Jihong Zhou

Spinal trauma in mainland China from 2001 to 2007: an epidemiological study based on a nationwide database.

Study Design. Descriptive epidemiological study. Objective. To determine the epidemiological characteristics of spinal trauma in Mainland China. Summary of Background Data. To date, a large-scale epidemiological analysis of spinal trauma in Mainland China has not been undertaken. Methods. Data were acquired from Chinese Database of Traumas. Patients with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding of 805.x and 806.x (spinal column fracture with and without spinal cord injury) from 2001 to 2007 were identified. Variables assessed included patient demographics, etiology, segmental distribution, and outcomes. Results. A total of 82,720 patients with spinal trauma were identified, accounting for 4.58% of all trauma patients in the study period. Spinal cord injuries (SCIs) and fracture-dislocations accounted for 16.87% and 7.17% of spinal trauma and 0.74% and 0.32% of all traumas in the same period, respectively. The male-to-female ratio was 2.33:1. About 79.32% of spinal trauma occurred in patients between 20 and 60 years of age. There was an annual increase in incidence during the study period. A total of 64,630 patients (78.13%) had a definitive cause, with motor vehicle accidents identified as the leading etiological factor (33.61%), followed by high falls (31.25%) and trivial falls (23.23%). Lumbar spine was most frequently involved (56.09%), followed by thoracic spine (23.77%), cervical spine (17.75%), and sacrococcygeal vertebrae (2.39%). Fracture-dislocation occurred most frequently in the cervical and lumbar spines, whereas spinal cord injury occurred most frequently in the cervical and thoracic spines. Children younger than 10 years of age were prone to cervical spine injury, whereas adults older than 60 years were more prone to osteoporotic thoracic and lumbar fractures. Overall rate of conservative treatment (55.88%) was higher than that of operative treatment (44.12%). Overall combined cure and improvement rates exceeded 90%. The male mortality rate was twice that of the female population. Lumbar spine injury was the most curable, whereas cervical spine injury was associated with the worst prognosis and the highest medical costs. Conclusion. This is the first large-scale epidemiological study of spinal injury in Mainland China. The results obtained have important implications for future public health care planning, public safety, and resource allocation.

The epidemiology of civilian inpatients’ burns in Chinese military hospitals, 2001–2007

BACKGROUNDnIn China, large sample research directed at the epidemiology of burns is still scarce. Given the leading position of Chinese military hospitals in domestic clinical practice pertaining to burns, a look into their cases would help shed light on the incidence and hospital care of burns in China today.nnnMETHODSnData were collected from information systems of all the Chinese military hospitals, for the years 2001-2007 inclusive. Retrospective analyses on the epidemiology characteristics of burns from those in patients admitted to all the Chinese military hospitals within this period were conducted.nnnRESULTSnA total of 172,256 cases were studied, with a total number of 1384 fatalities, and the median length of hospital stay (LOS) 11.00 days (interquartile range 6.00-19.00 days). Rate of burn incidence remained high in May, June, July and August. Children of preschool aged and adults in the labor force were at the highest risk of injury. Scalds constituted the majority of injuries (80.5%). Multiple body site burns are the most commonly seen category (31.98%) in terms of injured body region distribution. In fire-related burns, major burns (TBSA>30%) represented a significant proportion. Males with TBSA>30%, fire-related burns resulted in the greatest number of fatalities. Gender, age, site of injury, burn size and outcome are all correlated with the length of hospitalization.nnnCONCLUSIONnAlthough this paper cannot provide information on population estimates of burns due to the absence of data on burns attending civilian hospitals, it finds that the epidemiology of burns in China shows distinct characteristics compared with previous studies of other country and regions, including that of other developing or low and middle-income countries (LMICs), irrespective of Chinas inclusion in that group.

Motorcycle accidents in China

OBJECTIVEnTo analyze the characteristics and causes of motorcycle accidents in China from 2000 to 2005.nnnMETHODSnWe collected data on possession of motorcycles and automobiles, number of traffic crashes, casualty and economic loss from 2000-2005 Statistic Annual Report of Traffic Management Bureau, Ministry of Public Security of China. The data was processed statistically by SPSS 11.0 software package.nnnRESULTSnDuring 6 years, the number of motorcycle accidents were up to 122,300 in 2003, which was the highest, and then gradually decreased. However, the casualty had the tendency of consistent increase, for example, the motorcycle accidents resulted in 26,200 deaths and 157,500 injuries in 2005. The mortality per 10, 000 motorcycles and the ratio of deaths to injuries were lower than those of automobiles, but the mortality per 100 motorcycle accidents was significantly higher than that of automobiles (P less than 0.01).nnnCONCLUSIONSnChina has attached great importance to the management of traffic safety, which is beneficial to control and reduce traffic accidents in recent years. However, the casualty keeps increasing annually. Therefore, it is urgent to strengthen the management of motorcycles, promote the education of motorcyclists, take effective traffic measures and improve the first-aid system of traffic injuries.

