An LC-MS/MS method for creatine and creatinine analysis in paraquat-intoxicated patients

Abstract

A sudden increase in serum creatinine after paraquat intoxication has been reported in several clinical studies. However, this dramatic change of creatinine may be possibly due to an interconversion of creatine-creatinine in relation to paraquat toxicity. In order to investigate the creatine-creatinine relationship, a liquid chromatography tandem mass spectrometry in combination with electrospray ionization was developed and validated for simultaneous determination of creatine and creatinine in the serum. The chromatographic separation was achieved on a Gemini® C₆-Phenyl column with a gradient elution consisting of 0.1% formic acid in ultrapure water and methanol as the mobile phase. The method yielded suitable levels of specificity and selectivity, and calibration curves of creatine and creatinine in serum were linear over the concentration range of 0.5–200?µg mL^?1. The limit of quantification of both compounds was 0.5?µg mL^?1, and the method was accurate within the recovery range of 96.23–102.75%, indicating the robustness of the method. The method was successfully applied to toxicological samples from paraquat-intoxicated patients, and the concentrations of creatine and creatinine were quantified. High creatine concentrations in serum samples were observed which may lead to high serum creatinine despite normal kidney function as creatine is converted to creatinine in proportion to its concentration.     

Should 'Cyrus the Centipede' take a hike? Effects of exposure to a pedestrian safety program on children's safety knowledge and self-reported behaviors

INTRODUCTION: We report the first evaluation of the popular "Cyrus the Centipede" child pedestrian safety program. METHOD: A pre-test/post-test control versus experimental condition design was used to assess Cyrus' impact on third graders' pedestrian safety knowledge, and self-reported pedestrian behaviors. RESULTS: Although some beneficial effects were observed, the program was not reliably effective. In particular, the impact of exposure to Cyrus was strongly influenced by the individual teacher who delivered it, likely due to the highly unstructured nature of the curriculum. SUMMARY: We suggest that: (a) the effectiveness and reliability of such programs be demonstrated before they are widely adopted; and (b) programs that focus on training children in actual or simulated traffic environments may be more effective than those that primarily focus on teaching safety facts and rules.     

航空器场内失事应急演练评估指标体系与评估方法研究

针对目前我国民用运输机场航空器场内失事应急救援综合演练缺乏有效评估体系的现状，通过对演练过程进行系统分析，构建航空器场内失事应急救援演练评估指标体系，涵盖消防、医疗、公安、媒体应对、运行指挥中心、地服、飞行区7个组织部门的2级指标。结合航空器场内失事救援的业务特点以及指标体系内在逻辑，设计相应的评估方法，对开展的航空器场内失事应急演练进行评估；最后，以国内2个机场的相关应急演练过程为典型示例，进行应用分析。研究结果表明:构建的演练评估指标体系及评估方法能较好地应用于实际应急演练过程，进而在演练评估结果和建议的基础上，实现应急演练的持续改进。     

Possibilities of kinesio taping to prevent injuries of professional dancers

A literature review of the application of kinesio taping in the prevention of professional dancers’ injuries indicated frequent dance-related and overuse injuries and a lack of organized information about this issue. This study aimed to assess the impact of kinesio taping on the musculoskeletal system of dancers, based on scientific research data from 2015–2017. The analysis revealed that kinesio taping can effectively reduce muscle spasms, rebuild muscle strength of the injured extremity, improve static and dynamic balance and ease pain, due to its ability to improve proprioception of joints and regulate muscle tone. These effects reduce muscle imbalance and joint instability, thus increasing treatment efficacy and shortening the physical load limitation. Kinesio taping significantly reduces the risk of overuse syndromes and dance-related injuries during dance training and strenuous exercises of people with chronic musculoskeletal diseases. Therefore, kinesio taping has broad utility in primary and secondary prevention of dance-related injuries.     

Trauma demography and clinical epidemiology of motorcycle crash–related head injury in a neurosurgery practice in an African developing country

Objective: Though motor vehicle crashes (MVCs) were the main cause of head trauma from road traffic injuries (RTIs), motorcycle crashes (MCCs) are now a major cause of RTI-related head injury (HI) in many developing countries.

Methods: Using a prospective database of HIs from a neurosurgical practice in a sub-Saharan African developing country, a cross-sectional survey was conducted for the trauma demography and clinical epidemiology of this MCC-related HI.

Results: Motorcycle crashes accounted for 57% (473/833) of all RTI-related HIs in this registry. The victims, with a mean age of 33.1 years (SD = 18.3), consisted mainly of males (83.1%), those of low socioeconomic status (>90%), and those aged between 20 and 40 years old (56%). MCCs involved only riders in 114 cases (114/473, 32.1%), of which 69% were motorcycle–motorcycle crashes. The HI was moderate–severe in 50.8%; clinical symptomatology of significant HI included loss of consciousness (92%), anisocoria (35%), Abbreviated Injury Scale head (AIS–head) score > 3 (28%), and CT-Rotterdam score > 3 (30%). Extracranial systemic injury involved the limbs most frequently, with an Injury Severity Score (ISS) >25 in 49%. The fatality rate was 24%.

MCC-related HI among pedestrian victims involved more vulnerable age groups (the young and elderly) but have lower mean ISS compared to motorcycle passengers (mean ISS = 23.5 [11.6] vs. 27.4 [13.0]; 95% confidence interval [CI], 1.27–6.49; P = .004). In addition, compared to a contemporary cohort of MVC-related HIs in our registry, MCC victims were older (mean age 34.8 years [18.0] vs. 30.8 [18.4]; P = .002); had higher proportions of certain extracranial trauma like long bone fractures (71 vs. 29%; P = .02); and suffered fewer surgical brain lesions (25.5 vs. 17.2%; P = .004).

