Injury severity analysis： comparison of multilevel logistic regression models and effects of collision data aggregation

This paper describes an empirical study aiming at identifying the main differences between different logistic regression models and collision data aggregation methods that are commonly applied in road safety literature for modeling collision severity. In particular, the research compares three popular multilevel logistic models （i.e., sequential binary logit models, ordered logit models, and multinomial logit models） as well as three data aggregation methods （i.e., occupant based, vehicle based, and collision based）. Six years of collision data （2001-2006） from 31 highway routes from across the province of Ontario, Canada were used for this analysis. It was found that a multilevel multinomial logit model has the best fit to the data than the other two models while the results obtained from occupant-based data are more reliable than those from vehicle- and collision-based data. More importantly, while generally consistent in terms of factors that were found to be significant between different models and data aggregation methods, the effect size of each factor differ sub- stantially, which could have significant implications forevaluating the effects of different safety-related policies and countermeasures.

New injury severity score(NISS)outperforms injury severity score(ISS)in the evaluation of severe blunt trauma patients

Purpose:The injury severity score(ISS)and new injury severity score(NISS)have been widely used in trauma evaluation.However,which scoring system is better in trauma outcome prediction is still disputed.The purpose of this study is to evaluate the value of the two scoring systems in predicting trauma outcomes,including mortality,intensive care unit(ICU)admission and ICU length of stay.Methods:The data were collected retrospectively from three hospitals in Zhejiang province,China.The comparisons of NISS and ISS in predicting outcomes were performed by using receiver operator characteristic(ROC)curves and Hosmer-Lemeshow statistics.Results:A total of 1825 blunt trauma patients were enrolled in our study.Finally,1243 patients were admitted to ICU,and 215 patients died before discharge.The ISS and NISS were equivalent in predicting mortality(area under ORC curve[AUC]:0.886 vs.0.887,p=0.9113).But for the patients with ISS>25,NISS showed better performance in predicting mortality.NISS was also significantly better than ISS in predicting ICU admission and prolonged ICU length of stay.Conclusion:NISS outperforms ISS in predicting the outcomes for severe blunt trauma and can be an essential supplement of ISS.Considering the convenience of NISS in calculation,it is advantageous to promote NISS in China's primary hospitals.

Clinical Evaluation of Enteral Nutrition+Probiotics in the Treatment of Gastrointestinal Dysfunction After Severe Traumatic Brain Injury

Objective:To evaluate the therapeutic effect of enteral nutrition+probiotics in patients with gastrointestinal dysfunction after severe craniocerebral injury.Methods:From September 2018 to February 2023,80 patients(20-82 years old)with gastrointestinal dysfunction who were admitted to the Intensive Care Unit at the Third People’s Hospital of Xining were included in the study.Their primary condition was severe craniocerebral injury,and all of them received conventional symptomatic treatment.Group A received enteral nutrition+probiotic therapy,whereas group B received enteral nutrition only.The differences in the following indicators were compared before and after treatment:nutritional and biochemical indicators,gastrointestinal function indicators,Glasgow Coma Scale(GCS),Sequential Organ Failure Assessment(SOFA),APACHE II score,serum procalcitonin(PCT),neutrophil(N)ratio,and C reactive protein(CRP).Result:The nutritional and biochemical indicators in group A were higher than those in group B,P<0.05;the time to first passage of flatus,time to first passage of stool,and bowel sound recovery time in group A were shorter than those in group B,P<0.05;the GCS of group A was higher than that of group B,P<0.05;the SOFA and APACHEⅡscores of group A were not different from those of group B,P>0.05;and the PCT,N ratio,and CRP levels of group A were lower than those of group B,P<0.05.Conclusion:In patients with gastrointestinal dysfunction after severe craniocerebral injury,enteral nutrition+probiotic therapy is highly effective and feasible,as it can optimize various nutritional indicators,shorten the gastrointestinal function recovery time,and reduce the body’s stress response.

