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Case of a fatal congenital transmesenteric hernia in infancy 一例致命的婴儿先天性跨肠管疝。
IF 1.3 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-12 DOI: 10.1016/j.legalmed.2024.102540
Veljko Milošević, Tijana Petrović, Irina Banjanin, Bojana Radnić, Milenko Bogdanović
We present a case of transmesenteric hernia resulting in the death of a 3-month-old female infant, the seventh such autopsy case reported so far. A three-month-old female infant, who initially presented with two episodes of vomiting, cramps, and constipation, was admitted to the hospital. She received symptomatic therapy and was released home. Immediately after she had been put to bed at home, she stopped breathing. There was no record of previous illnesses in the infant’s medical history. At autopsy, a necrotic segment of ileum and jejunum, length about 50 cm, was found herniated through an oval defect in the mesentery and multiply strangulated. The shock caused by small intestinal obstruction with consequent intestinal necrosis due to strangulation of the small intestine through a congenital mesenteric defect was considered to be the cause of death. In clinical practice, cases of transmesenteric hernias are uncommon, especially in the population of infants and toddlers; however, these can potentially be the cause of serious intestinal obstruction, with a high mortality rate in cases left untreated. Despite the low incidence of this condition, we believe that the clinicians should keep this diagnosis in mind as a potential cause of acute abdomen and pay special attention to revealing the cause of presented symptoms.
我们报告了一例导致一名 3 个月大女婴死亡的经肠管疝气病例,这是迄今为止报告的第七例此类尸检病例。一名三个月大的女婴最初因两次呕吐、痉挛和便秘而入院。她接受了对症治疗后出院回家。她在家中就寝后,立即停止了呼吸。在婴儿的病史中,没有以往患病的记录。尸检发现,一段长度约为 50 厘米的坏死回肠和空肠通过肠系膜上的椭圆形缺损疝出并多处绞窄。先天性肠系膜缺损导致的小肠梗阻引起的休克和随后的肠坏死被认为是死亡原因。在临床实践中,经肠系膜疝的病例并不常见,尤其是在婴幼儿群体中;然而,这些病例有可能导致严重的肠梗阻,如果不及时治疗,死亡率很高。尽管这种疾病的发病率很低,但我们认为临床医生应将其作为急腹症的潜在病因,并特别注意揭示引起症状的原因。
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引用次数: 0
Development of two step reverse transcription droplet digital PCR (RT-ddPCR) for simultaneous identification of saliva and semen 开发用于同时鉴定唾液和精液的两步逆转录液滴数字 PCR (RT-ddPCR)
IF 1.3 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-12 DOI: 10.1016/j.legalmed.2024.102536
So Eun Lee , Un Na Koh , Rita Fakhr , Si-Keun Lim
Determination of the type of body fluids is essential for crime scene reconstruction and for improving the reliability of expert testimonies. Messenger RNA (mRNA) analysis by reverse transcription quantitative PCR (RT-qPCR) has been used in forensic genetics, particularly for body fluid identification. It is a relative quantification method that compares the Ct values of target and reference gene. Thus, the method is unsuitable for determining exact copy numbers of the target gene. To address this limitation, this study performed body fluid-specific mRNA analysis using two-step reverse transcription droplet digital PCR (RT-ddPCR), which is capable of absolute quantification. We found that RT-ddPCR was accurate and sensitive enough to detect as little as 1.5 copies/μl of complementary DNA (cDNA), making it suitable for application using casework samples. It was also highly