One Size Doesn’t Fit All

Using real-world injuries to build safer cars

Human bodies come in all shapes and sizes, but crash test dummies used for vehicle safety tests are built to represent an “average” person. In real car crashes, human variation can mean the difference between walking away from a crash and a trip to the ER.

“Crash test dummies are designed to match the 50th-percentile male,” says Stewart C. Wang, M.D., Ph.D. — a trauma surgeon, Endowed Professor of Burn Surgery and director of the U-M International Center for Automotive Medicine. “Safety features work really well if you’re a 5-foot-10-inch, 170-pound male, but you’re not going to get the same protection if you’re a 300-pound linebacker or a 90-pound grandmother.”

Wang and his colleagues are creating a new research tool to bridge the gap between the data-driven world of automotive engineering and the all-too-human world of trauma medicine.

Using tens of thousands of information-rich computed tomography (CT) scans from crash victims and control subjects, they are building a three-dimensional encyclopedia of the human body — and what crashes do to it.

“It turns out that the categories medicine tends to use — age, gender, height, weight — still leave a lot of room for variation,” explains Wang, who first started bringing car engineers and medical professionals together to review individual cases in 1998. “What we’ve seen is that the factors that really matter are things like how strong and dense your bones are, and how much muscle you have.”

With the help of advances in computing power, and software similar to what scientists used to decode the human genome, Wang and his colleagues can pinpoint where, in a particular crash scenario or population, ribs tend to snap or pelvises buckle.

“Obviously we can’t go out and conduct experiments that intentionally put people in car crashes, but there are thousands of these ‘natural’ experiments between bodies and physical forces happening all the time,” Wang says. “In the last decade, crash victims who come through emergency rooms started routinely getting CT scans, and people happily let us use their scans because we’re using them to save lives.”

The ultimate goal is to make car safety systems more robust. The wealth of CT-derived data on body characteristics can one day be used to create virtual crash test dummies that span the spectrum of body types and provide information automotive engineers need to protect more than just the average Joe.

“They will eventually be able to take this data and adjust the power and timing of the airbag or tune seatbelt tension so that the car can protect differently depending on who’s behind the wheel,” Wang notes.

“I always tell engineers the vehicle is important,” he adds, “but the patient is more important.” —IAN DEMSKY

U-M International Center for Automotive Medicine

Spiritual Retreat Promotes Hope in Patients

A recent U-M clinical study found that attending a non-denominational spiritual retreat helped patients with serious heart disease feel less depressed and more hopeful about the future. The retreat included meditation, guided imagery, drumming, journal writing and outdoor activities. Patients showed immediate improvement on standardized tests measuring depression and hopefulness that was still evident at three- and six-month follow-up testing.

“Retreats may be of interest to patients who don’t want to take antidepressants for the depression that often accompanies coronary heart disease and heart attack,” says Sara Warber, M.D. (Residency 1997), associate professor of family medicine and lead author of the study. —SP

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Breathing Easier with COPD

A common antibiotic called azithromycin (trade name Zithromax) reduced the number of attacks of coughing, wheezing, and labored breathing in patients with chronic obstructive pulmonary disease (COPD), according to results from a national clinical trial.

The U-M Health System and the VA Ann Arbor Healthcare System participated in the clinical trial, along with nine other research centers. The trial was funded by the National Heart, Lung, and Blood Institute.

COPD is a progressive lung disease that affects more than 12 million people in the U.S. and is now the third leading cause of death in this country. There is no cure, but a combination of drugs and lifestyle changes can help manage symptoms and slow progression of the disease.

U-M physicians Fernando Martinez, M.D., and Jeffrey Curtis, M.D., both professors of internal medicine, led the U-M’s participation in the study. They also provided preliminary research data indicating that azithromycin might reduce exacerbations of COPD, which are often caused by bacteria or viruses.