Association between homicide injury severity and benzodiazepine influence

There are case reports of offenders inflicting excessive injuries on their victims when under the influence of benzodiazepines.However,the potential association between benzodiazepine influence on the offender and victim injury severity in a general homicide population has not been studied.We investigated associations between offender positive testing for benzodiazepines or z-drugs(zolpidem,zopiclone and zaleplon)and victim injury severity.Data were drawn from 95 Swedish homicide cases from 2007–2009 in which offenders had known toxicology.There were no significant differences in injury severity between cases in which the offender tested positive vs.negative for benzodiazepines/z-drugs.Thus,the findings do not support the hypothesis that there is an association between benzodiazepine influence on the offender and victim injury severity in a general homicide population.

Investigating crash injury severity at unsignalized intersections in Heilongjiang Province,China

Many studies suggest that more crashes occur due to mixed traffic flow at unsignalized intersections. However, very little is known about the injury severity of these crashes. The objective of this study is therefore to investigate how contributory factors affect crash injury severity at unsignalized intersections. The dataset used for this analysis derived from police crash reports from Dec. 2006 to Apr. 2009 in Heilongjiang Province, China. An ordered probit model was developed to predict the probability that the injury severity of a crash will be one of four levels ： no injury, slight injury, severe injury, and fatal injury. The injury severity of a crash was evaluated in terms of the most severe injury sustained by any person involved in the crash. Results from the present study showed that different factors had varying effects on crash injury severity. Factors found to result in the increased probability of serious injuries include adverse weather, sideswiping with pedestrians on poor surface, the interaction of rear-ends and the third-class highway, winter night without illumination, and the interaction between traffic signs or markings and the third-class highway. Although there are some limitations in the current study, this study provides more insights into crash injury severity at unsignalized intersections.

Correlation between expectations of recovery and injury severity perception in whiplash-associated disorders

Objective:To assess the correlation between expectations of recovery and whiplash patients' perceptions of injury severity using a simplified instrument.Expectations of recovery have been shown to predict rate of recovery from whiplash injury in population-based studies.The perception of having more severe pathology or more ominous diagnostic labels has also been associated with a worse prognosis.Methods:Consecutive patients with whiplash-associated disorder grade 1 or 2,presenting in the acute stage to a primary care centre,were asked "do you think that your injury will…" with response options "get better soon;get better slowly;never get better;don't know." Injury severity perception (ISP) was measured with a numerical rating scale which ranged from 0-10,on which subjects were asked to rate how severe (in terms of damage) they thought their injury was.The anchors were labeled "no damage" (0) and "severe,and maybe permanent damage" (10).The primary outcome measure was the correlation between the subject's ISP score and expectation of recovery.Results:A total of 94 subjects (34 males,60 females,and mean age (40.6±10.0) years,range 19-60 years) were included.The initial responses to expectation of recovery were:get better soon (29/94);get better slowly (22/94);never get better (11/94);don't know (32/94).The mean ISP score was 4.9±1.7 (range 2-9 out of 10).There was a high correlation between expectations and ISP scores (Spearman's rank correlation coefficient 0.68).Those who expected to recover soon and those who expected to get better slowly had the lowest ISP scores.Conclusions:The more slowly whiplash patients expect to recover,or the less sure they are of recovery,the more severe their initial perceptions of injury.

Using random-parameter and fixed-parameter ordered models to explore temporal stability in factors affecting drivers' injury severity in single-vehicle collisions