specific for body fluids, as non-specific amplification did not occur. In addition, saliva-semen mixtures with ratios ranging from 1:50 to 50:1 were successfully identified. When comparing the results of RT-qPCR and RT-ddPCR, some samples were difficult to interpret because of the high Ct values of RT-qPCR. However, when the same samples were analyzed using RT-ddPCR, saliva and semen were distinctly identified. Thus, RT-ddPCR is useful for mixed samples (e.g., in sexual assault cases) with low amounts of DNA, which often leads to ambiguous results when using RT-qPCR. Other body fluids (e.g., vaginal fluid and menstrual blood) can also be identified by including additional markers. This study demonstrates the potential of RT-ddPCR for applications in forensic science.
确定体液类型对于重建犯罪现场和提高专家证词的可靠性至关重要。通过反转录定量 PCR(RT-qPCR)分析信使 RNA(mRNA)已被用于法医遗传学,特别是体液鉴定。这是一种比较目标基因和参照基因 Ct 值的相对定量方法。因此,该方法不适合确定目标基因的确切拷贝数。为了解决这一局限性,本研究使用两步逆转录液滴数字 PCR(RT-ddPCR)进行了体液特异性 mRNA 分析,这种方法能够进行绝对定量。我们发现,RT-ddPCR 的准确性和灵敏度足以检测到低至 1.5 个拷贝/μl 的互补 DNA (cDNA),因此适合应用于病例样本。它对体液的特异性也很高,不会出现非特异性扩增。此外,比例从 1:50 到 50:1 的唾液-精液混合物也能成功鉴定。在比较 RT-qPCR 和 RT-ddPCR 的结果时,由于 RT-qPCR 的 Ct 值较高,有些样本难以解释。然而,当使用 RT-ddPCR 对相同样本进行分析时,唾液和精液被明显地识别出来。因此,RT-ddPCR 适用于 DNA 含量较低的混合样本(如性侵犯案件),而使用 RT-qPCR 时往往会导致结果模糊不清。其他体液(如阴道分泌物和月经血)也可以通过加入额外的标记物来进行鉴定。这项研究证明了 RT-ddPCR 在法医学领域的应用潜力。
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引用次数: 0
Anthropological and forensic significance of facial soft tissue thickness in Montenegrin population 黑山人面部软组织厚度的人类学和法医学意义
IF 1.3 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-10 DOI: 10.1016/j.legalmed.2024.102537
T. Tapuskovic , D. Nenezic , N. Radojevic , R. Dedeic
A lack of soft tissue leads to difficulties in facial reconstruction and further identification in the absence of DNA (deoxyribonucleic acid), finger print and dental data. If these data are not available, then identification based on facial soft tissue thickness (FSTT) is the next reliable method. There is no data in the literature about facial soft tissue thickness in Montenegrin population. Once the measurement is performed, a software algorithm based on the multidetector computerized tomography (MDCT) imaged bone structures and use of FSTT would be able to provide a useful picture of the face for identification purposes. This prospective research was performed by MDCT head examinations of 83 adults aged 18–85, living in Montenegro. The FSTT was measured at eight central points (glabella (GL), nasion (NA), rhinion (RHI), mid-philtrum (MID), upper lip (UL), lower lip (LL), mental eminence (ME), and the point beneath the chin (BC)), and five bilateral points (frontal tubers (FT), supraorbital (SO), external orbital marginal point (EX), zygomatic arch (ZY), and middle masseter (MST)). It was observed that the points RHI, MID, UL, LL, ME, FT, SO and MST are thicker in men compared to women. With an increase in BMI, FSTT in the central points also increases, as well as bilaterally at the ZY, FT, SO and MST points. With aging, there is an increase of the thickness of the FSTT at the RHI and bilaterally at the EX and ZY, while at the MID, LL and MST, the thickness decreases with aging, in both sexes.