Intra-hepatic expression of scavenger receptor and CD14 and their relationship with local inflammatory responses in endotoxemia in mice.

Our objective was to investigate the expression of scavenger receptor (SR) and CD14 in the liver and their relationship with local anti-inflammatory and proinflammatory responses in endotoxemia in order to uncover the mechanism for the liver to turn into effector organ from defense one at the level of cell receptors in sepsis. Mouse models of endotoxemia of different severity were reproduced by injection of different doses of lipopolysaccharide (LPS) via tail vein. Expression of SR and CD14 in the liver was assayed by immunohistochemistry and was then analyzed with an image analysis system. The levels of TNFalpha, IL-6, IL-4, and IL-10 in liver tissue were determined with ELISA. Expression of SR in the liver in the high-dose group was markedly decreased 1 h after injection of LPS, and also in low- and medium-dose groups at 3 h. The expression of SR in the liver in the three groups was shown to be progressively decreased with the time prolonged. There was significant difference in average optical density (OD) values of SR among the three groups. The expression of CD14 in the liver in the three groups was shown to be significantly increased 1 h after injection of LPS, and much more with the time prolonged. But there was no significant difference in OD values of CD14 among the three groups. The contents of intrahepatic proinflammatory mediators TNFalpha and IL-6 and anti-inflammatory mediators IL-4 and IL-10 were successively significantly increased after injection of LPS. The release of anti-inflammatory mediators was shown to be later than that of proinflammatory mediators. Correlation analysis indicated that there was negative correlation between expression of SR and CD14, and that changes of TNFalpha, IL-6, IL-4, and IL-10 levels in liver tissues were correlated significantly positively with OD values of CD14 and negatively with OD values of SR. Expression of SR in the liver was shown to be progressively decreased, and that of CD14 increased in endotoxemia, which was closely related to the uncontrolled inflammatory response in liver. This might be an important mechanism for the liver to turn into effector organ from defense one in sepsis.

Pediatric burns in military hospitals of China from 2001 to 2007: A retrospective study

BACKGROUNDnChildhood burns are a global health problem. To date, no epidemiological study with a large sample size of hospitalized pediatric burn patients from the Chinese mainland has been conducted. This study retrospectively analyzed pediatric burn cases to identify the characteristics of pediatric burns and their risk factors in China.nnnMETHODSnData for pediatric burn inpatients younger than 14 years were retrieved from the Chinese Trauma Databank (CTDB). The epidemiological characteristics of pediatric burns and risk factors for mortality were analyzed.nnnRESULTSnA total of 61,068 cases were included in the study. Children under 3 years old were at the highest risk of injury. Scalds were the commonest burns (87.59%). Flame burns occurred more in winter, and electrical burns occurred mainly in July and August. Age, etiology, depth of injury, total body surface area (TBSA), site of injury, and outcome were correlated with length of hospital stay. Risk factors for pediatric burn mortality included being male, having third degree burns, ≥30% TBSA, and having multi-site burns.nnnCONCLUSIONnThe results showed the epidemiological characteristics of pediatric burns in China, which differ from those reported for other countries and regions. These characteristics can be used to develop measures to prevent pediatric burns.

Chinese traffic fatalities and injuries in police reports, hospital records, and in-depth records from one city

Objectives: Claims of sharp reductions in Chinese traffic casualties after 2002 based on police-reported data have been questioned in the literature. The objective of this study is to determine whether a decline in casualties occurred and to better understand the police data. Methods: The first of 2 unrelated studies analyzed data from 210 military hospitals throughout China providing records for inpatients injured in traffic accidents (2001–2007). The second compared in-depth crash records (2000–2006) from one city to officially released data. Results: Hospital data showed that casualties increased from 2002 to 2007. The city investigation showed consistently far more fatalities and injuries in the in-depth data than officially released. For example, in-depth data showed 1,720 fatalities. Only 557 of these were reported officially (data loss = 68%). Disaggregating into 3 regions showed a data loss of 41% in urban areas, 63% in rural areas, and 90% in rural–urban fringe zones. For injuries, data losses were even greater. Conclusions: Traffic fatalities and injuries did not decrease from 2002 to 2006. The in-depth city data contained 3 times as many fatalities and 5 times as many injuries as reported by police. Reasons why this occurred and suggestions to improve data collection and reduce casualties are given.