Understanding the temporal stability in the factors influencing drivers' injury severity in single-vehicle collisions would help evaluating the effectiveness of implementing different safety treatments so that researchers could understand whether any safety improvements,observed after applying a certain safety treatment, are attributed to the specific treatment or simply attributed to the temporal instability of the factors being addressed. This study investigates the temporal stability of the factors affecting drivers' injury severity in singlevehicle collisions involving light-duty vehicles. The study is based on utilizing ordinal regression modeling to analyze the severity of drivers' injuries in all police-reported lightduty single-vehicle collisions that occurred in North Carolina from January 1, 2007, to December 31, 2013. A separate regression model was estimated for each year so that statistical significance of each risk factor may be compared over the years. The study also estimated random-parameter(mixed) ordered logit models to explore the heterogeneity in data. The most significant factor that was found to increase the severity of drivers' injuries in light-duty single-vehicle collisions is driving under the influence of alcohol or illicit drugs. Other significant factors, in decreasing order in terms of their significance, include driving on a highway curve, exceeding speed limit, lighting conditions, the age of the driver, and the age of the vehicle. In contrast, there were six factors that were found to be significant in only some years and not in all years. These six temporally unstable factors include the use of seatbelt, driver's gender, rural highways, undivided highways, the type of the light-duty vehicle, and weather and road surface conditions. These same factors were found by other previous research studies to be significant and stable predictors of drivers' injury severity in single-vehicle collisions.

Exploring injury severity of children and adolescents involved in traffic crashes in Greece

For the purpose of exploring the factors affecting injury severity of children and adolescents involved in traffic crashes in Greece,disaggregate crash data including 13,431 involving children and adolescents from all regions of Greece for the period 2006–2015 were utilized.In order to identify factors affecting injury severity and account for potential unobserved heterogeneity,a series of mixed logit models were utilized.To explore and address potential temporal instability of crash-related risk factors,the likelihood ratio test was applied.Results indicated that night crashes,crashes outside urban areas as well as crashes involving bicycles or powered-two-wheelers are associated with higher injury severity of children and adolescents.Interestingly,crashes involving pedestrians are associated with lower injury severity than head-on collisions and run-off-road collisions with fixed objects.Side and sideswipe crashes also result in lower injury severities.The likelihood ratio test indicated that crash-related factors are instable when comparing the models utilizing data before and after 2010 respectively.This study contributes to the current knowledge in the field,as to the best of our knowledge this is the first study that addresses unobserved heterogeneity when analyzing child and adolescent injury severity.Overall,the findings of this study provide useful insights and could assist in unveiling crash risk factors and prioritize programs and measures to promote road safety of children and adolescents.

Driver injury severity analysis of crashes in a western China’s rural mountainous county:Taking crash compatibility difference into consideration

China’s traffic safety attracts increasing research interest.Official data show that crashes in the western region of China are more severe than those in the eastern region.However,research on crash severity in western China is scarce.This study applied a hierarchical Bayesian logistic model to examine the significant factors related to crash and vehicle/driver levels and their heterogeneous impacts on the severity of drivers’ injury.Crash data were collected from Lintao,a rural mountainous county in western China.A variable was proposed to measure the relative difference between the crashworthiness of one vehicle and the aggressivity of the other vehicle in the mixed traffic flow.Results indicated that the majority of the total variance was induced by between-crash variance,showing the suitability of the utilized hierarchical modeling approach.One crash-level variable and six vehicle/driver-level variables,namely,road type,compatibility difference,age,vehicle type,drunk driving,driving unregistered vehicle,and driving years,significantly affected modeling drivers’ injury severities.Among these variables,road type(national and provincial),age(young and senior drivers),driving unregistered vehicle,and drunk driving tended to increase the odds of crash-related mortality.Driving years(new drivers with less than six years of driving experience) and vehicle type(heavy vehicle) were likely to decrease the probability of fatal outcomes.Compatibility difference was relatively significant,and the possibilities of mortality in single vehicle crashes were higher than those inmultivehicle and pedestrian-involved crashes.The developed methodology and estimation results provided insights into the internal mechanism of rural crashes and effective countermeasures to prevent rural crashes.

