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For a significant percentage of subjects, with chronic traumatic brain injury (TBI), who report persisting cognitive impairment and functional loss, the diagnosis is often impeded by the fact that routine neuroimaging often does not reveal any abnormalities. In this paper, we used diffusion tensor imaging (DTI) to investigate the apparently normal white matter (as assessed by routine magnetic resonance imaging) in the brains of 19 subjects with sub-acute (9) and chronic (10) TBI. We also assessed memory, executive function, and visual-motor coordination in these subjects. Using a voxel-wise approach, we investigated if parameters of diffusion were significantly different between TBI subjects and 17 healthy controls (HC), who were demographically matched to the TBI group. We also investigated if changes in DTI parameters were associated with neuropsychological performance in either group. Our results indicate significantly increased mean and axial diffusivity (MD and AD, respectively) values in widespread brain locations in TBI subjects, while controlling for age, sex, and time since injury. HC performed significantly better than the TBI subjects on tests of memory and executive function, indicating the persisting functional loss in chronic TBI. We found no correlation between diffusion parameters and performance on test of executive function in either group. We found negative correlation between FA and composite memory scores, and positive correlation between RD and visuomotor coordination test scores, in various tracts in both groups. Our study suggests that changes in MD and AD can indicate persisting micro-structure abnormalities in normal-appearing white matter in the brains of subjects with chronic TBI. Our results also suggest that FA in major white matter tracts is correlated with memory in health and in disease, alike; larger and longitudinal studies are needed to discern potential differences in these correlations in the two groups.

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Injuries are the major cause of morbidity among children and one of the leading causes of death for children ages 1-17 years in developing countries. Of particular importance is whether child injuries are equally distributed across all socioeconomic groups and the implications of this question for child injury prevention, but there is a lack of research on the relationship between socioeconomic status and risk of child injuries in developing countries, including China. This study used a provincially-representative, population-based sample of 98,385 Chinese children under age 18 to investigate the relationships between socioeconomic status (SES) and child injuries. Despite the lack of a SES gradient in the overall incidence of nonhospitalized injuries, evidence of SES disparity was found for the overall incidence of H/PD injuries (injuries resulting in hospitalization or permanent disability) and fatal injuries. The odds of getting injured in the poorest wealth quintile were about 1.3 and 3.5 times greater than the odds found in the richest wealth quintile for H/PD and fatal injuries respectively. Further analyses showed that the associations between SES and injuries varied by type and severity of injury, and across different life stages. The findings have important implications for identifying at-risk populations and the optimal times for interventions to reduce different types and severity levels of child injuries.

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OBJECTIVE: This study evaluated the risk factors of incomplete thrombosis in the false lumen after thoracic endovascular aortic repair (TEVAR) in patients with extensive acute type B aortic dissection. METHODS: This was a retrospective study at Zhongda Hospital and Henan Provincial People's Hospital, China. Between January 2005 and May 2008, patients with acute type B dissection who underwent TEVAR at two centers were reviewed and 124 who met the following criteria were included in this study: (1) dissection involving the aorta below the level of the celiac artery, (2) completely patent false lumen at the time of intervention, and (3) complete initial diagnostic computed tomography (CT) scans and all follow-up CT scans available. Exclusion criteria were (1) aortic dissection secondary to trauma, (2) intramural hematoma, and (3) Marfan patients. The main outcome measures were demographics, comorbidity profiles, technical details of procedures, anatomic characteristics of dissection, and false lumen status of thrombosis during follow-up. Ordinal regression analysis was performed with variables that reached P < .20 on univariate analysis to investigate independent risk factors of incomplete thrombosis in the false lumen. RESULTS: Univariate analysis showed that the age at TEVAR, hypertension, maximum diameter of the abdominal aorta and false lumen at the abdominal level, re-entry tears, and visceral branches that arose partially or totally from the false lumen had a P < .20. Further analysis with an ordinal regression model showed that the visceral branches that arose partially or totally from the false lumen (odds ratio [OR], 10.054; P < .001), re-entry tears (OR, 30.661; P < .001), and maximum diameter of the false lumen on the abdominal aorta (OR, 1.265; P = .004) were the significant risk factors of incomplete thrombosis in the false lumen after TEVAR. CONCLUSIONS: Visceral branches that arose partially or totally from the false lumen, re-entry tears, and maximum diameter of the false lumen on the abdominal aorta were the risk factors of incomplete thrombosis in the false lumen after TEVAR in extensive acute type B dissection.

