Antibody-directed coupling of endoglin and MMP-14 is a key mechanism for endoglin shedding and deregulation of TGF-ß signaling.

Endoglin is a transforming growth factor ß (TGF-ß) coreceptor that serves as a prognostic, diagnostic and therapeutic vascular target in human cancer. A number of endoglin ectodomain-targeting antibodies (Abs) can effectively suppress both normal and tumor-associated angiogenesis, but their molecular actions remain poorly characterized. Here we define a key mechanism for TRACON105 (TRC105), a humanized monoclonal Ab in clinical trials for treatment of advanced or metastatic tumors. TRC105, along with several other endoglin Abs tested, enhance endoglin shedding through direct coupling of endoglin and the membrane-type 1 matrix metalloproteinase (MMP)-14 at the cell surface to release the antiangiogenic factor, soluble endoglin (sEng). In addition to this coupling process, endoglin shedding is further amplified by increased MMP-14 expression that requires TRC105 concentration-dependent c-Jun N-terminal kinase (JNK) activation. There were also notable counterbalancing effects on canonical Smad signaling in which TRC105 abrogated both the steady-state and TGF-ß-induced Smad1/5/8 activation while augmenting Smad2/3 activation. Interestingly, TRC105-induced sEng and aberrant Smad signaling resulted in an excessive migratory response through enhanced stress fiber formation and disruption of endothelial cell-cell junctions. Collectively, our study defines endoglin shedding and deregulated TGF-ß signaling during migration as major mechanisms by which TRC105 inhibits angiogenesis.

The Relationship between Sexual Minority Verbal Harassment And Utilization of Health Services: Results from Countywide Risk Assessment Survey (CRAS) 2004.

We examined the prevalence of and associations between sexual orientation-based verbal harassment and reported utilization of health services across levels of sexual orientation in a diverse sample of adult recipients of Los Angeles County-funded HIV-related health and social services. Thirty-two percent reported they had experienced verbal harassment, the majority (80.3%) of whom identified as lesbian, gay, orbisexual. Those who reported being verbally harassed received significantly more services overall than those who were not verbally harassed, and service utilization varied by sexual orientation. These findings inform future efforts to identify and assess social discrimination in health and social service settings.

Pain in the aftermath of trauma is a risk factor for post-traumatic stress disorder.

BACKGROUND: Identifying risk factors for the development of post-traumatic stress disorder (PTSD) is important for understanding and ultimately preventing the disorder. This study assessed pain shortly after traumatic injury (i.e. peritraumatic pain) as a risk factor for PTSD. METHOD: Participants (n=115) were patients admitted to a Level 1 Surgical Trauma Center. Admission to this service reflected a severe physical injury requiring specialized, emergent trauma care. Participants completed a pain questionnaire within 48 h of traumatic injury and a PTSD diagnostic module 4 and 8 months later. RESULTS: Peritraumatic pain was associated with an increased risk of PTSD, even after controlling for a number of other significant risk factors other than acute stress disorder symptoms. An increase of 0.5 s.d. from the mean in a 0-10 pain rating scale 24-48 h after injury was associated with an increased odds of PTSD at 4 months by more than fivefold, and at 8 months by almost sevenfold. A single item regarding amount of pain at the time of hospital admission correctly classified 65% of participants. CONCLUSIONS: If these findings are replicated in other samples, high levels of peritraumatic pain could be used to identify individuals at elevated risk for PTSD following traumatic injury.

Stride parameters and hindlimb length in horses fatigued on a treadmill and at an endurance ride.

REASON FOR PERFORMING STUDY: The relationship between fatigue and stride and/or muscle stiffness requires further study. OBJECTIVE: To measure stride parameters in horses undergoing fatigue associated with running at submaximal speeds both on a treadmill and in an endurance ride. HYPOTHESIS: Stride frequencies and estimates of hindlimb stiffness would be decreased in fatigued horses. METHODS: Horses were fatigued using 2 paradigms: run to exhaustion at a treadmill (4.5 m/sec, 6% incline) and finishing an 80 km endurance ride. Videos were digitised before and after fatigue and analysed for stride parameters: hind limb length, stride frequency, time of contact, step length, duty factor and stride length. RESULTS: In fatigued horses, stride durations were 5% longer (P = 0.007) resulting in lower stride frequencies (P = 0.016) and longer stride lengths (P = 0.006). The time of contacts (tc) for stance phase were not different (P = 0.108) nor was duty factor (tc/stride period, P = 0.457). Step length (speed x tc) and hindlimb lengths were also not different (P = 0.104, P = 0.8). For endurance horses, stride data for nonfatigued horses were consistent with data extrapolated to 4.5 m/sec from nonfatigued horses on the treadmill. Endurance horses slowed (P = 0.002) during the race from 4.55 to 4.03 m/sec and stride lengths were shorter. Despite a slower speed, other stride parameters were unchanged. Hindlimb length was shorter in fatigued horses. CONCLUSION: Horses fatigued on a treadmill and during the natural course of an endurance ride responded differently, biomechanically. On the treadmill, where speed is constrained, stride frequencies decreased and stride lengths increased. During one endurance ride, stride frequencies were the same, although speeds were substantially reduced. Limb length was shorter in fatigued endurance horses. It remains to be determined if these changes in mechanics are advantageous or disadvantageous in terms of energetics or injury. Further examination of endurance rides is also warranted.