Evaluating the impact of traffic violations on crash injury severity on Wyoming interstates:An investigation with a random parameters model with heterogeneity in means approach

This study investigated the impact of traffic violations on crash injury severity on Wyoming’s interstate highways.A random parameters multinomial logit(MNL)model with heterogeneity in means was estimated as an alternative to the mixed logit model.This was done to better account for unobserved heterogeneity in the crash data.As per the results,the random parameters model with heterogeneity in means not only exhibited a better fit but also uncovered more insights regarding the factors influencing crash injury severity.The advanced model showed that traffic violations,crash characteristics and environmental characteristics among other factors impact crash injury severity on Wyoming’s interstate highways.With regards to traffic violations,driving too fast for prevailing conditions and driving under the influence of alcohol and drugs were identified as the main violations that significantly influenced crash severity.Among other useful insights,the heterogeneity in mean specification indicated that the likelihood of severe injury crashes is increased by the interactive effect between non-trucks(vehicles not classified as trucks)and driving too fast for conditions.This is a significant implication that high speed behavior by non-truck drivers in adverse weather conditions is ranked as one of the hazardous traffic violations on Wyoming’s interstates.This study provided for the first time important information on the impact of traffic violations on crash severity of crashes that occurred on challenging roadways that characterized by mountainous terrain and severe weather conditions.Results from the study will help enforcement agencies in the state to better identify appropriate countermeasures to mitigate the impact of violations on crash severity.

Predicting crash injury severity at unsignalized intersections using support vector machines and naïve Bayes classifiers

The Washington,DC crash statistic report for the period from 2013 to 2015 shows that the city recorded about 41789 crashes at unsignalized intersections,which resulted in 14168 injuries and 51 fatalities.The economic cost of these fatalities has been estimated to be in the millions of dollars.It is therefore necessary to investigate the predictability of the occurrence of theses crashes,based on pertinent factors,in order to provide mitigating measures.This research focused on the development of models to predict the injury severity of crashes using support vector machines(SVMs)and Gaussian naïve Bayes classifiers(GNBCs).The models were developed based on 3307 crashes that occurred from 2008 to 2015.Eight SVM models and a GNBC model were developed.The most accurate model was the SVM with a radial basis kernel function.This model predicted the severity of an injury sustained in a crash with an accuracy of approximately 83.2%.The GNBC produced the worst-performing model with an accuracy of 48.5%.These models will enable transport officials to identify crash-prone unsignalized intersections to provide the necessary countermeasures beforehand.

Comparison of the severity of injury of hippocampal neuron in rats induced by simulated push-pull maneuver at various degrees

BACKGROUND： Push-pull effect is often caused during maneuver, and the changes of unconsciousness induced can affect or damage cerebral neurons at various degrees. OBJECTIVE： To observe the effect of simulated push-pull maneuver at various degrees on injury of hippocampal neurons in rats and analyze its phase effect. DESIGN： Randomized control study.SETTING ： Physiological Department of Jilin Medical College.MATERIALS： A total of 40 healthy male Wistar rats, of clean grade, weighting 205-300 g, aged 3-4 months, were randomly divided into control group （n=4） and three push-pull experimental groups, including ＋2 Gz group （intensity： -2 Gz to ＋2 Gz, n=12）, ＋6 Gz group （-6 Gz to ＋6 Gz, n=12） and ＋8 Gz group （-8 Gz to ＋8 Gz, n=12）.METHODS： The experiment was completed in the Physiological Department of Jilin Military Medical College from March 2002 to May 2003. ① Rats in the experimental groups were put at the specially rolling arm of animal centrifugal machine. Then, they were pushed and pulled with ±2 Gz, ±6 Gz and ±8 Gz, respectively. The jolt was 1 Gz/s. However, rats in control group were not treated with any ways. ② Stroke index and neurological evaluation were performed on rats in the experimental groups at 0.5, 6 and 24 hours after push-pull. Stroke index was 25 points in total. The higher the scores were, the severer the cerebral injury was. Neurological evaluation was 10 points in total. The higher the scores were, the severer the nerve injury was. ③ Hippocampal tissue in brain of rats were selected to cut into sections at each time points, and form and distribution of neurons were observed in hippocampal areas with HE staining. Degrees of neuronal injury in hippocampal CA1 area were assayed after push-pull at various degrees with electron microscope. ④ Measurement data were compared with t test.MAIN OUTCOME MEASURES：① Stroke index and neurological evaluation; ② form and distribution of neurons in hippocampal areas;③ degrees of neuronal injury in hippocampal CA1 area.RESULTS： A total of 40 rats were involved in the final analysis. ① Stroke index and neurological evaluation of rats in experimental groups： At 30 minutes and 6 hours after push-pull exposure, stroke index and neurological evaluation were higher in ±6Gz group and ±8 Gz group than those in control group （P 〈 0.01）, especially at 6 hours after push-pull exposure, those in ±8 Gz group were the highest at each time points [（11.00±2.16）, （5.75±1.70） points]. At 24 hours after exposure, those were decreased as compared with those within the former two time points, but the values were still higher than those in control group （P 〈 0.05-0.01）. ② Results of HE staining： At 6 and 24 hours after exposure, partially neuronal degeneration was observed in pyramidal layer in ±6 Gz group and ±8 Gz group, including crenation of neurons, tdangle or polygon, and karyopycnosis, especially the injury in ±8 Gz group was the most obvious at 6 hours after exposure. ③ Results of ultrastructure with electron microscope： Partially neuronal degeneration at various degrees was observed in hippocampal CA1 area in ±2 Gz group at 6 hours after exposure and in ±6 Gz group and ±8 Gz group at 6 and 24 hours after exposure. At 6 hours after exposure, nucleus of hippocampal neurons in ±8 Gz group was irregular and umbilication. Caryotin was aggregated, nuclear matrix was swelled and disorder, and vacuolation was also observed. Rough endoplasmic reticulum was expanded, mitochondrium was swelled, and crista was disappeared.CONCLUSION： ① Push-pull cannot damage hippocampal neurons of rats in ±2 Gz group. ② Exposure can cause injury of hippocampal neurons of rats in ±6Gz group and ±8 Gz group, especially the injury is the severest at 6 hours after exposure in ±8 Gz group and relieves gradually 24 hours later.