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OBJECTIVE: Road traffic injuries (RTIs) have become the leading cause of injury deaths in China. This article analyzed the trends in all crashes, nonfatal injuries, and fatalities from road traffic crashes from 1951 to 2008 and compared the crash frequency, crash severity, and crash patterns by provinces, types of road, and injured road users. METHODS: Road traffic crash data were obtained from the Bureau of Traffic Management at the Ministry of Public Security and National Bureau of Statistics of China. Descriptive statistical analyses were conducted. RESULTS: Over the past 5 decades, road traffic injuries have increased substantially in China. From 1951 to 2008, the total number of road traffic crashes, nonfatal injuries, and fatalities increased by 43-fold, 58-fold, and 85-fold, respectively. Linear regression suggested a significant decline of 30.1 percent (95% confidence interval [CI]: 24.8-35.3) in the mortality rate per 100,000 people during the period 2002 to 2008. From 2004 to 2008, road traffic crash mortality rate per 100,000 people varied greatly in China from the lowest of 3.0 in Henan in 2008 to the highest of 21.7 in Xizang in 2004. RTIs in China disproportionally affected the following populations: males, persons 21 to 50 years of age, pedestrians, and motorcyclists/bicyclists. Adults aged more than 65 years accounted for approximately 10 percent of total road traffic deaths. Road types and RTIs severity were closely related; highways were associated with greater mortality rates. CONCLUSION: Road traffic injuries have become a burgeoning public health problem in China. Programs need to be developed to prevent nonfatal injuries and fatalities caused by road traffic crashes in this emerging country.

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BACKGROUND: Pesticide poisoning is an important health problem among Chinese farm workers, but there is a paucity of pesticide poisoning data from China. Using the WHO standard case definition of a possible acute pesticide poisoning, we investigated the prevalence and risk factors of acute work-related pesticide poisoning among farmers in Southern China. METHODS: A stratified sample of 910 pesticide applicators from two villages in southern China participated in face-to-face interviews. Respondents who self-reported having two or more of a list of sixty-six symptoms within 24 hours after pesticide application were categorized as having suffered acute pesticide poisoning. The association between the composite behavioral risk score and pesticide poisoning were assessed in a multivariate logistic model. RESULTS: A total of 80 (8.8%) pesticide applicators reported an acute work-related pesticide poisoning. The most frequent symptoms among applicators were dermal (11.6%) and nervous system (10.7%) symptoms. Poisoning was more common among women, farmers in poor areas, and applicators without safety training (all p < 0.001). After controlling for gender, age, education, geographic area and the behavioral risk score, farmers without safety training had an adjusted odds ratio of 3.22 (95% CI: 1.86-5.60). The likelihood of acute pesticide poisoning was also significantly associated with number of exposure risk behaviors. A significant "dose-response" relationship between composite behavioral risk scores calculated from 9 pesticides exposure risk behaviors and the log odds of pesticide poisoning prevalence was seen among these Chinese farmers (R2 = 0.9246). CONCLUSIONS: This study found that 8.8% of Chinese pesticide applicators suffered acute pesticide poisoning and suggests that pesticide safety training, safe application methods, and precautionary behavioral measures could be effective in reducing the risk of pesticide poisoning.

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OBJECTIVE: To understand the relationship between childhood non-intentional injury and socio-economic status (SES) in Jiangxi province. METHODS: Nearly 100 000 households were selected by PPS sampling method, in Jiangxi province. All children aged 0 - 17 years in selected households were surveyed using an 'injury questionnaire'. SES was calculated under the World Bank method. RESULTS: 98 335 children were surveyed and the identified number of non-intentional injury cases was 5429 and with 52 fatal cases. The morbidity was 5.52% and mortality was 52.88/100 000. The mortality of children with higher SES was lower than that of other groups but without statistical significance. The morbidity of moderate injury increased with the increasing SES, also without statistical significance. However, the morbidity of severe injury in male children decreased with the increasing SES. Rates of moderate injury morbidities of fall and road traffic injury also increased with the increasing SES. Moderate injury morbidity caused by animals decreased with the increasing SES. Severe injury morbidity of fall decreased with the increasing SES. CONCLUSION: The morbidity of injury in children was affected by the SES and the relationship between injury and SES varied along with the results of different types of injuries.

