Risk evaluation in chorionic villus sampling

The occasion of the 18th symposium of the European Society of Human Genetics, 20 May to 2 June, provided an opportunity for the WHO to sponsor a small meeting on the progress of risk evaluation in three large programmes of chorionic villus sampling (CVS). Their pooled information showed a rate of fetal loss of 3·4 per cent in the first 300 cases in each programme, falling to 1·7 per cent in the following 400 cases.     

水环境中镍毒性的机制研究：有害结局路径(AOP)分析

目前对镍(Ni)生态风险评估和水质法规采用了基于机制的预测工具,如生物配体模型(BLMs)。然而,尽管有许多具体细致的研究,Ni对水生生物毒性的精确机制仍然难以确定。对Ni行为机制的不确定性导致了大家在一些管理设置中应用像BLM这样的工具时,有所顾虑。为了解决这一认知差距,作者使用了有害结局路径(AOP)分析,也是第一个用于金属的AOP分析,来确定Ni毒性的多种潜在机制以及它们与淡水水生生物的相互作用。在金属的分子起始事件(molecular initiating events)在分类群中可能存在的前提下,在许多不同种水生和陆生生物数据的基础上,考虑建立一种潜在的行为机制。通过分析,作者识别了Ni可能对水生生物产生毒性的5个潜在的分子起始事件：Ca²⁺体内平衡的破坏,Mg²⁺体内平衡的破坏,Fe²⁺/³⁺体内平衡的破坏,活性氧类物质引起的氧化损伤,以及呼吸上皮细胞的过敏反应。在生物组织的器官水平,这5个潜在的分子起始事件会分解成3个可能的途径：支持外骨骼、外壳和骨骼生长的Ca²⁺减少;呼吸受损;细胞毒性和肿瘤形成。在整个生物体的水平,器官水平的反应将可能导致生长、繁殖的降低和/或能量代谢的改变,并且在每个通路之间有几个潜在的反馈回路。总体来说,目前的AOP分析可指导Ni的毒性机制研究,并为其他金属开发AOPs提供了有效的参考。
精选自Brix, K. V., Schlekat, C. E. and Garman, E. R. (2017), The mechanisms of nickel toxicity in aquatic environments: An adverse outcome pathway analysis. Environmental Toxicology and Chemistry, 36: 1128–1137. doi: 10.1002/etc.3706
详情请见http://onlinelibrary.wiley.com/wol1/doi/10.1002/etc.3706/full
     

A Framework for Fully Integrating Environmental Assessment

A new framework for environmental assessment is needed because no existing framework explicitly includes all types of environmental assessments. We propose a framework that focuses on resolving environmental problems by integrating different types of assessments. Four general types of assessments are included: (1) condition assessments to detect chemical, physical, and biological impairments; (2) causal pathway assessments to determine causes and identify their sources; (3) predictive assessments to estimate environmental, economic, and societal risks, and benefits associated with different possible management actions; and (4) outcome assessments to evaluate the results of the decisions of an integrative assessment. The four types of assessments can be neatly arrayed in a two-by-two matrix based on the direction of analysis of causal relationships (rows) and whether the assessment identifies problems or solves them (columns). We suggest that all assessments have a common structure of planning, analysis, and synthesis, thus simplifying terminology and facilitating communication between types of assessments and environmental programs. The linkage between assessments is based on intermediate decisions that initiate another assessment or a final decision signaling the resolution of the problem. The framework is applied to three cases: management of a biologically impaired river, remediation of a contaminated site, and reregistration of a pesticide. We believe that this framework clarifies the relationships among the various types of assessment processes and their links to specific decisions.     

Functional outcomes of motor vehicle crash thoracic injuries in pediatric and adult occupants

Objective: Characterization of the severity of injury should account for both mortality and disability. The objective of this study was to develop a disability metric for thoracic injuries in motor vehicle crashes (MVCs) and compare the functional outcomes between the pediatric and adult populations.

Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank for the most frequently occurring Abbreviated Injury Scale (AIS) 2–5 thoracic injuries. Occupants with thoracic injury were classified as disabled or not disabled based on the FIM scale, and comparisons were made between the following age groups: pediatric, adult, middle-aged, and older occupants (ages 7–18, 19–45, 46–65, and 66+, respectively). For each age group, DR was calculated by dividing the number of patients who were disabled and sustained a given injury by the number of patients who sustained a given injury. To account for the effect of higher severity co-injuries, a maximum AIS adjusted DR (DR_MAIS) was also calculated for each injury. DR and DR_MAIS could range from 0 to 100% disability risk.

Results: The mean DR_MAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DR_MAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, and rib and sternum fracture compared to the other age groups. The pediatric population possessed a higher DR_MAIS value for flail chest compared to the other age groups.

Conclusion: Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can influence future age-specific modifications to AIS.     

Injury outcomes and costs for cross-median and median barrier crashes

Introduction

The objective of this research was to quantify the injury outcomes and develop reliable and comprehensive injury costs for cross-median crashes (CMC) and median barrier crashes (MBC).

Method

A three-step methodology was developed to quantify the crash costs for each crash severity and type. All CMC and MBC between 2001 and 2007 in Wisconsin were identified and used in this analysis. The Wisconsin CODES database provided comprehensive injury costs based on the injury types and severities suffered by participants in study crashes.

Results

As expected, multi-vehicle CMC result in more total injuries and more severe injuries than single-vehicle CMC. Injury costs for the same injury level on KABCO scale are different for different crash types. Injury costs for concrete MBC are 33% to 50% less than those of multi-vehicle CMC, while the injury costs of concrete MBC for lower severities (B and C) are similar to those of single-vehicle CMC for the same severities; but for incapacitating injuries the costs are 30% less. As expected, concrete MBC result in lower severities than CMC. The costs, by crash severity, vary significantly between different crash types. Concrete median barrier injury crashes are roughly 20% of multi-vehicle CMC costs and 50% of single-vehicle CMC costs.

Conclusions

Results indicate that using one set of crash costs for all crash types biases any evaluation. Therefore, it is recommended that crash-type-specific costs be used in applications such as development of median barrier warrant where specific types of crashes are considered (CMC and MBC).

Impact on industry

Using crash specific costs can lead to a more realistic benefit-cost analysis and enable better decision-making.     

The significance of fetal ventriculomegaly: etiology,short- and long-term outcomes

Fetal cerebral ventriculomegaly (VM) is diagnosed when the width of one or both ventricles, measured at the level of the glomus of the choroid plexus (atrium), is ≥ 10 mm. VM can result from different processes: abnormal turnover of the cerebrospinal fluid (CSF), neuronal migration disorders, and destructive processes. In a high percentage of cases, it is associated with structural malformations of the central nervous system (CNS), but also of other organs and systems. The rate of associated malformations is higher (≥60%) in severe VM (>15 mm) and lower (10–50%) in cases of borderline VM (10–15 mm). When malformations are not present, aneuploidies are found in 3–15% of borderline VM; the percentage is lower in severe VM. The neurodevelopmental outcome of isolated VM is normal in > 90% of cases if the measurement of ventricular width is between 10 and 12 mm; it is less favorable when the measurement is > 12 mm. Copyright © 2009 John Wiley & Sons, Ltd.