,the occupant's head acceleration decreased,and the forward-leanangle decreased.Occupants in the standard sitting position had the greatest neck injury,with an Nij of0.95,and were susceptible to abbreviated injury scale 2+cervical medullary injuries.As the seatbackangle increased,the geometric position of the lumbar spine tended to be horizontal,and the impact loadtransmitted greater forces to the lumbar spine.The occupant's lumbar injury was greatest in the lyingposition,with a peak axial compression force on the lumbar region of 5.5 KN,which was 2.3 KN greaterthan in the standard sitting position.Conclusion:The study of occupant lumbar and neck injuries based on different recline states can providea theoretical basis for optimizing lumbar evaluation indexes,which is conducive to the understanding ofthe lumbar injury mechanism and the comprehensive consideration of occupant safety protection.
文摘Background: Cut-throat injury is a potentially fatal condition that may be associated with serious morbidity and mortality. The neck region is particularly at risk of serious injuries due to the location of vital structures, including nerves, viscera, and major vessels. Although cut-throat injury is said to be rare in children, its occurrence has been reported in some series. Management of this condition requires a multidisciplinary approach for a better outcome. Aim: The aim of this report is to highlight the successful management of an alarming case of severe cut-throat injury with associated laryngeal injury in a child. Case presentation: A 12-year-old boy presented with a cut-throat following an assault by an unknown person. Examination revealed an acutely ill child, conscious but pale. He sustained a deep transverse laceration that transected the thyroid cartilage, exposing the laryngeal cavity. An assessment of Zone II penetrating neck injury was made. He was resuscitated, and had emergency neck exploration, tracheostomy, and repair of the injuries. The patient was followed up for 6 months, and had a good voice outcome, with no significant complication. Conclusion: Cut-throat injury is rare in children. But it is a potentially life-threatening condition. It is therefore important to recognize this entity and develop effective protocol of management in our environment.
文摘Objectives:Pelvic fracture urethral injuries(PFUI)result from traumatic disruption of the urethra.A significant proportion of cases are complex rendering their management challenging.We described management strategies for eight different complex PFUI scenarios.Methods:Our centre is a tertiary referral centre for complex PFUI cases.We maintain a prospective database(1995e2016),which we retrospectively analysed.All patients with PFUI managed at our institute were included.Results:Over two decades 1062 cases of PFUI were managed at our institute(521 primary and 541 redo cases).Most redo cases were referred to us from other centres.Redo cases had up to five prior attempts at urethroplasty.We managed complex cases,which included bulbar ischemia,young boys and girls with PFUI,PFUI with double block,concomitant PFUI and iatrogenic anterior urethral strictures.Bulbar ischemia merits substitution urethroplasty,most commonly,using pedicled preputial tube.PFUI in young girls is usually associated with urethrovaginal fistula.Young boys with PFUI commonly have a long gap necessitating trans-abdominal approach.Our success rate with individualised management is 85.60%in primary cases,79.13%in redo cases and 82.40%in cases of bulbar ischemia.Conclusion:The definition of complex PFUI is ever expanding.The best chance of success is at the first attempt.Anastomotic urethroplasty for PFUI should be performed in experienced hands at high volume centres.
基金Sponsored by the National High Technology Research and Development Program of China("863"Program) (2006AA110102)
文摘Neck injury is a severe problem in traffic accidents.While most studies are focused on the neck injury in rear and front impacts,few are conducted in side impact.This study focuses on the difference of neck injury under different postures and the difference of 7 cervical vertebras under the same posture using the method of prescribed structure motion（PSM）.The analytical results show that the maximum changes of mean force and mean moment of 7 cervical vertebras under 8 different postures are 20% and 47% respectively.The variation of each cervical vertebra is different under different neck postures.Up cervical vertebras （C1-C4） and low cervical vertebras （C5-C7） suffer different forces and moments under the same neck posture.Generally speaking,No.6 （neck right leaning 40°） is the posture with lowest neck injury risk.
文摘Introduction-The cervical spine is subjected to injury frequently,especially among pilots who are usually on the condition of high acceleration.Injuries of the cervical spine will be potential risk of damage to the spinal cord,which could be result in life threatening
文摘BACKGROUND Penetrating neck injuries require prompt recognition,diagnosis and management of critical airways.This case demonstrates an emergent situation that a“medical negligence”was avoided with the aid of end-tidal carbon dioxide(ETCO2)waveform.CASE SUMMARY We report a case of malposition of the endotracheal tube into the right hemithoracic cavity for cervical knife trauma,resulting in pneumothorax.Tube placement was not confirmed during emergency airway management,and the patient was directly transferred to the emergency operation room.Assisted by ETCO2 and imaging examinations,the anesthetist timely noticed the absence of ETCO2 waveform and resolved this urgent situation before anesthesia induction.CONCLUSION This case emphasizes the necessity of ETCO2 waveform and/or X-ray confirmation of endotracheal intubation even in emergent situations.
