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Traffic Injury Prevention Feb 2018The research objective was to quantify the influence of child restraint lower attachment method on head kinematics, head impact potential, and head, neck, and thorax...
OBJECTIVE
The research objective was to quantify the influence of child restraint lower attachment method on head kinematics, head impact potential, and head, neck, and thorax injury metrics for a child occupant secured in a forward-facing child restraint system (FFCRS) in oblique side impacts.
METHODS
Fifteen sled tests were conducted with a Q3s seated in an FFCRS secured to the center position on a production small SUV bench seat. Three lower attachment methods were evaluated: rigid ISOFIX, a flexible single loop lower anchors and tethers for children (LATCH) webbing routed through the vehicle belt path of the FFCRS, and dual flexible LATCH webbing attachments on either side of the FFCRS. All were tested with and without a tether with one repeat test in each test condition. The same model FFCRS was used for all tests; only the attachment method varied. The vehicle bench seat was fixed on the sled carriage at 80° (from full frontal). The input pulse was the proposed FMVSS 213 side impact pulse scaled to a 35 km/h delta-v. Two-way analysis of variance (ANOVA) was used to evaluate the effect of lower attachment and tether use on 3 outcome metrics: lateral head excursion, neck tension, and neck lateral bending. Data included anthropomorphic test dummy (ATD) head excursions, head linear accelerations and angular velocities, neck loads and moments, thoracic accelerations, lateral chest deflections, lower anchor loads, and tether webbing loads. ATD head kinematics were collected from 3-dimensional motion capture cameras.
RESULTS
Results demonstrated a reduction in injury measures with the rigid ISOFIX and dual webbing attachment compared to the single webbing attachment with decreased lateral head excursions (331, 356, and 441 mm for the rigid ISOFIX, dual webbing, and single webbing systems, respectively, P <.0001), neck tension (1.4, 1.6, and 2.2 kN, P <.01), and neck lateral bending (31.8, 38.7, and 38.0 Nm, P =.002). The tether had a greater influence on lateral head excursion for the FFCRS with flexible webbing attachments than those with the rigid attachment, with the tether forces being highest with the single webbing attachment. Lateral head excursions were significantly lower and lateral neck bending moments were significantly higher with tether use (P <.0001) across all lower attachments. The effect of tether on neck tension was mixed, only showing an increased effect with the rigid ISOFIX system.
CONCLUSION
The CRS lower attachment system influenced occupant kinetics. The results indicate that CRS attached to the vehicle via rigid and dual webbing systems exhibit improved kinematics by reducing the rotation and tipping seen with the single webbing attachment. This leads to reduced lateral head excursions and neck tension values. The advantages of the tether in reducing lateral head excursion in side impacts are most pronounced with the flexible webbing attachments. With tether use low in the United States, a dual webbing type FFCRS attachment system may be a better attachment method than single webbing and provide a simpler engineering solution than rigid ISOFIX attachment.
Topics: Accidents, Traffic; Biomechanical Phenomena; Child; Child Restraint Systems; Craniocerebral Trauma; Equipment Design; Head; Humans; Manikins; Neck; Neck Injuries; Posture; Thoracic Injuries; Thorax; Weight-Bearing
PubMed: 29584498
DOI: 10.1080/15389588.2017.1369532 -
The Journal of Craniofacial Surgery Jun 2017Webbed neck deformity (WND) can have significant functional and psychosocial impact on the developing child. Surgical correction can be challenging depending on the...
Improving Functional and Aesthetic Outcomes in Syndromic Patients With Webbed Neck Deformity: Utilizing a Staged Endoscopic-Assisted Approach to Improve the Posterior Hairline and Decrease Scar Burden.
INTRODUCTION
Webbed neck deformity (WND) can have significant functional and psychosocial impact on the developing child. Surgical correction can be challenging depending on the extent of the deformity, and patients often also have low posterior hairlines requiring simultaneous correction. Current surgical techniques include various methods of single-stage radical excision that often result in visible scar burden and residual deformity. There is currently no general consensus of which technique provides the best outcomes.