Oxygen consumption (VO2) during trotting on a 10% decline.

REASONS FOR PERFORMING STUDY: Although there have been reports of oxygen consumption measurements of horses running on the level and incline, there are no measurements during decline locomotion. This may be due, in part, to the potential for muscle damage produced by eccentric contractions. In man, running on a 10% decline, VO2 decreased by 35% and stride frequency (SF) decreased by 3% when compared to level locomotion. HYPOTHESIS: The rate of O2 consumption and SF would be decreased in horses on a 10% decline when compared to the level. METHODS: Six horses (average 467 +/- 68 kg) were acclimated to trotting on the level and decline prior to data collection. VO2 under moderate conditions was measured (using open flow respirometry) during trotting between 2.25 and 4.0 m/sec (at 0.25 m/sec increments) on a treadmill on the level and declined 10%. Stride frequencies were counted manually. RESULTS: VO2 decreased (P<0.009) on the decline by an average of 45% (range 42-47%), and SF was 2.7% slower. The speed at which the minimum Cost of Transport occurs on the decline was faster than on the level. SF was reduced on the decline. No evidence of muscle soreness was noted in response to the downhill running. CONCLUSIONS AND POTENTIAL RELEVANCE: Downhill trotting, eccentric exercise, can be done safely in the horse and requires almost half the energetic costs as trotting on the level. It is not known whether this is the optimum downhill gradient or if the horse adjusts its preferred speed to accommodate downhill trotting.

Energetic and kinematic consequences of weighting the distal limb.

REASON FOR PERFORMING STUDY: It is well known that adding a load to a horse's back increases its energetic costs of locomotion, but the magnitude of increase obtained by loading the most distal portion of limb has not been measured. OBJECTIVES: To measure oxygen consumption in horses with mass added to the back and hooves. Because such mass distribution alters inertial parameters of the limbs, kinematic measurements were made to quantify the magnitude of change in limb movement. METHODS: Steady-state oxygen consumption was measured in 6 horses with a load of 2.4 kg. The load was either carried on the back or distributed equally between the 4 limbs. Modified bell boots kept the mass at the level of P3. Horses trotted on a treadmill at speeds ranging from 2 to 5 m/sec (in 0.5 m/sec increments). High-speed (250 Hz) digital images were recorded in a sagittal plane and the positions of retroreflective markers located on standard positions on the limbs were digitised for kinematic analysis. RESULTS: Loading of the distal limbs produced a 6.7% increase in metabolic rate, an order of magnitude higher than when the mass was added over the back. Although the stride period was 2% longer in horses with loads on the distal limbs, time of contact and duty factor were not different. Distal limb loading increased the range of motion in hind- but not forelimbs. CONCLUSIONS: The costs of swinging the limbs in the horse are considerable and the addition of weights to the distal limb can have a profound effect on not only the energetics of locomotion but also the kinematics, at least in the hindlimb. POTENTIAL RELEVANCE: The use of weighted shoes, intended to increase animation of the gait, increases the metabolic effort of performance horses a disproportionate amount. The additional mass also increases the joint range of motion and, potentially, the likelihood of injury.

The cost of transport in an extended trot.

We hypothesised that trotters during an extended trot have lower energetic costs of locomotion (CT) than horses not bred for this behaviour. VO2 was measured as a function of speed in 7 Arabian horses (3 trained to extend their trotting speeds) and in 2 horses, of similar mass, bred to trot (Hackney). Both oxygen consumption and CT increased with speed and there was, contrary to our hypothesis, no difference between breeds. In Arabians at 6.5 m/s, CT had increased 25% above the CT at 5.0 m/s (normal transition speed). For Hackneys at 6.8 m/s, the CT was almost 35% higher. Stride frequencies increased linearly in all horses up to 5.0 m/s. At the canter at 5.0 m/s, the frequency increased 9% to 111 strides/min, but then increased minimally with speed. In the Hackneys and the Arabians that extended the trot, stride frequencies were approximately 102 and did not increase with speed. Stride length (SL) increased linearly with speed in both trotting and cantering horses, and cantering SL were lower than trotting (at 5.0 m/s, SL for trotting = 3.04 m and for cantering SL = 2.68 m). There were no differences between breeds in stride frequency or stride length. Extending the trot can have profound energetic requirements that could limit athletic performance and may lead to increased concussive impact on the limbs.

