Predictors Of Injury Research Articles

Identification of factors associated with vancomycin-induced acute kidney injury: A retrospective analysis using the Common Data Model.

Previous findings on predictors of vancomycin-induced acute kidney injury (AKI) are inconsistent. We aimed to identify the predictors of vancomycin-induced AKI using the Observational Medical Outcome Partnership Common Data Model. We analyzed data from patients treated with vancomycin between January 1, 2012, and May 31, 2022, who were positive for Staphylococcus aureus and had undergone oxacillin susceptibility tests. After excluding patients without data for vancomycin or baseline serum creatinine levels, 116 patients were included in the final dataset. Data up to the third measured vancomycin concentration were collected for each patient. Logistic regression models were used to estimate the odds ratio and 95% confidence interval for each variable associated with vancomycin-induced AKI. High baseline serum creatinine levels, intensive care unit admission, and concurrent renal disorders were significantly associated with vancomycin-induced AKI. Although high trough levels or area under the curve values were not significantly associated with vancomycin-induced AKI, both were significantly higher in patients with AKI than in those without AKI at the second vancomycin concentration measurement. The proportion with trough levels >20mg/L was higher in patients with AKI than in those without AKI at the third measurement. Our findings revealed that underlying renal disease and intensive care unit admission are more significantly associated with vancomycin-induced AKI than vancomycin pharmacokinetic parameters or dosage, likely due to vancomycin concentration-based dosage adjustment in clinical settings. Our findings may help develop strategies for reducing the incidence of vancomycin-induced AKI; however, further prospective studies are essential.

Determination of distal fibula fracture for prediction of ankle injuries

Objective This study quantified the local fracture tolerance of the distal fibula. The purpose of this data is to refine the understanding of ankle fracture tolerance in the population and enhance injury prediction by computational tools. Methods Fracture patterns of the fibula were obtained from the US National Highway Traffic Safety Administration (NHTSA) Crash Injury Research Engineering Network (CIREN). Of 143 cases of ankle injury, 120 included fibula fracture, many of which accompanied by radiology images. The most common fibula fracture type was a Weber C fracture, which was then used as the testing target to replicate with postmortem human surrogates. Isolated distal fibulae (male and female, across a wide anthropometric range) were subjected to quasi-static lateral-medial four-point bending superimposed on axial precompression. Results Of the 20 specimens tested, 17 fractured in compression and bending, two fractured in compression, bending, and shear, and one did not fracture upon the imposed displacement. Fractures occurring outside of the target testing span were treated as right-censored data points. Fracture patterns varied among specimens, with oblique fractures being most common, followed by segmental fractures. At failure, compressive force ranged from 77 N to 370 N and bending moment from 17 Nm to 47 Nm. Conclusions From the 19 fractured specimens, the variety of fracture patterns observed were generally consistent with the range of fibula fracture types and locations commonly observed in the field. While comparative studies with fibula specimens are largely absent from literature, comparison of this study to other long bones (radius and ulna) show that bending moment at fracture is similar. To the author’s knowledge, this is the first study to quantify the fracture tolerance of isolated distal fibulae under loading conditions representative of ankle injury mechanisms in motor vehicle collisions. By combining the results of this study with complementary results from parallel tibia-focused experiments (currently in-press), these results will aid development of tissue-level lower leg fracture prediction of human body models, thus enhancing prediction of ankle injury during safety assessment simulations. Specifically, the fracture tolerance information might generate an injury risk function to guide tissue-level injury prediction with human body models.

The risk factors and predictors of injury among collegiate rugby players under the age of 20.