In the study, one group of 570 patients took 250 mg of azithromycin daily for a year in addition to their usual treatment regimen, and averaged 1.48 acute COPD exacerbations during the year. A second group of 572 patients who did not take the antibiotic averaged 1.83 exacerbations. Study participants who took azithromycin responded more favorably on questionnaires that asked them to assess their breathing ability and overall well-being. Side effects were minimal, but a few patients reported some hearing loss.

“This important research is just one of many efforts — both at the U-M and around the country — aimed at helping people with COPD breathe easier and enjoy a better quality of life,” says Martinez.

More research will be required to determine the long-term effects of azithromycin treatment and to identify which COPD patients are most likely to benefit, adds Martinez. Results of the trial were published in the New England Journal of Medicine on August 25. —SP

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Information about the clinical trial

Screening for Prostate Cancer

A new clinical study of a urine test developed by U-M Cancer Center researchers shows that it detects prostate cancer more accurately and with greater specificity than current screening tests for prostate-specific antigen, or PSA, alone.

“Many more men have elevated PSA than actually have cancer, but it can be difficult to determine this without a biopsy,” says Arul Chinnaiyan (M.D. and Ph.D. 1999), the S.P. Hicks Professor of Pathology.

The test detects a specific anomaly found in about half of all prostate cancers — a gene fusion called TMPRSS2:ERG, caused by two genes that change places and fuse together. Previous studies found that this gene fusion almost always indicates prostate cancer. But because it is present only half the time, U-M researchers included another marker, PCA3, in the urine test. The combination of both markers was more predictive of cancer than either marker alone.

In the new study, Chinnaiyan’s research team analyzed urine samples from 1,312 men at three academic medical centers and seven hospitals. All the men had elevated PSA levels and had received either a biopsy or prostate-removal surgery. The researchers tested the urine samples for TMPRSS2:ERG and PCA3. Based on results, they divided patients into low, intermediate or high risk groups and then compared this to biopsy data.

Biopsies had detected cancer in 21 percent of men from the low-score group, 43 percent in the intermediate group and 69 percent in the high group. Only 7 percent of men in the low-score group had an aggressive tumor while 40 percent of those in the high-score group did. Researchers believe the new test could one day help some men delay or avoid a needle biopsy, while identifying those at highest risk for aggressive forms of prostate cancer. —SP

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Patient information on prostate cancer

The Lifetime Dose Matters Most

Obesity is a known risk factor for type 2 diabetes, but it hasn’t been clear whether the “dose” of obesity — how much excess weight a person has, and for how long — affects the risk of diabetes.

A new University of Michigan study of about 8,000 adolescents and young adults shows that both the degree and duration of obesity are cumulative risk factors for developing type 2 diabetes in adulthood. “We found that the relationship between weight and type 2 diabetes is similar to the relationship between smoking and the risk of lung cancer,” says Joyce Lee, M.D. (Fellowship 2006), M.P.H., an assistant professor of pediatrics. “It’s not just the amount of excess weight you carry, it’s the number of years you carry it.”—SP

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Patient information on diabetes in children and adolescents

Health Briefs

No one should have to face cancer alone. Cancer patients, survivors and family members can share experiences and get needed support at MCancerTalk.org — a new blog provided by the U-M Cancer Center. The site includes information from cancer specialists and open forums for patients and caregivers. U-M oncology nurses, physicians and care providers will answer questions posted on the website.

A new U-M research study finds that menopause — whether natural or surgical — does not raise a woman’s risk for diabetes. Being on hormone replacement therapy had no effect on post-menopausal women’s risk for diabetes. Researchers also found that lifestyle changes, like losing weight or starting an exercise program, helped all women lower their risk of diabetes.

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An older patient who needs carotid artery stenting to reduce the risk of stroke is more likely to have a better outcome if an experienced physician does the job. In fact, new U-M research shows that patients aged 65 and older were nearly twice as likely to die within 30 days if their stent was inserted by a doctor who did fewer than six procedures per year. —SP

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