METHODS
A modified approach to WND was designed by the senior author aimed to decrease scar burden. Endoscopic-assisted fasciectomy was performed with simultaneous posterior hairline reconstruction with local tissue rearrangement camouflaged within the hair-bearing scalp. Staged surgical correction was planned rather than correction in a single operation. A retrospective review was performed to evaluate all patients who underwent this approach over a 2-year period.
RESULTS
Two patients underwent the modified approach, a 17-year-old female with Noonan syndrome and a 2-year-old female with Turner syndrome. Both patients showed postoperative improvement in range of motion, contour of the jaw and neckline, and posterior hairline definition. Patients were found to have decreased scar burden compared with traditional techniques.
DISCUSSION
A staged, combination approach of endoscopic-assisted fasciectomy and strategic local tissue reconstruction of the posterior hairline to correct WND achieves good functional and aesthetic results and good patient satisfaction. This modification should be considered when managing WND.
Topics: Adolescent; Child, Preschool; Endoscopy; Fasciotomy; Female; Humans; Neck; Noonan Syndrome; Range of Motion, Articular; Retrospective Studies; Scalp; Skin Abnormalities; Turner Syndrome
PubMed: 28207470
DOI: 10.1097/SCS.0000000000003531 -
Clinical Case Reports Jul 2023Lethal multiple pterygium syndrome is a very rare genetic disorder. The manifestations of this condition include growth deficiency of the fetus, craniofacial anomalies,...
Lethal multiple pterygium syndrome is a very rare genetic disorder. The manifestations of this condition include growth deficiency of the fetus, craniofacial anomalies, joint contracture, and skin webbing (pterygia). This disorder is fatal before birth or shortly after birth. We reported a case of lethal multiple pterygium syndrome with multiple anomalies including pterygia involving the axilla, bilateral antecubital fossa, and groin. Arthrogryposis involving multiple lower and upper extremities joints. Cleft palate, microstomia and limitation of mouth opening, webbed neck, asymmetric small and narrow chest, ambiguous genitalia, depressed and wide nasal bridge, antemongoloid slant, low-set, malformed, and posteriorly rotated ears, pterygia, syndactyly and camptodactyly of hands and rocket bottom feet. LMPS is a congenital genetic disease with multiple anomalies that is fatal in the second and third trimesters of pregnancy or shortly after birth. With genetic testing and counseling, it can be prevented from recurring in subsequent pregnancies.
PubMed: 37448946
DOI: 10.1002/ccr3.7678 -
Cureus Oct 2023Turner syndrome (TS) is a genetic anomaly that is characterized by the absence of an X chromosome, either completely or partially. Primary amenorrhea, short stature,...
Turner syndrome (TS) is a genetic anomaly that is characterized by the absence of an X chromosome, either completely or partially. Primary amenorrhea, short stature, webbed neck, cubitus valgus, and a little intellectual disability are some of the characteristics. Infertility is also one of the most common clinical symptoms of TS-affected females. With the advent of assisted reproductive technology (ART), chances of childbearing possibilities for TS females have risen. Infertility issues in females with TS are challenging, but they can be managed with proper counseling and ART by artificial implantation, oocyte donation, and others. This case report aims to present the case of a 27-year-old female who had not attained her menarche and wanted to conceive. She was diagnosed with TS on the basis of clinical and laboratory investigations. The patient was, thereafter, treated for infertility by oocyte donation and conceived successfully.
PubMed: 38022282
DOI: 10.7759/cureus.47172 -
Biomedical and Environmental Sciences :... Sep 2017This study investigated the role of long non-coding RNAs (lncRNAs) in the development of the palatal tissues. Cleft palates in mice were induced by...
This study investigated the role of long non-coding RNAs (lncRNAs) in the development of the palatal tissues. Cleft palates in mice were induced by 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Expression levels of long non-coding RNA H19 (lncRNA H19) and insulin-like growth factor 2 (IGF2) gene were measured by quantitative real-time polymerase chain reaction (qRT-PCR). The rate of occurrence of cleft palate was found to be 100% by TCDD exposure, and TCDD could cause short upper limb, cerebral fissure, webbed neck, and short neck. The expression levels of lncRNA H19 and IGF2 gene specifically showed embryo age-related differences on E13, E14, and E15 in the palatal tissues. The expression levels of lncRNA H19 and IGF2 gene showed an inverse relationship on E13, E14, and E15. These findings demonstrated that lncRNA H19 and IGF2 can mediate the development of mouse cleft palate.