The risk of injury in rugby is high, due to the contact nature of the game. Players are constantly exposed to impact and collision during training and match-play. Rugby union consists of various risk factors that predispose players to injury. The aim of the study was to determine the risk factors of injury and to predict the risk of injury per playing position during match-play. The study followed a quantitative, non-experimental, and cross-sectional research design. A total of 252 male rugby players, aged 18 to 20 years, who played in a collegiate rugby competition in South Africa (SA) for the 2022 season were conveniently sampled for the study. The playing position, time of injury (whether during a match or training), use of protective equipment, and phase of play in which the injury occurred were recorded. Injury data was captured by qualified healthcare professionals using an adapted injury surveillance questionnaire. The study found that potential risk factors for injury included illegal or dangerous play, playing in the second half of the match (more specifically the third quarter of the match), and playing in the offensive part of the field (more specifically between the opposition-22 and halfway line). Contact events were the most common cause of match injury (91.1%). The half of the match in which an injury was sustained was significantly different between forwards and backs (P=0.011). A statistically significant association was found between playing position and the phase of play in which injury was sustained (P=0.021). Regression analysis showed that playing between the opposition-22 m line and the halfway line was a significant predictor of injury for both forwards and backs (P=0.035). In conclusion, potential risk factors for injury were related to dangerous play, time during the match (specifically the third quarter of the match), and location of play (specifically between the opposition-22 m line and halfway line). The area of play was a significant predictor of injury for all players. It is recommended that greater efforts in collecting epidemiological data need to be made to broaden the knowledge base on injuries and provide strategies to coaches and players to reduce the risk of injury in rugby.

Comprehensive biomarker assessment for predicting severe acute kidney injury and need of kidney replacement therapy in liver transplantation patients

Background Renal dysfunction is a common complication following liver transplantation (LT). This study aimed to determine whether a comprehensive assessment of kidney function using nineteen serum and urinary biomarkers (BMs) within the first 48 h post-LT could enhance the prediction of severe acute kidney injury (AKI) and the need of kidney replacement therapy (KRT) during the first postoperative week. Methods Blood and urine (U) samples were collected during the pre- and postoperative periods. Nineteen BMs were evaluated to assess kidney health in the first 48 h after LT. Classification and regression tree (CART) cross-validation identified key predictors to determine the best BM combination for predicting outcomes. Results Among 100 LT patients, 36 developed severe AKI, and 34 required KRT within the first postoperative week. Preoperative assessment of U neutrophil gelatinase-associated lipocalin (NGAL) and liver-type fatty acid-binding protein (L-FABP) predicted the need for KRT with 75% accuracy. The combined assessment of U osmolality (OSM), U kidney injury molecule 1 (KIM-1), and tissue inhibitor of metalloproteinase (TIMP-1) within 48 h post-LT predicted severe AKI with 80% accuracy. U-OSM alone, measured within 48 h post-LT, had an accuracy of 83% for predicting KRT need, outperforming any BM combination. Conclusions Combined BM analysis can accurately predict severe AKI and KRT needs in the perioperative period of LT. U-OSM alone proved to be an effective tool for monitoring the risk of severe AKI, available in most centers. Further studies are needed to assess its impact on AKI progression postoperatively. Registered at Clinical Trials (clinicaltrials.gov) in March 24th, 2014 by title ‘Acute Kidney Injury Biomarkers: Diagnosis and Application in Pre-operative Period of Liver Transplantation (AKIB)’ and identifier NCT02095431.

An Objective Injury Threshold for the Maximum Principal Strain Criterion for Brain Tissue in the Finite Element Head Model and Its Application.

Although the finite element head model (FEHM) has been widely utilized to analyze injury locations and patterns in traumatic brain injury, significant controversy persists regarding the selection of a mechanical injury variable and its corresponding threshold. This paper aims to determine an objective injury threshold for maximum principal strain (MPS) through a novel data-driven method, and to validate and apply it. We extract the peak responses from all elements across 100 head impact simulations to form a dataset, and then determine the objective injury threshold by analyzing the relationship between the combined injury degree and the threshold according to the stationary value principle. Using an occipital impact case from a clinical report as an example, we evaluate the accuracy of the injury prediction based on the new threshold. The results show that the injury area predicted by finite element analysis closely matches the main injury area observed in CT images, without the issue of over- or underestimating the injury due to an unreasonable threshold. Furthermore, by applying this threshold to the finite element analysis of designed occipital impacts, we observe, for the first time, supra-tentorium cerebelli injury, which is related to visual memory impairment. This discovery may indicate the biomechanical mechanism of visual memory impairment after occipital impacts reported in clinical cases.