The translational importance of establishing biomarkers of human spinal cord injury

The evaluation of such novel therapies for acute spinal cord injury in clinical trials is extremely challenging.Our current dependence upon the clinical assessment of neurologic impairment renders many acute SCI patients ineligible for trials because they are not examinable.Furthermore,the difficulty in predicting neurologic recovery based on the early clinical assessment forces investigators to recruit large cohorts to have sufficient power.Biomarkers that objectively classify injury severity and better predict neurologic outcome would be valuable tools for translational research.As such,the objective of the present review was to describe some of the translational challenges in acute spinal cord injury research and examine the potential utility of neurochemical biomarkers found within cerebrospinal fluid and blood.We focus on published efforts to establish biological markers for accurately classifying injury severity and precisely predict neurological outcome.

Fibrinogen degradation product levels on arrival for trauma patients requiring a transfusion even without head injury

BACKGROUND: There have been few reports on the clinical significance of the fibrinogen degradation product(FDP) level in trauma patients with and without head injury. We retrospectively analyzed trauma patients with or without head injury to investigate the clinical signifi cance of the FDP level.METHODS: From April 2013 to June 2015, a medical chart review was retrospectively performed for all patients with trauma. The exclusion criteria included patients who did not receive a transfusion. The patients were divided into two groups: a FDP>100 group, which included patients who had an FDP level on arrival over 100 ng/m L, and a FDP≤100 group.RESULTS: The ratio of open fractures and the prothrombin ratio in the FDP>100 group were significantly smaller than those observed in the FDP≤100 group. The average age, ratio of blunt injury, Injury Severity Score(ISS), volume of transfusion and mortality ratio in the FDP>100 group were signifi cantly greater than those in the FDP≤100 group. There was a weakly positive correlation between the FDP level and ISS(R=0.35, P=0.002), but it was not associated with the transfusion volume. The results of an analysis excluding patients with head injury showed a similar tendency.CONCLUSION: The FDP levels may be a useful biochemical parameter for the initial evaluation of the severity of trauma and mortality even in blunt traumatized patients without head injury or with stable vital signs.