在没有 DNA(脱氧核糖核酸)、指纹和牙齿数据的情况下,软组织的缺乏会导致面部重建和进一步鉴定的困难。如果没有这些数据,那么根据面部软组织厚度(FSTT)进行鉴定是下一个可靠的方法。文献中没有关于黑山人口面部软组织厚度的数据。一旦进行了测量,基于多载体计算机断层扫描(MDCT)成像骨骼结构的软件算法和 FSTT 的使用将能够为识别目的提供有用的面部图像。这项前瞻性研究是通过对居住在黑山的 83 名年龄在 18-85 岁之间的成年人进行 MDCT 头部检查来完成的。FSTT 在八个中心点(颧骨 (GL)、鼻翼 (NA)、鼻小柱 (RHI)、咽中线 (MID)、上唇 (UL)、下唇 (LL)、精神突起 (ME) 和颏下点 (BC))和五个双侧点(额管 (FT)、眶上 (SO)、眶外缘点 (EX)、颧弓 (ZY) 和中颌肌 (MST))进行测量。观察发现,与女性相比,男性的 RHI、MID、UL、LL、ME、FT、SO 和 MST 点较厚。随着体重指数的增加,中心点的 FSTT 也会增加,双侧 ZY、FT、SO 和 MST 点的 FSTT 也会增加。随着年龄的增长,RHI 点以及 EX 和 ZY 双侧的 FSTT 厚度增加,而 MID、LL 和 MST 点的厚度则随着年龄的增长而减少,男女均是如此。
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引用次数: 0
Decapitation by hanging: Insights from vertebral fractures 上吊斩首:脊椎骨折的启示
IF 1.3 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-10 DOI: 10.1016/j.legalmed.2024.102534
Anja Petaros
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引用次数: 0
Evaluating protective helmet efficacy in work-related accident: A forensic biomechanical analysis of concussion risk from falling objects 评估防护头盔在工伤事故中的功效:对高空坠物造成脑震荡风险的法医生物力学分析
IF 1.3 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-10 DOI: 10.1016/j.legalmed.2024.102535
Zdenek Horak , Petr Tichy , Miloslav Vilimek
This study investigates the risk of head injuries, specifically concussions, from falling objects in workplace accidents. A case study focuses on a construction worker who sustained a head injury despite wearing a protective helmet. Utilizing finite element (FE) analysis, the helmet-head system was modeled to assess impact forces and head accelerations. The helmet, made of High-Density Polyethylene with a 6-point suspension system, was tested against falling objects of 332 g and 665 g. Simulations, conducted from heights of 5 to 25 m, revealed that objects weighing as little as 332 g could cause severe concussions from a 10-meter fall. These findings demonstrate that helmets, while mitigating some impact, absorb significantly less energy than the kinetic energy of falling objects. The analyses carried out confirmed the worker’s statement that his injury was caused by a foreign object falling on his head, which was protected by a helmet.
本研究调查了工伤事故中物体坠落造成头部伤害(特别是脑震荡)的风险。案例研究的重点是一名建筑工人,尽管他戴着防护头盔,但头部仍然受伤。利用有限元(FE)分析,对安全帽-头部系统进行建模,以评估冲击力和头部加速度。该安全帽由高密度聚乙烯制成,配有 6 点悬挂系统,针对重量为 332 克和 665 克的坠落物体进行了测试。从 5 米至 25 米的高度进行的模拟显示,重量仅为 332 克的物体从 10 米高处坠落会造成严重脑震荡。这些研究结果表明,头盔虽然可以减轻一些冲击力,但其吸收的能量远远低于坠落物体的动能。分析结果证实了这名工人的说法,即他的受伤是由于有头盔保护的头部受到异物坠落造成的。
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引用次数: 0
Intraoral gunshot injury associated with soot in the deep airways 口内枪伤与深呼吸道烟灰有关
IF 1.3 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-10-09 DOI: 10.1016/j.legalmed.2024.102533
Markus Große Perdekamp , Dominik Schuldis , Angela Cornacchia , Katrin Mierdel , Stefan Pollak
In suicidal gunshots to the head, the oral cavity ranks among the preferred entrance sites. If the weapon’s muzzle end is located within the mouth, it is to be expected that the cartridge discharge residues are deposited on the buccal and palatal mucosa, the tongue and the pharynx, often in combination with tears of the lips due to the expanding combustion gases. Ensuing from the bullet entrance wound and any concomitant injuries, blood is released into the upper airways and subsequently aspirated into the lung periphery provided that respiration continues for at least a short time. Evidently, this impedes the detection of additional soot deposits in the trachea, bronchi and alveoli. Using the example of an intraoral gunshot with a revolver cal. 357 Magnum, the paper points out that in individual cases it may be possible to prove the presence of gunshot residues in the deep airways.