Conclusions: Motorcycle crashes are now a significant threat to the heads, limbs, and lives of vulnerable road users in developing countries.     

The need to improve information on road user type in National Vital Statistics System mortality data

Objectives: Both the National Vital Statistics System (NVSS) and the Fatality Analysis Reporting System (FARS) can be used to examine motor vehicle crash (MVC) deaths. These 2 data systems operate independently, using different methods to collect and code information about the type of vehicle (e.g., car, truck, bus) and road user (e.g., occupant, motorcyclist, pedestrian) involved in an MVC. A substantial proportion of MVC deaths in NVSS are coded as “unspecified” road user, which reduces the utility of the NVSS data for describing burden and identifying prevention measures. This study aimed to describe characteristics of unspecified road user deaths in NVSS to further our understanding of how these groups may be similar to occupant road user deaths.

Methods: Using data from 1999 to 2015, we compared NVSS and FARS MVC death counts by road user type, overall and by age group, gender, and year. In addition, we examined factors associated with the categorization of an MVC death as unspecified road user such as state of residence of decedent, type of medical death investigation system, and place of death.

Results: The number of MVC occupant deaths in NVSS was smaller than that in FARS in each year and the number of unspecified road user deaths in NVSS was greater than that in FARS. The sum of the number of occupant and unspecified road user deaths in NVSS, however, was approximately equal to the number of FARS occupant deaths. Age group and gender distributions were roughly equivalent for NVSS and FARS occupants and NVSS unspecified road users. Within NVSS, the number of MVC deaths listed as unspecified road user varied across states and over time. Other categories of road users (motorcyclists, pedal cyclists, and pedestrians) were consistent when comparing NVSS and FARS.

Conclusions: Our findings suggest that the unspecified road user MVC deaths in NVSS look similar to those of MVC occupants according to selected characteristics. Additional study is needed to identify documentation and reporting challenges in individual states and over time and to identify opportunities for improvement in the coding of road user type in NVSS.     

Analysis of bicycle crashes in Sweden involving injuries with high risk of health loss

Objective: The objectives of the present article were to (a) describe the main characteristics of bicycle crashes with regard to the road environment, crash opponent, cyclist, and crash dynamics; (b) compare individuals who describe their health after the crash as declined with those who describe their health as not affected; and (c) compare the number of injured cyclists who describe their health as declined after the crash with the predicted number of permanent medical impairments within the same population.

Methods: A sample of individuals with specific injury diagnoses was drawn from the Swedish Traffic Accident Data Acquisition (STRADA) database (n?=?2,678). A survey form was used to collect additional information about the crash and the health-related outcomes. The predicted number of impaired individuals was calculated by accumulating the risk for all individuals to sustain at least a 1% permanent medical impairment, based on the injured body region and injury severity.

Results: Nine hundred forty-seven individuals (36%) responded, of whom 44% reported declined health after the crash. The majority (68%) were injured in single bicycle crashes, 17% in collisions with motor vehicles, and 11% in collisions with another cyclist or pedestrian. Most single bicycle crashes related to loss of control (46%), mainly due to skidding on winter surface conditions (14%), followed by loss of control during braking (6%). There was no significant difference in crash distribution comparing all crashes with crashes among people with declined health. The predicted number of impaired individuals (n?=?427) corresponded well with the number of individuals self-reporting declined health (n?=?421).

Conclusions: The types of crashes leading to health loss do not substantially differ from those that do not result in health loss. Two thirds of injuries leading to health loss occur in single bicycle crashes. In addition to separating cyclists from motorized traffic, other preventive strategies are needed.     

Factors affecting use and nonuse of child safety car seats in Gorgan,Iran

Objective: Motor vehicle accidents, which are among the main causes of child mortality in Iran and the Middle East, impose staggering costs for the community. Ignoring use of safety devices for children in most motor vehicle crashes will lead to death or serious injury. Because few studies have been performed on effective and predictive factors regarding use of child safety seats, the purpose of this study was to examine the factors affecting the use and nonuse of child safety seats, along with the factors that can facilitate how a child safety seat is used.

Method: This study was conducted in the urban area of Gorgan using a questionnaire. Through random selection, 204 parents with at least one child, aged 8?years or younger, reported their knowledge about the benefits of using a child safety seat.

Results: The results showed that 80% of parents never use a child safety seat, and 13% always use a child safety seat. More than 93% thought that it was necessary to make usage of the child safety seat obligatory. In addition, 80% of parents believed that a child safety seat prevents children from injury in crashes. In addition, 38% of parents were not aware of child safety devices and child safety, less than 20% said that they did not use a child safety seat because their spouse did not support its use, and 28% of them thought that a child safety seat does not affect the safety of the child. In general, 91% of parents reported that if child safety seat use were mandated, the frequency of use would increase. A law on the use of child safety seats is a very important variable in their use, which can enhance the chance of using a child safety seat by 6.5 times.

Conclusion: Special instructions should be developed to create incentive strategies for using a child safety seat. Mandating the use of a child safety seat, equipping cars with a child safety seat, encouraging children to use it, and providing continuous education and training are important factors for increasing the use of child safety seats.