Evaluation of hop tests based on Y-Balance test and FMS test outcomes in volleyball and basketball players to identify those prone to injury: a potential predictor of injury

BackgroundThe quest for a reliable and effective method to identify athletes at risk of injury holds the promise of significantly reducing injury rates and improving overall athletic performance. This research delved into the relationship between the Functional Movement Screen (FMS), Y-Balance Test (YBT), and Hop tests (Side hop, Medial triple hop, and Lateral step-down hop), aiming to determine the potential in predicting injuries of hop tests among division 1 volleyball and basketball players.MethodsThis research was conducted with fifty-two participants from the Division 1 league, encompassing both volleyball and basketball players. The study rigorously employed the Functional Movement Screen (FMS), the Y-Balance Test (YBT), and various hop tests (side hop test, medial triple hop test, lateral step-down hop) to measure relevant variables. The data analysis used logistic regression, ensuring a comprehensive approach to the study.ResultsResults showed no significant relationship between FMS and Hop test for predicting injuries, but there was a relationship between ΔY and side hop that shows side hop test can predict injury, but there was no relationship between Lateral step down, Medial triple hop, and ΔY.ConclusionsBased on our findings, side hop, despite the medial triple hop and lateral step-down test, can be used as a sports injury predictor.

The role of psychological status in the incidence of traumatic dental injuries in schoolchildren.

Cohort study. Confirmatory Factor Analysis (CFA) and Structured Equation Modeling (SEM). Psychosocial status emerged as the main predictor of traumatic dental injuries (TDIs). Better psychosocial status had a direct protective effect on the incidence of TDIs. The impact of increased overjet and lower parental schooling on TDIs was mediated through psychosocial status. Children residing in areas with poorer contextual socio-economic indicators faced a higher risk of experiencing new TDIs due to psychosocial factors. Poor psychosocial status directly correlated to TDIs. Indirectly, psychosocial factors mediated the occurrence of TDIs through overjet, parental schooling and contextual residential area.

Predictors and risk factors of bile duct injury after transcatheter arterial chemoembolization for hepatocellular carcinoma

PurposeBile duct injury is a serious complication after transcatheter arterial chemoembolization (TACE). If it is not detected early and treated actively, it will not only affect the subsequent tumor-related treatment of hepatocellular carcinoma (HCC) patients, but also may lead to serious consequences such as infection, liver failure and even death. To analyze the risk factors of bile duct injury after TACE in patients with HCC and explore the predictive indicators of bile duct injury after TACE, which is helpful for doctors to detect and intervene early and avoid the occurrence of serious complications.MethodWe retrospectively analyzed the clinical data of 847 patients with primary hepatocellular carcinoma who underwent TACE for the first time in our interventional department. Patients were divided into two groups according to whether bile duct injury occurred after TACE: (1) bile duct injury group, N = 55; (2) no bile duct injury group, N = 792. The basic data, intraoperative conditions and the outcome of bile duct injury were analyzed. The chi-square test was used for comparison of enumeration data. The Mann-Whitney U test was used for comparison of measurement data. Risk factor analysis was performed using binary logistic regression analysis.ResultsBasic data and intraoperative conditions were compared between the bile duct injury group and the group without bile duct injury: preoperative alkaline phosphatase (ALP) (103.24 ± 32.77U/L vs. 89.17 ± 37.35U/L, P = 0.003); history of hepatobiliary surgery (36.4% vs. 20.8%, P = 0.011); intraoperative lipiodol volume (P = 0.007); combined use of gelatin sponge particles (65.5% vs. 35.0%, P < 0.001); hypovascularity (58.2% vs. 24.5%, P < 0.001); and embolization site (P < 0.001). Comparison of postoperative liver function between bile duct injury group and non-bile duct injury group: postoperative total bilirubin (43.34 ± 25.18umol/L vs. 21.94 ± 9.82umol/L, P < 0.001); postoperative γ-glutamyltransferase(GGT) (188.09 ± 55.62U/L vs. 84.04 ± 36.47U/L, P < 0.001); postoperative ALP(251.51 ± 61.51U/L vs. 99.92 ± 45.98U/L, P < 0.001).ConclusionThe dosage of lipiodol in TACE, supplementation of gelatin sponge particles, embolization site, and hypovascularity of the tumor are risk factors for biliary duct injury after TACE. After TACE, GGT and ALP increased ≥ 2 times compared with preoperative indicators as predictors of bile duct injury. Bile duct injury occurring after TACE can achieve good outcomes with aggressive management.