在头部自杀性枪击中,口腔是首选的入口部位之一。如果武器的枪口位于口腔内,预计弹壳排出的残留物会沉积在颊粘膜、腭粘膜、舌和咽部,通常还会因燃烧气体膨胀而导致嘴唇撕裂。子弹入口处的伤口和任何伴随的损伤都会导致血液排入上呼吸道,随后吸入肺部周围,前提是呼吸至少要持续很短的时间。显然,这阻碍了对气管、支气管和肺泡中其他烟尘沉积物的检测。论文以 357 口径马格南左轮手枪口内枪击为例,指出在个别情况下,有可能证明深呼吸道中存在枪击残留物。
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引用次数: 0
Relationship between fat embolism and endothelial glycocalyx 脂肪栓塞与内皮糖萼之间的关系
IF 1.3 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-26 DOI: 10.1016/j.legalmed.2024.102531
Rikimaru Kuwata
Fat embolism (FE) is acknowledged as one of the significant causes of sudden death following traumatic injury. To clarify the relevance of vascular endothelial glycocalyx (EGC) damage and FE, temporal changes in the mRNA levels of inflammatory cytokines associated with EGC components were investigated in an experimental fat embolization rat model. Nine-week-old rats were used as FE models through triolein injection (TO) and femoral fracture (FX), and physiological saline was administered to the control group. RT-qPCR and fat staining were performed. The target genes were Il6, Il10, Tnf, Elane, Sdc1, Sdcbp, Vcan, Hyal1, Fn1, and CD14. Notably, FE was detected in 100% and 5.6% of the TO and FX groups, respectively, using fat staining. Bimodal peaks in the mRNA expression levels of Sdc1, Tnf, Elane, IL6, and IL10 were observed 4 and 20 h after treatment in both groups. In the TO group, mRNA expression peaked at 4 h and then declined to the lowest level at 16 h. The incidence of fat emboli due to trauma was consistent with that reported in previous studies. Bimodal mRNA peaks may correspond to FE progression, in which physical obstructions are followed by biochemical reactions. The fluctuation in Sdc1 expression suggests that the initial peak resulted from physical EGC damage. The subsequent peak could be because of EGC damage caused by the secretion of inflammatory cytokines induced by oleic acid from lipid droplet decomposition. These results suggest that EGC disorders caused by lipid droplets may induce lung damage during FE.
脂肪栓塞(FE)被认为是创伤后猝死的重要原因之一。为了阐明血管内皮糖萼(EGC)损伤与脂肪栓塞的相关性,研究人员在实验性脂肪栓塞大鼠模型中调查了与EGC成分相关的炎性细胞因子mRNA水平的时间变化。将九周大的大鼠作为脂肪栓塞模型,通过注射三尖杉脂(TO)和股骨骨折(FX)进行治疗,对照组使用生理盐水。进行 RT-qPCR 和脂肪染色。靶基因为 Il6、Il10、Tnf、Elane、Sdc1、Sdcbp、Vcan、Hyal1、Fn1 和 CD14。值得注意的是,使用脂肪染色法,TO 组和 FX 组分别有 100% 和 5.6% 的人检测到 FE。两组患者在治疗后 4 和 20 h,Sdc1、Tnf、Elane、IL6 和 IL10 的 mRNA 表达水平均出现双峰。在 TO 组中,mRNA 表达在 4 h 达到峰值,然后在 16 h 下降到最低水平。mRNA 的双峰现象可能与 FE 的发展过程相对应,即物理障碍之后发生生化反应。Sdc1 表达的波动表明,最初的峰值是由 EGC 物理损伤引起的。随后的峰值可能是由于脂滴分解产生的油酸诱导炎症细胞因子分泌造成的EGC损伤。这些结果表明,脂滴引起的EGC紊乱可能会在FE期间诱发肺损伤。
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引用次数: 0
Post-mortem transmission risk of infectious disease: A systematic review 传染病的死后传播风险:系统综述。
IF 1.3 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-23 DOI: 10.1016/j.legalmed.2024.102530
L. Geoffray , L. Tuchtan , M-D. Piercecchi-Marti , C. Delteil