The Buffering analysis to identify common geographical factors within the vicinity of severe injury related to motor vehicle crash in Malaysia

BACKGROUND:The main objective was to identify common geographical buildup within the100-meter buffer of severely injured based on injury severity score(ISS) among the motor vehicle crash(MVC) victims in Malaysia.METHODS:This was a prospective cohort study from July 2011 until June 2013 and involved all MVC patients attending emergency departments(ED) of two tertiary centers in a district in Malaysia.A set of digital maps was obtained from the Town Planning Unit of the district Municipal Office(local district map).Vector spaces were spanned over these maps using GIS software(ARCGIS 10.1licensed to the study center),and data from the identified severe injured cases based on ISS of 16 or more were added.Buffer analysis was performed and included all events occurring within a 100-meter perimeter around a reference point.RESULTS:A total of 439 cases were recruited over the ten-month data collection period.Fifty two(11%) of the cases were categorized as severe cased based on ISS scoring of 16 and more.Further buffer analysis looking at the buildup areas within the vicinity of the severely injured locations showed that most of the severe injuries occurred at locations on municipal roads(15,29%),straight roads(16,30%) and within villages buildup(suburban) areas(18,35%).CONCLUSION:This study has successfully achieved its objective in identifying common geographical factors and buildup areas within the vicinity of severely injured road traffic cases.

Application effect for a care bundle in optimizing nursing of patients with severe craniocerebral injury

BACKGROUND Severe craniocerebral injury(STBI)is a critical physical trauma caused by a sudden external force acting on the head.The condition is complex and changeable,and disability and mortality rates are high.Although the life of STBI patients can be saved through treatment,the sequelae of consciousness,speech,cognitive impairment,stiffness,spasm,pain and abnormal behavior in the early rehabilitation stage can be a heavy burden to a family.In the past,routine nursing was often used to treat/manage STBI;however,problems,such as improper cooperation and untimely communication,reduced therapeutic effectiveness.AIM To investigate the effect of a proposed care bundle to optimize the first aid process and assess its effectiveness on the early rehabilitation nursing of patients with STBI.METHODS From January 2019 to December 2020,126 STBI patients were admitted to the emergency department of Chongqing Emergency Medical Center.These patients were retrospectively selected as the research participants in the current study.The study participants were then divided into a control group(61 cases)and a study group(65 cases).The control group was treated with routine nursing.The study group adopted the proposed care bundle.The National Institutes of Health Stroke Scale/Score and Glasgow Coma Scale(GCS)were used to evaluate neurological function before and after emergency treatment.After 3 mo of rehabilitation,experimental outcomes were assessed.These included the GCS,Barthel Index,complication rate,muscle strength grade and satisfaction.RESULTS There was no significant difference in gender,age,cause of injury and GCS between the two groups.After emergency,the National Institutes of Health Stroke Scale/Score of the study group(10.23±3.26)was lower than that of the control group(14.79±3.14).The GCS score of the study group(12.48±2.38)was higher than that of the control group(9.32±2.01).The arrival time of consultation in the study group was 20.56±19.12,and the retention time in the emergency room was 45.12±10.21,which were significantly shorter than those in the control group.After 3 mo of rehabilitation management,the GCS and Barthel Index of the study group were 14.56±3.75 and 58.14±12.14,respectively,which were significantly higher than those of the control group.The incidence of complications in the study group(15.38%)was significantly lower than that in the control group(32.79%).The proportion of muscle strength≥grade III in the study group(89.23%)was significantly higher than that in the control group(50.82%).The satisfaction of patients in the study group was significantly higher than that in the control group.CONCLUSION Care bundles are used to optimize the nursing process.During first-aid,care bundles can effectively improve the rescue effect and improve neurological function of STBI patients as well as shorten the treatment time.In early rehabilitation,they can effectively improve the consciousness of STBI patients,improve the activities of daily living,reduce the risk of complications,accelerate the recovery of muscle strength and improve their satisfaction.