Hip Muscle Strength Ratios Predicting Groin Injury in Male Soccer Players Using Machine Learning and Multivariate Analysis—A Prospective Cohort Study

Despite ongoing efforts, the relationship between groin strength and injury remains unclear. The challenge of accurately predicting injuries presents an opportunity for researchers to develop prevention strategies to reduce the occurrence of such injuries. Consequently, this issue requires further investigation to obtain insights into effective mitigation strategies. In 120 male soccer players, the maximum isometric strength of the hip muscle groups was measured, and the strength ratios were calculated. Previous injury and anthropometric data were registered. Injury data were collected following the FIFA/UEFA consensus. k-nearest neighbor (k-NN) was used to predict the incidence of injury, while the significant predictive variables of the k-NN algorithm were fitted into a multivariate logistic regression model (LR) to analyze the likelihood of players sustaining a groin injury. The LR model determined two variables as significant predictors of groin injury. Players were less likely to sustain a groin injury by 76% for each decrease of the adductor/abductor isometric strength ratio in the non-dominant limb (OR = 0.238, CI 95% = [(0.098–0.572]). Players with a history of previous injury had a 67% greater risk of sustaining an injury (OR = 0.333, CI 95% = [(0.1068–1.038]). Isometric hip adductor and abductor strength imbalances of the non-dominant lower limb and a history of previous injury were risk factors for groin injury in soccer players.

Predictors of Anterior Cruciate Ligament Tears in Adolescents and Young Adults

Background: Anterior cruciate ligament (ACL) injury in youth can lead to expensive treatment, lengthy rehabilitation, and long-term impairment. Injuries to the ACL are more common in adolescents who participate in organized sports. Purpose: To examine whether there is an association between age, physical activity patterns, pubertal timing (Tanner stage), or body mass index (obesity/overweight status) and the risk of developing an ACL injury in youth. Study Design: Cohort study; Level of evidence, 2. Methods: Data from the Growing Up Today Study (GUTS), a prospective cohort study of youth throughout the United States, were used in this study. From 1996 to 2003, questionnaires were sent to GUTS participants every 12 to 18 months to assess a variety of self-reported factors; in a related 2004 questionnaire, ACL tears and other diagnoses among the participants were reported. Cox proportional hazard models were run to determine the sex-specific association of activity patterns and pubertal timing with risk of developing an ACL tear. Results: A total of 4519 boys and 5622 girls (age: 9-15 years) were included, with 2.4% and 2.0% sustaining an ACL injury, respectively. Age was found to be a significant risk factor for ACL injury in both sexes (male: hazard ratio [HR] = 1.30 [95% CI, 1.14-1.48]; female: HR = 1.23 [95% CI, 1.10-1.38]). Mean hours per week engaged in vigorous activity was also predictive of a higher risk of ACL injury (male: HR = 1.04 [95% CI, 1.01-1.08]; female: HR = 1.10 [95% CI, 1.07-1.14]). The sports that were the most predictive of injury were running, basketball, soccer, and cheerleading/gymnastics in girls and running, football, and karate/martial arts in boys. Additionally, in boys, overweight/obese status was found to be a significant predictor of ACL injury (HR = 2.61 [95% CI, 1.60-4.26]). Furthermore, among 9- to 13-year-old girls, advanced Tanner stage was a strong predictor of injury risk (HR = 2.43 [95% CI, 1.10-5.36]). Conclusion: Age, time engaged in vigorous activity, overweight/obese status, and advanced Tanner stage were associated with an increased risk of ACL injury in young adults and adolescents. Further research with follow-up data will help complement this study and continue to highlight the risk factors associated with ACL reconstruction in adolescents and young adults.