Introduction

Autopsies may expose to infectious risks. The objective of this study is to assess the risk of post-mortem transmission of HIV, HBV, HCV, Mycobacterium tuberculosis (MBT), SARS-CoV2 and prion in the workplace and to estimate the duration of their infectiousness.

Material and method

the PRISMA 2020 guideline was used. Pubmed, Web of Science, Google Scholar and Sciencedirect databases were assessed until February 28, 2023. We searched for articles in any language and any date of publication. Studies involving animals, transmission between two living people or transmission outside the workplace were excluded. Risk of bias was assessed using the appropriate assessment tools for each type of study. A descriptive analysis was performed.

Results

A total of 46 studies were included. Cases of post-mortem transmission were certain for HIV (n = 1) and MBT (n = 18). The longest post-mortem interval for positive diagnostic tests was 17 days for HIV, 60 for HBV, 7 for HCV, 36 for MBT and 17 for SARS-CoV2. The longest post-mortem interval for positive cultures was 21 h for HIV, 6 days for HBV, 36 days for MBT, 17 days for SARS-CoV2. The methodology of the studies was heterogeneous, some of them associated with a high risk of bias.

Conclusion

There is a lack of consistent data in the literature concerning the infectivity of cadavers, except for MBT. Legislation appears to be based on minimizing contact between the biological agent and the professional. In the absence of recent robust scientific data, workers should systematically follow the best practice recommendations.
介绍:尸体解剖可能面临传染风险。本研究的目的是评估工作场所死后传播 HIV、HBV、HCV、结核分枝杆菌(MBT)、SARS-CoV2 和朊病毒的风险,并估计其传染性的持续时间。对 Pubmed、Web of Science、Google Scholar 和 Sciencedirect 数据库进行了评估,直至 2023 年 2 月 28 日。我们搜索了任何语言、任何出版日期的文章。涉及动物、两个活人之间传播或工作场所以外传播的研究均被排除在外。针对每种类型的研究,我们使用适当的评估工具对偏倚风险进行了评估。对结果进行了描述性分析:共纳入 46 项研究。确定了艾滋病毒(1 例)和甲基溴(18 例)的死后传播病例。艾滋病毒、乙型肝炎病毒和丙型肝炎病毒的死后诊断检测呈阳性的最长间隔时间分别为 17 天、60 天、7 天、36 天和 17 天。艾滋病毒培养呈阳性的最长尸检间隔时间为 21 小时,乙型肝炎病毒为 6 天,甲基溴检测为 36 天,SARS-CoV2 为 17 天。这些研究的方法不尽相同,其中一些研究存在较高的偏倚风险:结论:文献中缺乏有关尸体感染性的一致数据,甲基溴灭菌法除外。立法似乎以尽量减少生物制剂与专业人员的接触为基础。在缺乏最新可靠科学数据的情况下,工作人员应系统地遵循最佳做法建议。
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引用次数: 0
Comparison of the accuracy and bias of Demirjian’s method for East Asian children and development of Japanese population-specific age estimation formulae 比较德米尔坚方法对东亚儿童的准确性和偏差以及日本特定人口年龄估算公式的制定情况
IF 1.3 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-14 DOI: 10.1016/j.legalmed.2024.102529
Sang-Seob Lee , Akiko Kumagai

Despite the increased global mobility owing to the development of the international community, there remains a need for population-specific methods to estimate children’s ages. Therefore, this study aimed to substantiate the necessity for a Japanese-specific age estimation method by contrasting the formerly reported age estimation accuracy and bias using Demirjian’s method for Chinese, Taiwanese, South Korean, and Japanese children. We analyzed 1,558 panoramic radiographs from Japanese children (777 boys and 781 girls), assessed the maturity of seven left permanent teeth using Demirjian’s criteria, and calculated the estimated age using Demirjian’s method. The accuracy of the estimated ages was compared with previous reports of children from other East Asian countries which used the same age estimation method. Chinese, Taiwanese, and South Korean boys and girls were all reported to be older than their chronological ages, with the Eastern and Northern Chinese regions being the only exceptions. The same was true for Japanese children: the estimated ages of both sexes tended to be higher than their chronological age. However, there were significant variations in the values, indicating the differences in tooth growth and development between East Asian countries and sexes. Therefore, new regression equations specific to the Japanese population were formulated, and their accuracy was evaluated as the final result of this study.