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OBJECTIVE: To explore the morbidity, mortality, and disease burden of traffic injury in children aged 0-17 years so as to develop a related strategy on prevention. METHODS: 100,000 households were selected by PPS sampling method in Jiangxi province. All children aged 0-17 years in selected households were interviewed by trained interviewers using a standardized 'traffic injury questionnaire'. RESULTS: The overall mortality and fatality rates of traffic injury were 10.17/100,000 and 1.36% respectively while the traffic injury morbidity in children of 0-17 years old was 7.40 per thousand. Morbidity in males was 8.29 per thousand compared to 6.26 per thousand in females. Severe cases accounted for 1.79 per thousand of the total but those living in urban area appeared to be 0.93 per thousand compared to 1.88 per thousand in the rural area, with statistical significance. Pedestrian and cyclists related injuries accounted for 80.48% of all the injured children. The average medical cost per case was 1369.57 Yuan with an average of 3.63 days of hospitalization. The average days of missing school/working was 8.79. CONCLUSION: The morbidity and mortality among male children were higher than those among female children. The morbidity of severe traffic injury cases in children living in rural area was higher than that of children living in urban area. The disease burden of traffic injury in Jiangxi province was heavy and the development of relative intervention strategy seemed urgent in Jiangxi province.

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OBJECTIVE: To explore the morbidity, burdens caused and risk factors of injuries among children and to provide information for policy making on prevention. METHODS: By PPS sampling method, we selected 28 000 households in Beijing and using a questionnaire developed by UNICEF, TASC and China CDC. RESULTS: The morbidity of child injury in Beijing was 2.25%, higher than that of adults (1.56%) with 6-9 year group the highest (2.83% ). The morbidity of boys was 3.04% higher than that of girls (1.37%). Among the 7 death cases, 3 were caused by injury(2 RTA, 1 drowning). The three leading causes of injuries were fall, animal bite and road traffic accident in children. Among children aged 0-5 years, fall, animal and burn/machine injuries were the leading causes. Among children aged 0-5 years, the leading causes were hurt by animals, fall and RTA with the leading causes as fall, sprain and RTA. The average medical cost of injury cases was 1617.57 Yuan. There were 3500 children (injured orphan) whose parents were injured leading to death or disability in Beijing in 2003. CONCLUSION: Injury was the leading cause of child deaths in Beijing with children of 6-9 years old having the highest morbidity with RTA the most severe type of injuries in Beijing which affects both children and their parents.

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OBJECTIVE: To understand the changing trend on the way of delivery since 1970s and its related factors that influencing the attitude of choice on Cesarean section (C-section) in women at child-bearing age. METHODS: A face-to-face interview was conducted anonymously in pregnant and lying-in women visited at the out-patient department of Gynecology and Obstetrics, Tiantan Hospital of Beijing. Totally, 415 women at child-bearing age, with a history of previous birth were interviewed on date, place and way of delivery of last birth, as well as on information that could have had impact on the choice of C-section. RESULTS: The average rate of C-section in Tiantan Hospital had been 29% since the year of 2000, much higher than that during 1970s, 1980s and 1990s (chi(2) = 22.81, P = 0.001) which showed an increasing trend. Rate of C-section among lying-in women with native Beijing origin was 25.0%, significantly higher than 9.6% (chi(2) = 21.96, P = 0.000 002) that in the migrants. Lying-in women with education level of high school or above had higher chance to choose C-section than those with lower level of education (chi(2) = 43.64, P < 0.000 01). Workers, managerial staff or clerks had more chance to choose C-section than those with other occupations (chi(2) = 20.07, P = 0.01). As reported by the interviewees, 93% (70/75) of C-section in the hospital were performed and recommended by obstetricians. CONCLUSION: Rate of C-section in the hospital showed an increasing trend which suggested that intervention with health education be carried out for both pregnant women and obstetricians.

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