Relationship of calcitonin gene-related peptide with disease progression and prognosis of patients with severe traumatic brain injury

Calcitonin gene-related peptide（CGRP） has been implicated in multiple functions across many bioprocesses; however, whether CGRP is associated with severe traumatic brain injury（TBI） remains poorly understood. In this study, 96 adult patients with TBI（enrolled from September 2015 to December 2016） were divided into a mild/moderate TBI group（36 males and 25 females, aged 38 ± 13 years） and severe TBI group（22 males and 13 females, aged 38 ± 11 years） according to Glasgow Coma Scale scores. In addition, 25 healthy individuals were selected as controls（15 males and 10 females, aged 39 ± 13 years）. Radioimmunoassay was used to detect serum levels of CGRP and endothelin-1 at admission and at 12, 24, 48, 72 hours, and 7 days after admission. CGRP levels were remarkably lower, but endothelin-1 levels were obviously higher in the severe TBI group compared with mild/moderate TBI and control groups. Levels of CGRP were remarkably lower, but endothelin-1 levels were obviously higher in deceased patients compared with patients who survived. Survival analysis and logistic regression showed that both CGRP and endothelin-1 levels were associated with patient mortality, with each serving as an independent risk factor for 6-month mortality of severe TBI patients. Moreover, TBI patients with lower serum CGRP levels had a higher risk of death. Thus, our retrospective analysis demonstrates the potential utility of CGRP as a new biomarker, monitoring method, and therapeutic target for TBI.

Severe bilateral anterior cingulum injury in patients with mild traumatic brain injury

The cingulum,the neural tract connecting the orbitofrontal cortex with the medial temporal lobe,plays an important role in cognition（Bush et al.,2000）.It is also important in memory because it provides cholinergic innervations to the cerebral cortex after obtaining innervation from the medial septal nucleus,the vertical nucleus of the diagonal band, and the nucleus basalis of Meynert via the medial cholinergic pathway （Nieuwenhuys et al., 2008; Naidich and Duvernoy, 2009; Hong and Jang, 2010a）.

Assessment of load-sharing thoracolumbar injury: A modified scoring system

BACKGROUND Many classification systems of thoracolumbar spinal fractures have been proposed to enhance treatment protocols,but none have achieved universal adoption.AIM To develop a new patient scoring system for cases with thoracolumbar injury classification and severity score(TLICS)=4,namely the load-sharing thoracolumbar injury score(LSTLIS).METHODS Based on thoracolumbar injury classification and severity score,this study proposes the use of the established load-sharing classification(LSC)to develop an improved classification system(LSTLIS).To prove the reliability and reproducibility of LSTLIS,a retrospective analysis for patients with thoracolumbar vertebral fractures has been conducted.RESULTS A total of 102 cases were enrolled in the study.The scoring trend of LSTLIS is roughly similar as the LSC scoring,however,the average deviation based on the former method is relatively smaller than that of the latter.Thus,the robustness of the LSTLIS scoring method is better than that of LSC.LSTLIS can further classify patients with TLICS=4,so as to assess more accurately this particular circumstance,and the majority of LSTLIS recommendations are consistent with actual clinical decisions.LSTLIS is a scoring system that combines LSC and TLICS to compensate for the lack of appropriate inclusion of anterior and middle column compression fractures with TLICS.Following preliminary clinical verification,LSTLIS has greater feasibility and reliability value,is more practical in comprehensively assessing certain clinical circumstances,and has better accuracy with clinically significant guidelines.

A mouse model of weight-drop closed head injury:emphasis on cognitive and neurological deficiency

Traumatic brain injury（TBI） is a leading cause of death and disability in individuals worldwide.Producing a clinically relevant TBI model in small-sized animals remains fairly challenging.For good screening of potential therapeutics,which are effective in the treatment of TBI,animal models of TBI should be established and standardized.In this study,we established mouse models of closed head injury using the Shohami weight-drop method with some modifications concerning cognitive deficiency assessment and provided a detailed description of the severe TBI animal model.We found that 250 g falling weight from 2 cm height produced severe closed head injury in C57BL/6 male mice.Cognitive disorders in mice with severe closed head injury could be detected using passive avoidance test on day 7 after injury.Findings from this study indicate that weight-drop injury animal models are suitable for further screening of brain neuroprotectants and potentially are similar to those seen in human TBI.