Assessment of liver graft quality during hypothermic oxygenated perfusion: the first international validation study

Background and AimWhile it is currently assumed that liver assessment is only possible during normothermic machine perfusion (NMP), there is uncertainty regarding a reliable and quick prediction of graft injury during ex situ hypothermic oxygenated perfusion (HOPE). We therefore intended to test, in an international liver transplant cohort, recently described mitochondrial injury biomarkers measured during HOPE before liver transplantation. Study designPerfusate samples of human livers from 10 centers in 7 countries with HOPE-experience were analyzed for released mitochondrial compounds, i.e. flavin mononucleotide (FMN), NADH, purine derivates and inflammatory markers. Perfusate FMN was correlated with graft loss due to primary non-function or symptomatic non-anastomotic biliary strictures (NAS), and kidney failure, as well as liver injury after transplantation. Livers deemed unsuitable for transplantation served as negative control. ResultsWe collected 473 perfusate samples of human DCD (n=315) and DBD livers (n=158). Fluorometric assessment of FMN in perfusate was validated by mass spectrometry (R=0.7011,p<0.0001). Graft loss due to primary non-function or cholangiopathy was predicted by perfusate FMN values (c-statistic mass spectrometry 0.8418 (95%CI 0.7466-0.9370,p<0.0001), c-statistic fluorometry 0.7733 (95%CI 0.7006-0.8461,p<0.0001). Perfusate FMN values were also significantly correlated with symptomatic NAS and kidney failure, and superior in prediction of graft loss when compared to conventional scores derived from donor and recipient parameters, such as the donor risk index and the balance of risk score. Mitochondrial FMN values in liver tissues of non-utilized livers were low, and inversely correlated to high perfusate FMN values and purine metabolite release. ConclusionsThis first international study validates the predictive value of the mitochondrial co-factor FMN, released from complex I during HOPE, and may therefore contribute to a better risk stratification of injured livers before implantation. Impact and ImplicationsAnalysis of 473 perfusates, collected from 10 international centers during hypothermic oxygenated perfusion (HOPE), revealed that mitochondria derived flavin mononucleotide (FMN) values in perfusate is predictive for graft loss, cholangiopathy, and kidney failure after liver transplantation. This result is of high clinical relevance, as recognition of graft quality is urgently needed to improve the safe utilization of marginal livers. Ex-situ machine perfusion approaches, such as HOPE, are therefore likely to increase the number of useable liver grafts.

P02-12 Development of a hepatic spheroid co-culture model for prediction of cholestatic drug-induced liver injury

P02-12 Development of a hepatic spheroid co-culture model for prediction of cholestatic drug-induced liver injury

Abstract P343: Cerebral injury and cognitive performances are correlated with immunoinflammatory markers in hypertensive patients

Immunity and inflammation play a pivotal role in hypertension onset and cardiovascular organ damage. This role has been thoroughly characterized for classical hypertension targets as the kidneys, the heart and the vasculature. Many studies have characterized this in the experimental context, however immunoinflammatory challenges links with brain injury in the clinical context of hypertension are still lacking. In this study we will characterize how immunoinflammatory mediators can be predictors of cerebral injury characterized by advanced neuroimaging in hypertensive patients. Hypertensive patients underwent cerebral MRI and by advanced neuroimaging we characterized the microstructural injury by DTI fiber tracking. We administered the Montreal Cognitive Assessment to evaluate cognitive function, measured circulating C-reactive protein (hs-CRP) and counted circulating white blood cells (WBC). We found a large cluster of white matter tracts whose integrity parameters were associated with immunoinflammatory biomarkers (Figure A). In particular, a cluster of tracts of the limbic system and encompassing the corpus callosum show a correlation between their loss of integrity and hs-CRP levels. Another cluster of associative tracts spanning the temporal lobe show association between their loss of integrity and the WBC. Finally, the Frontal Aslant and the Uncinate Fasciculus show association with both immunoinflammatory markers (Figure B). In this study we performed advanced neuroimaging analyses to characterize the interplay between immunoinflammatory risk and cerebral alterations in hypertensives. Furthermore, our previous work identified that white matter damage in the Forceps Minor and Superior Longitudinal Fasciculus was a typical trait of hypertensive patients and associated to loss of cognitive functions. Our data further show the inflammatory risk association with worse cognitive functions, suggesting a clinical relevance in terms of damage evidenced by advanced MRI in hypertensive patients.