Lipopolysaccharide upregulates the expression of corticotropin-releasing hormone via MAP kinase pathway in rat peritoneal macrophages

The stress neuropeptide, corticotropin-releasing hormone (CRH) is expressed in peripheral tissues and inflammatory sites and is implicated in the modulation of the inflammatory response in a paracrine/ autocrine manner. However, the mechanisms by which CRH expression is regulated in peripheral immune cells are unclear. In this article, we address this question by employing primary rat peritoneal macrophages treated with lipopolysaccharide (LPS). Our results showed that CRH could be detected at the mRNA and protein levels in normal peritoneal macrophages and the levels increased significantly and reached a peak at 4xa0h after stimulation with 100xa0ng/ml LPS. Furthermore, LPS-induced CRH expression was inhibited by pretreatment with PD98059, a specific MAP kinase inhibitor, in a dose-dependent fashion in which the mRNA and protein levels of CRH was decreased by 90% and 95%, respectively. In addition, pretreatment with 50xa0μM SB203580, a p38 MAPK inhibitor, led to the decrease of CRH mRNA level by about 41%. Altogether, these results demonstrate that LPS significantly upregulates CRH expression through MAP kinase signaling pathway in rat peritoneal macrophages.

High-dose glucocorticoids induce decreases calcium in hypothalamus neurons via plasma membrane Ca2+ pumps

In our previous studies, we occasionally found that high-dose glucocorticoids (GC) induced decrease in [Ca2+]i in hypothalamus neurons. In previous articles, modulation of Ca2+ channels by GC has been shown to contribute to the elementary regulation of several neuronal functions. However, little is known about the regulation of the Ca2+ efflux pathways that counterbalance the Ca2+ influx in neurons caused by high-dose GC. In this study, we demonstrate that a high-dose of GC (10–6 M dexamethasone) caused a 20% decrease in [Ca2+]i within 2 s in cultured hypothalamic neurons; furthermore, we show that an antagonist of the GC receptor blocks this action. To ascertain the temporal sequence of relevant calcium transport mechanisms we selectively blocked the main calcium transporters, including sodium/calcium exchanger (NCX), plasma membrane calcium pumps (PMCA), and P-type Ca2+-ATPases of the sarcoplasmic reticulum (SERCA). The GC-induced [Ca2+]i decrease disappeared completely when PMCA was blocked, but not when NCX and SERCA were blocked. These results suggest that high-dose GC (10–6 M) rapidly decreases [Ca2+]i by activating PMCA but not NCX or SERCA.

Road Crash in China from 2003 to 2005

OBJECTIVEnTo analyze characteristics and causes of road crash and injuries in China from 2003 to 2005.nnnMETHODSnThe data of road crash in 2003-2005 were collected to study the characteristics including total vehicle number, occurrence rates of traffic accidents and serious traffic accidents so as to discuss the causes and characteristics of road crash in China.nnnRESULTSnFrom 2003 to 2005, the numbers of traffic accidents, injuries and deaths as well as the mortality rates per 100,000 persons and per 10,000 vehicles declined in China. Until 2005, the total number of traffic accidents decreased to 450,000 and deaths to 99,000, with the mortality rate per 10,000 vehicles being 7.6 persons. While the drivers and passengers accounted for 33.2% and 26.6% of death casualties respectively in 2005. Most traffic accidents were caused by drivers, especially those with driving experience less than 3 years. Traffic accidents occurred on suburban roads accounted for 60%. The mortality rate of the traffic accidents per 100 km on the first grade road ranked the highest. The mortality rate of the traffic accidents on expressways ranked the highest, with continual increase of death and injury.nnnCONCLUSIONSnAt present, the increase trend of traffic accidents and casualties in China has been slowed down to some extent and shows a declining tendency, but the situation is far away from being optimistic. In order to cut down the number of traffic accidents and casualties, we should pay more attention to training and managing drivers with less than three driving years and those driving buses. Strict prevention measures should be laid on traffic accidents on first grade roads, expressways and suburban roads as well as the enhancement on improving first-aid system.

Commentary: How Traffic Crashes Were Reduced in China–Experience and Difficulties

1. In 2007, even though the number of motor vehicles (MVs) increased by 100 percent compared to 2002, traffic crashes were reduced by 57.68 percent; crashes of MVs were reduced by 54.31 percent, and crashes involving pedestrians and passengers were reduced by 70.95 percent. 2. The death toll was reduced by 25.36 percent, in which the number of deaths from MV crashes was reduced by 9.91 percent, and those involving pedestrians and passengers was reduced the most, going up by 70.84 percent. 3. Road traffic injuries were reduced by 32.31 percent; injuries from MV crashes were reduced by 24.38 percent, and those involving pedestrians/passengers reduced the most, going up by 74.96 percent.