Topics: Animals; Cleft Palate; Female; Gene Expression Regulation; Gene Expression Regulation, Developmental; Male; Mice; Mice, Inbred C57BL; Palate; Polychlorinated Dibenzodioxins; RNA, Long Noncoding; Real-Time Polymerase Chain Reaction
PubMed: 29081343
DOI: 10.3967/bes2017.090 -
Journal of Cutaneous Medicine and... 2018Erythema multiforme (EM) is a mucocutaneous disease most often associated with preceding herpes simplex virus or Mycoplasma pneumoniae infection. It is characterized by... (Review)
Review
BACKGROUND
Erythema multiforme (EM) is a mucocutaneous disease most often associated with preceding herpes simplex virus or Mycoplasma pneumoniae infection. It is characterized by targetoid lesions occurring on the limbs and head and neck. Mucosal involvement can be extensive.
OBJECTIVE
We report a case of lip adhesion as a complication of EM in a child who required corrective surgery and review similar oral commissure complications.
METHODS
We completed a review of the literature for similar cases using PubMed and Medline.
CONCLUSIONS AND RELEVANCE
We present the youngest report of lip adhesion due to striking mucositis related to EM. Sequelae of erythema multiforme can be significant, in our case requiring surgery. Meticulous oral hygiene should be encouraged when mucosal lesions are identified.
Topics: Adolescent; Child; Erythema Multiforme; Female; Humans; Lip; Male; Mycoplasma pneumoniae; Pneumonia, Mycoplasma
PubMed: 29463113
DOI: 10.1177/1203475418761038 -
Traffic Injury Prevention 2019The study aimed to evaluate the protection offered by a center-mounted airbag in far-side impacts using the Test device for Human Occupant Restraint (THOR)...
The study aimed to evaluate the protection offered by a center-mounted airbag in far-side impacts using the Test device for Human Occupant Restraint (THOR) anthropometric test device (ATD). A rigid buck was designed based on a production vehicle. The buck consisted of a rigid seat, center console, dash, and far-side door structure. The center console and dash were covered with paper honeycomb (152 kPa), and the far-side door structure was covered with Ethafoam 220 padding material. The airbag was mounted on the seat, to the right of the occupant. The THOR-M50 ATD was positioned according to the standard seating procedure and restrained using a standard 3-point seat belt with a pretensioner and retractor. The buck was mounted on an acceleration sled in 2 orientations. Four tests at 45° (oblique) and 2 tests at 90° (lateral) orientations were conducted. Tests were performed with and without an airbag at 30 km/h delta-V and 14 acceleration. The head accelerations, neck forces and moments, thoracic accelerations and forces, pelvis accelerations, anterior superior iliac spine (ASIS) forces and moments, and belt webbing loads were obtained from sensors, and the external kinematics was obtained using an optical motion capture system and high-speed digital cameras. With the center-mounted airbag, in 90° and 45° tests, reductions were observed for the following parameters: head lateral excursions by 6% and 11%, head vertical excursions by 19% and 26%, and peak head resultant accelerations by 36% and 11%. Other regional accelerations, forces, and moments were also reduced for both impact angles. A reduction in seat belt forces with the airbag was observed in 90° tests. The center-mounted airbag reduced the ATD excursions and accelerations in the 45° and 90° tests, thus reducing the risk of injury due to contact with the intruding structure. The results of this study may assist in designing countermeasures for vehicles in far-side impact.
Topics: Acceleration; Accidents, Traffic; Air Bags; Biomechanical Phenomena; Equipment Design; Head; Humans; Manikins; Seat Belts; Wounds and Injuries
PubMed: 31567026
DOI: 10.1080/15389588.2019.1650266 -
Genetic Counseling (Geneva, Switzerland) 2015Turner syndrome (TS) is a sex chromosome abnormality with a frequency of 1/2,000-3,000 among female live births. Characteristic findings are short stature and gonadal...