Early diagnostic and prognosis prediction of circ_0054633 for acute lung injury/acute respiratory distress syndrome in children with severe pneumonia

To explore the value of circ_0054633 in early diagnosis and prognosis prediction of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in children with severe pneumonia. A retrospective case-control study was conducted on children with diagnosed severe pneumonia admitted to Tianjin Children's Hospital from July 1, 2022, to February 29, 2024. The clinical data was collected by electronic medical record system and clinical follow-up, including gender, age, lung injury prediction score (LIPS), pediatric critical illness score (PCIS), serum circ_0054633, interleukin-6 (IL-6), the indicators of the arterial blood-gas analysis, oxygenation index (PaO2/FiO2) within 24 hours of admission and the survival status of 28 days. According to whether ALI/ARDS occurred, they were divided into the ALI/ARDS group and the non-ALI/ARDS group. The differences of clinical data between the two groups were compared, and multivariate Logistic regression was used to analyze the risk factors for ALI/ARDS in children with severe pneumonia. The receiver operator characteristic curve (ROC curve) will be used to explore the early diagnostic value of ALI/ARDS in children with severe pneumonia. The patients of ALI/ARDS were divided into mild group, moderate group and severe group according to the level of PaO2/FiO2. The levels of serum circ_0054633 and IL-6 in various severity ALI/ARDS were compared. The differences of serum circ_0054633, IL-6 levels, PCIS score and LIPS score were compared between the two groups of ALI/ARDS patients according to different prognoses in 28 days, as well as the correlation between various risk factors and circ_0054633. A total 74 children with severe pneumonia were included, with 34 cases in the ALI/ARDS group and 40 cases in the non-ALI/ARDS group. In ALI/ARDS group, there were 9 cases in the mild group, 15 cases in the moderate group and 10 cases in the severe group; while 12 cases died and 22 cases survived after 28 days. The serum circ_0054633, IL-6 level and LIPS score were higher in the ALI/ARDS group than the non-ALI/ARDS group, while the PCIS score was lower, and the two groups had significant difference. Multivariate Logistic regression analysis showed that circ_0054633 was independent predictors of ALI/ARDS in children with severe pneumonia [odds ratio (OR) = 3.853, 95% confidence interval (95%CI) was 1.912-7.805, P = 0.017]. ROC curve analysis showed that the cut-off values for circ_0054633 in the diagnosis of ALI/ARDS were 3.955, sensitivity was 79.4%, specificity was 92.5%, area under the ROC curve (AUC) was 0.892. The serum circ_0054633 and IL-6 levels were higher in the children who died in 28 days than the children who were survived, while the PCIS score was lower, and the two groups had significant difference. Spearman correlation analysis showed that the level of circ_0054633 in children with ALI/ARDS was positively correlated with 28-day mortality and IL-6 (r value was 0.675, 0.763, respectively, all P < 0.001), but negatively correlated with PCIS score (r = -0.626, P < 0.001), while no significant correlation with LIPS score (r = 0.389, P = 0.023). The level of serum circ_0054633 has a better value in early diagnosis and prognosis prediction of ALI/ARDS caused in children with severe pneumonia.

Proenkephalin Improves Cardio-Renal Risk Prediction in Acute Coronary Syndromes: The KID-ACS Score.

Circulating proenkephalin (PENK) is a stable endogenous polypeptide with fast response to glomerular dysfunction and tubular damage. This study examined the predictive value of PENK for renal outcomes and mortality in patients with acute coronary syndromes (ACS). Proenkephalin was measured in plasma in a prospective multicentre ACS cohort from Switzerland (n=4787) and in validation cohorts from the UK (n=1141), Czechia (n=927), and Germany (n=220). A biomarker-enhanced risk score (KID-ACS score) for simultaneous prediction of in-hospital acute kidney injury (AKI) and 30-day mortality was derived and externally validated. On multivariable adjustment for established risk factors, circulating PENK remained associated with in-hospital AKI (per log2 increase: adjusted odds ratio [OR] 1.53, 95% confidence interval [CI] 1.13-2.09, P=0.007) and 30-day mortality (adjusted hazard ratio [HR] 2.73, 95% CI 1.85-4.02, P<0.001). The KID-ACS score integrates PENK and showed an area under the receiver operating characteristic curve (AUC) of 0.72 (95% CI 0.68-0.76) for in-hospital AKI, and of 0.91 (95% CI 0.87-0.95) for 30-day mortality in the derivation cohort. Upon external validation, KID-ACS achieved similarly high performance for in-hospital AKI (Zurich: AUC 0.73, 95% CI 0.70-0.77; Czechia: AUC 0.75, 95% CI 0.68-0.81; Germany: AUC 0.71, 95% CI 0.55-0.87) and 30-day mortality (UK: AUC 0.87, 95% CI 0.83-0.91; Czechia: AUC 0.91, 95% CI 0.87-0.94; Germany: AUC 0.96, 95% CI 0.92-1.00) outperforming the CA-AKI score and the GRACE 2.0 score, respectively. Circulating PENK offers incremental value for predicting in-hospital AKI and mortality in ACS. The simple 6-item KID-ACS risk score integrates PENK and provides a novel tool for simultaneous assessment of renal and mortality risk in patients with ACS.