尽管随着国际社会的发展,全球流动性增加,但仍然需要针对特定人群的儿童年龄估计方法。因此,本研究旨在通过对比之前报道的使用 Demirjian 方法对中国、台湾、韩国和日本儿童进行年龄估计的准确性和偏差,来证实日本特定年龄估计方法的必要性。我们分析了 1,558 张日本儿童(777 名男孩和 781 名女孩)的全景照片,使用戴米尔鉴标准评估了七颗左恒牙的成熟度,并使用戴米尔鉴方法计算了估计年龄。估算年龄的准确性与之前其他东亚国家使用相同年龄估算方法的儿童报告进行了比较。据报告,中国、台湾和韩国的男孩和女孩的年龄都比他们的实际年龄大,只有中国东部和北部地区例外。日本儿童的情况也是如此:男女儿童的估计年龄往往高于他们的实际年龄。然而,这些数值之间存在着明显的差异,这表明东亚各国和男女儿童在牙齿生长发育方面存在着差异。因此,我们制定了专门针对日本人口的新回归方程,并对其准确性进行了评估,这是本研究的最终结果。
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引用次数: 0
Assessing head injury risks in electric scooter accidents: A multi-body simulation study with insights into sex differences 评估电动滑板车事故中的头部伤害风险:洞察性别差异的多体模拟研究
IF 1.3 4区 医学 Q3 MEDICINE, LEGAL Pub Date : 2024-09-12 DOI: 10.1016/j.legalmed.2024.102526
André Salgado , Daniel Wdowicz , Fábio Fernandes , Mariusz Ptak , Ricardo Alves de Sousa

E-scooters have become increasingly popular for short-distance travel in urban areas, but this rise in usage also brings about an increased risk of accidents. Studies have shown that approximately 40% of electric scooter accident victims admitted to hospitals suffer head injuries. Therefore, it is crucial to implement safety measures and improve safety systems and equipment to mitigate these risks. One approach to gaining insights into the injuries users face is through simulations using the multi-body method. This method allows for the reconstruction of accidents by modeling and analyzing the dynamic behavior of interconnected bodies. This study aims to assess the impacts on the user’s head and the injuries they may sustain in electric scooter accidents using numerical methods. Initially, a reference scenario was established based on a YouTube video, with the assumption that the user was an average-height man. Simulations were conducted for various percentiles, including both males and females. Different velocities were simulated to determine the threshold velocity at which survival becomes practically impossible. Two scenarios were considered: one where the car braked for 0.333 s and another where the distance between the start the braking task and the collision was kept constant. The location of the first head impact on the vehicle was also examined. Injury assessment was conducted using two criteria: Head Injury Criterion (HIC) and Brain Injury Criterion (BrIC). The study found that smaller individuals are more vulnerable to severe injuries, and higher car velocities correlate with more severe user injuries. Furthermore, the location of the first impact varies between genders, with women more likely to experience impacts in the lower part of the windshield, while men tend to experience impacts in the central zone. This study highlights the importance of considering user characteristics and accident dynamics in assessing injury risks associated with e-scooters.

电动滑板车在城市地区的短途旅行中越来越受欢迎,但使用率的上升也带来了事故风险的增加。研究表明,在入院治疗的电动代步车事故受害者中,约有 40% 的人头部受伤。因此,采取安全措施、改进安全系统和设备以降低这些风险至关重要。要深入了解用户面临的伤害,一种方法是使用多体方法进行模拟。这种方法可以通过模拟和分析相互连接的物体的动态行为来重建事故。本研究旨在使用数值方法评估电动滑板车事故对用户头部的影响以及可能造成的伤害。首先,根据 YouTube 视频建立了一个参考情景,假设使用者是一名身高中等的男性。针对不同的百分位数进行了模拟,包括男性和女性。模拟了不同的速度,以确定几乎不可能存活的阈值速度。模拟了两种情况:一种是汽车制动 0.333 秒,另一种是制动开始与碰撞之间的距离保持不变。此外,还考察了头部首次撞击车辆的位置。伤害评估采用两个标准进行:头部损伤标准(HIC)和脑损伤标准(BrIC)。研究发现,体型较小的人更容易受到严重伤害,而车速越高,使用者受到的伤害越严重。此外,第一次撞击的位置因性别而异,女性更容易在挡风玻璃下部受到撞击,而男性则倾向于在中央区域受到撞击。这项研究强调了在评估与电动摩托车相关的伤害风险时考虑用户特征和事故动态的重要性。
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引用次数: 0
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