Turner syndrome (TS) is a sex chromosome abnormality with a frequency of 1/2,000-3,000 among female live births. Characteristic findings are short stature and gonadal dysgenesis. Short and webbed neck, low posterior hairline, broad chest, widespread nipples, cubitus valgus, short 4th and 5th metacarpals, multiple pigmented nevi, primary amenorrhea, lack of secondary sexual characteristics, cardiovascular and renal anomalies are the most common presentations. Most of the cases are infertile. Spontaneous pregnancy is unusual and the risk for congenital anomaly, spontaneous abortion, stillbirth and aneuploidy is increased. Fifty percent of the patients have classical monosomy X (45,X). However mosaicism of 45,X/47,XXX is rare and accounts for 1.7% of the TS cases. Some cases may not reflect the characteristic phenotype. Some cases with normal height, normal menstrual cyclus and fertility have been defined before. The case we present herein is a 26 years old woman who was admitted to our clinic due to recurrent pregnancy loss. In her medical history she had type 1 diabetes mellitus and endometrium cancer, in her family history her mother had recurrent pregnancy loss. The patient's first, third, fourth, fifth and sixth pregnancies had resulted in spontaneous abortions in the first trimester. She had a healthy daughter with 46,XX karyotype from her second pregnancy. A 45,X[8]/47,XXX[12] karyotype was detected by conventional cytogenetic analysis of the patient who did not have dysmorphic findings. The mosaicism was confirmed by FISH analysis with CEP X probe. Of the 100 cells evaluated, 65 of them had 3 signals of X chromosome while 35 had 1 signal. We present the case because of its scarcity in the literature.
Topics: Adult; Chromosomes, Human, X; Female; Fertility; Humans; Mosaicism; Sex Chromosome Aberrations; Sex Chromosome Disorders of Sex Development; Trisomy; Turner Syndrome
PubMed: 26043504
DOI: No ID Found -
American Journal of Medical Genetics.... Jun 2020KBG syndrome is an intellectual disability (ID) associated with multiple congenital anomalies in which the macrodontia could be the clue for the diagnosis. It is caused...
KBG syndrome is an intellectual disability (ID) associated with multiple congenital anomalies in which the macrodontia could be the clue for the diagnosis. It is caused either by heterozygous variant in ANKRD11 gene or 16q24.3 microdeletions that involve the ANKRD11 gene. Here, we report on two unrelated male patients who presented with ID, short stature, webbing of neck, and cryptorchidism. Noonan syndrome was suspected first but the presence of macrodontia in both patients pointed to KBG syndrome which was confirmed thereafter by the identification of a novel pathogenic variant in ANKRD11 gene, c.5488G>T (p.E1830*). Macrodontia was noticed in all the deciduous anterior teeth in Patient 1. This observation was reported previously in few patients, but it seems to be a common feature that could be misdiagnosed as premature eruption of teeth. Therefore, our results confirm that maxillary permanent central incisors may not be the only teeth affected in KBG but also all the deciduous teeth. Interestingly, desquamative gingivitis was additionally noted in Patient 1, which has not been reported previously, however; it could be a coincidental finding. To the best of our knowledge, this is the first report from Egypt.
Topics: Abnormalities, Multiple; Adolescent; Bone Diseases, Developmental; Child, Preschool; Chromosome Deletion; Comparative Genomic Hybridization; Cryptorchidism; Dwarfism; Egypt; Facies; Heterozygote; Humans; Intellectual Disability; Male; Phenotype; Repressor Proteins; Tooth Abnormalities
PubMed: 32222090
DOI: 10.1002/ajmg.a.61552 -
Facial Plastic Surgery & Aesthetic... 2024Present an excellent outcome for a rare pterygium colli reconstruction. Establish techniques that have yielded a successful aesthetic and functional outcome for a...
Present an excellent outcome for a rare pterygium colli reconstruction. Establish techniques that have yielded a successful aesthetic and functional outcome for a patient with pterygium colli in a procedure that lacks consensus. Surgical pearls-description of considerations for a successful reconstruction. An academic practice. Pediatric patient with Turner's syndrome who underwent neck and auricular reconstruction.
Topics: Humans; Child; Turner Syndrome; Pterygium; Neck; Face; Esthetics
PubMed: 38237133
DOI: 10.1089/fpsam.2023.0299