Risk-factor analysis of the proximal tibia morphology for secondary ipsilateral injury after anterior cruciate ligament reconstruction: A retrospective cross-sectional study.

Many studies have reported the risk factors associated with primary anterior cruciate ligament (ACL) injury. However, few studies have focused on the bony morphology of secondary ipsilateral injury after ACL reconstruction. This study aimed to investigate the morphological risk factors of the proximal tibia contributing to secondary ipsilateral injury after ACL reconstruction. Twenty patients who were selected from secondary ipsilateral injury after ACL reconstruction between January 2015 and May 2020 were included in the secondary injury group. They were matched in a 1:2 ratio to the control group, which underwent primary ACL reconstruction during the same period and did not experience reinjury at the minimum 2-year follow-up, based on age, gender, and body mass index. All parameters, including medial tibial posterior slope, lateral tibial posterior slope (LTPS), medial tibial plateau depth, and lateral tibial plateau height, were recorded by using magnetic resonance imaging. Binary logistic regression analysis and receiver operator characteristic curves were conducted to explore the risk factors for reinjury and determine the cutoff value for the significant parameter. The LTPS was significantly larger in the secondary injury group than in the control group (9.6 ± 1.5° to 7.0 ± 1.4°, P < .001), and there was no significant difference in the medial tibial posterior slope, medial tibial posterior slope, and lateral tibial plateau height between the 2 groups (P > .05). The LTPS was found to be an independent risk factor for secondary ipsilateral injury after ACL reconstruction (odds ratio = 3.220, 95% confidence interval = 1.904-5.446, P < .001). The cutoff value of the LTPS was 8.8°, with a sensitivity of 91.7% and a specificity of 81.2%. The LTPS could be a unique predictor of secondary ipsilateral injury after ACL reconstruction. Orthopedists should implement effective measurements during primary reconstruction when the LTPS is >8.8°.

Optimizing vehicle Front-End structure for e-bike rider Safety: An advanced Multi-Objective approach using injury prediction models

A multi-objective optimization method based on an injury prediction model is proposed to address the increasingly prominent safety issues for e-bike riders in Chinese road traffic. This method aims to enhance the protective effect of vehicle front-end for e-bike riders by encompassing a broader range of test scenarios. Initially, large-scale rider injury response data were collected using automated Madymo simulations. A machine learning model was then trained to accurately predict the risk of rider injury under varied crash conditions. Subsequently, this model was integrated into a multi-objective optimization framework, combined with multi-criteria decision analysis, to effectively evaluate and rank various design alternatives on the Pareto frontier. This process entailed a comparative analysis of the design in a baseline scenario before and after optimization, focusing on both kinematic and injury responses of riders. Through detailed injury mechanism analysis, key design variables such as the height of the hood front and the width of the bumper were identified. This led to the proposal of specific optimization strategies for these structural parameters. The results from this study demonstrate that the proposed optimization method not only guides the design process accurately and efficiently but also balances the injury risks across different body parts. This approach significantly reduces the injury risk for riders in car-to-e-bike collisions and provides actionable insights for vehicle design enhancements.

Substance use and driver fatality in Norway: An expanded case-control study.