基金supported by a research grant from the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health (Grant No. R01OH010587)。
文摘Neck injuries are significant causes of morbidity and mortality, and their chronic forms due to repetitive or sustained physical acts(e.g., prolonged use of mobile phone with a dropped head) are becoming increasingly more prevalent. Many injuries are preventable but the prevention and control requires a clear basic understanding of the neck biomechanics. In this paper, we describe a first-of-its-kind study that integrates a gamut of state-of-the-art imaging modalities(dynamic radiography, computed tomography(CT), and magnetic resonance imaging(MRI)) and biodynamic measurements(motion capture, electromyography(EMG), force sensing), thereby investigating holistically the in vivo responses of the neck and its various interconnected musculoskeletal components during functional activities. We present a sample of findings to illustrate how the integrations at multiple levels can enable creating truly subject-specific neck musculoskeletal models and attaining novel insights that otherwise would be unattainable by a singular or subset of approaches.
文摘Neck injury is one of the most common types of injury in vehicle accidents.The mechanisms of neck injury remain controversial due to the complex structure of the cervical spine and various impact conditions.The aim of the present study is to provide a summary of recent research on neck injury mechanisms,neck injury criteria and neck injury prevention measures.The main types of neck injury resulting from vehicle accidents,including whiplash injury,cervical bone fractures and spinal cord injury,are introduced.Neck injury mechanisms are summarized according to load directions,test or simulation methods,and thresholds by means of impact intensity,load intensity and stress/strain conditions.Neck injury criteria are introduced,including NIC,N_(ij),N_(km) and LNL.Passive and active technologies for neck injury prevention are described and the challenge of neck injury prevention for future intelligent vehicles is discussed.
文摘Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially, life-threatening hemorrhage but also need profound surgical expertise in man- agement. Development of collateral circulation in neck is well known： however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of pene- trating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient pre- sented ~ith no neurological or motor de~,cits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.
文摘There is much material demonstrating the use of acupuncture and moxibustion as an effective method of treatment in a variety of neurological conditions involving both peripheral and central nervous system dysfunction. Acupuncture＇s effects are experienced throughout the body but specifically acupuncture can be seen to contribute significantly to nerve metabolism and rebuilding. However, very little is written on the mechanisms for this nerve recovery. This paper will reflect on these mechanisms in relation to the treatment of neck problems associated with nerve root impingement.
基金supported by the National Natural Science Foundation of China (51205117)Natural Science Foundation of Hunan Province (2019JJ70045)Hunan Province Education Department Science Research Project (19C1559).
文摘Active muscle response is a key factor in the motion and injury of the human head and neck.Due to the limitations of experimentation and the shortcomings of previous finite element models,the influence of material parameters of cervical muscle on motions of the head and neck during a car crash have not been comprehensively investigated.In the present work,a model of the cervical muscle in a 50th-percentile adult male was constructed.The muscles were modelled using solid finite elements,with a nonlinear-elastic and viscoelastic material and a Hill material modelling the passive and active parts of each muscle,respectively.The head dynamic responses of the model were validated using results obtained from volunteer sled tests.The influence of the material parameters of a muscle on head and neck motions were determined.Our key finding was that the greater the stiffness and the contraction strength of the neck muscles,the smaller the rotation angle of the head and the neck,and,hence,the lower the risk of head and neck injury to occupants in a car crash.
文摘Purpose： Suicide becomes a serious problem in today＇s society and hanging is a common method of suicide. We want to find the factors which can predict the final functional outcomes of these cases. Methods： All patients who presented to Accident and Emergency Department （ED） of the National Cheng Kung University Hospital from 1st January 2005 to 31th December 2013 with a hanging injury were included in this study. All cases were divided into good outcome group and bad outcome group according to Glasgow Outcome Scale （GOS）. Data was analyzed by Mann-Whitney test and chi-square test. Results： Glasgow Coma Scale （GCS） 〈 3, pupil dilation and no pupillary light reflex both at the scene and ED were the factors to indicate poor functional outcome. Out-hospital cardiac arrest （OHCA）, acidosis （pH 〈 Z2） and the need for intubation once arriving at ED were also related to poor functional outcome. OHCA cases all had poor functional outcome, Conclusion： GCS, pupil size, pupiUary light reflex, OHCA and acidosis are useful as prognostic factors. GCS= 3 lead to a very poor outcome. However, the functional outcome seems good in patients with GCS〉3. There parameters can help to predict the outcome before treatment.