Using alcohol or psychoactive drugs before driving a motor vehicle may increase the risk of crash involvement, injury, and death. This is better documented for alcohol than for drugs. The aim of this study was to expand a previous case-control study on substance use and driver fatality by doubling the number of cases and controls, and hence improve the statistical power and enable the analysis of combined substance use. We collected data on alcohol and drug use from all 1197 drivers of cars and vans who were fatally injured in road traffic crashes in Norway between 2005 and 2020 ('cases') by analyzing blood samples or reviewing other information on substance use. We also collected data on alcohol and drug use among 17,219 drivers in random road traffic ('controls') by analyzing oral fluid samples. Substance use was converted to dichotomous variables (no use/use). We used unconditional logistic regression to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) of driver fatality for mutually exclusive substance groups, adjusted for sex, age, geographic region, urban centrality class, and time interval of the week. Compared to no substance use, the aOR (95% CI) for driver fatality was for alcohol 91 (61-137), stimulants (primarily amphetamines) aOR 22 (9-56), benzodiazepines and z-hypnotics (BZDs) aOR 4.0 (2.7-5.9), tetrahydrocannabinol (THC) aOR 3.4 (1.7-6.7), and opioids aOR 1.4 (0.4-4.9). The aOR for any polysubstance use was 168 (96-297). The combinations of BZDs with stimulants or THC were associated with markedly higher aORs for driver fatality than the use of single substance groups. Alcohol and polysubstance use are the most important predictors of fatal injury, followed by stimulants.

Research on injury risk of elite male athletes in racing ice sports based on blood indexes.

This study aims to explore the relationship between blood biochemical indexes and injury risk of elite male athletes in racing ice sports. The male athletes compared the demographic indexes, monthly injuries, and longitudinal tracking data. The non-linear relationship was analyzed using an unrestricted cubic spline. Generalized estimating equations estimated the relative risk (OR) of injury occurrence. Receiver operating characteristics and the area under the curve determined diagnostic accuracy. In the snow sledding group, when creatine kinase rises to 489.46 u/L or Testosterone decreases to 41.32 ng/ml, the risk increases by 1.70 times (OR=1.70, p<0.001) and 1.69 times(OR=1.69, p<0.001) with statistical significance. the Creatine kinase (OR=1.01, P=0.007) and Testosterone (OR=1.00, P＜0.001) were included in the injury prediction model. The model exhibits excellent discrimination, with sensitivity and specificity of 82.8% and 86.5%, respectively. In the ice skating group, when Creatine kinase rise to 467.00 u/L, the risk increases by 2.56 times with statistical significance (OR=2.56, p<0.001). Creatine kinase (OR=1.01, P＜0.001) was included in the predictive model. The model demonstrates good discrimination, with sensitivity and specificity of 90.5% and 66.7%, respectively. Creatine kinase and Testosterone are the risk predictors of injury in elite snowmobile male athletes. Creatine kinase is an independent risk factor for injury in elite speed skaters.

Study on the Prediction of Liver Injury in Acute Pancreatitis Patients by Radiomic Model Based on Contrast-Enhanced Computed Tomography.

to predict liver injury in acute pancreatitis (AP) patients by establishing a radiomics model based on contrast-enhanced computed tomography (CECT). a total of 1223 radiomic features were extracted from late arterial-phase pancreatic CECT images of 209 AP patients (146 in the training cohort and 63 in the test cohort), and the optimal radiomic features retained after dimensionality reduction by least absolute shrinkage and selection operator (LASSO) were used to construct a radiomic model through logistic regression analysis. In addition, clinical features were collected to develop a clinical model, and a joint model was established by combining the best radiomic features and clinical features to evaluate the practicality and application value of the radiomic models, clinical model and combined model. four potential features were selected from the pancreatic parenchyma to construct the radiomic model, and the area under the receiver operating characteristic curve (AUC) of the radiomic model was significantly greater than that of the clinical model for both the training cohort (0.993 vs. 0.653, p = 0.000) and test cohort (0.910 vs. 0.574, p = 0.000). The joint model had a greater AUC than the radiomics model for both the training cohort (0.997 vs. 0.993, p = 0.357) and test cohort (0.925 vs. 0.910, p = 0.302). the radiomic model based on CECT has good performance in predicting liver injury in AP patients and can guide clinical decision-making and improve the prognosis of patients with AP.</p>.