Effect of trotting speed, load and incline on hindlimb stance-phase kinematics.

The objective was to understand how the stance-phase kinematics of the hindlimb of trotting horses change with speed under 3 conditions (level, loaded and incline), to compare our results with the predictions of the spring-mass model and to help focus our future studies of muscle function. Video recordings were made of 5 Arabian horses trotting on a treadmill. Five consecutive strides were digitised and averaged for each trial. The angle-time diagrams were qualitatively similar to those reported previously. As speed increases, the range of motion of the hindlimb increases, as predicted by the spring-mass model. This is the result of increased range of motion in the coxofemoral and tarsal joints. The hindlimb does not 'land short-take off long'. When trotting up an incline, the hindlimb undergoes a greater range of motion because of increased retraction resulting from increased extension of the coxofemoral joint. At hoof contact on an incline, the 3 proximal joints are more flexed than on the level. Carrying a load had no effect on kinematics. These results suggest that there may be larger changes in strain with speed in muscles acting at the coxofemoral and tarsal joints than at the femorotibial joint, and that locomotion up an incline will change muscle strain more than carrying a load.

Hindlimb net joint energies during swing phase as a function of trotting velocity.

Net joint powers and energies have been described in walking horses during the swing phase of the stride in the fore- and hindlimb (Clayton et al. 2001). During trotting, swing phase net joint powers have been described in the forelimb but not in the hindlimb. The effects of velocity on power profiles and energy patterns are important in relation to locomotor energetics. The objective of this study was to evaluate velocity-dependent changes in hindlimb net energy profiles of the swing phase during trotting. Inverse dynamic analysis was used to calculate net joint energies at the hindlimb joints of 6 horses trotting overground at velocities ranging from 2.27-5.17 m/s. At all velocities, there was net energy generation at the hip and tarsus and net energy absorption at the stifle, fetlock and coffin joints. Velocity-dependent bursts of energy generation at the hip actively protracted the limb in early swing and initiated retraction in late swing. Synchronous with the bursts of energy generation at the hip were velocity-dependent bursts of energy absorption across the stifle that acted to control flexion in early swing and extension in late swing. The distal limb was raised and lowered by velocity-dependent bursts of energy generation that flexed the tarsus in early swing and extended it in late swing. The energy bursts in early swing increased linearly with velocity, whereas the energy bursts in late swing increased as a function of the square or cube of velocity. The results contribute to understanding the mechanisms used to accelerate and decelerate the limbs more rapidly as velocity increases, which is an important consideration in racing and sporting performance.

Management of traumatic lung injury: a Western Trauma Association Multicenter review.

BACKGROUND: Improved outcomes following lung injury have been reported using "lung sparing" techniques. METHODS: A retrospective multicenter 4-year review of patients who underwent lung resection following injury was performed. Resections were categorized as "minor" (suture, wedge resection, tractotomy) or "major" (lobectomy or pneumonectomy). Injury severity, Abbreviated Injury Scale (AIS) score, and outcome were recorded. RESULTS: One hundred forty-three patients (28 blunt, 115 penetrating) underwent lung resection after sustaining an injury. Minor resections were used in 75% of cases, in patients with less severe thoracic injury (chest AIS scores "minor" 3.8 +/- 0.9 vs. "major" 4.3 +/- 0.7, p = 0.02). Mortality increased with each step of increasing complexity of the surgical technique (RR, 1.8; CI, 1.4-2.2): suture alone, 9% mortality; tractotomy, 13%; wedge resection, 30%; lobectomy, 43%; and pneumonectomy, 50%. Regression analysis demonstrated that blunt mechanism, lower blood pressure at thoracotomy, and increasing amount of the lung resection were each independently associated with mortality. CONCLUSION: Blunt traumatic lung injury has higher mortality primarily due to associated extrathoracic injuries. Major resections are required more commonly than previously reported. While "minor" resections, if feasible, are associated with improved outcome, trauma surgeons should be facile in a wide range of technical procedures for the management of lung injuries.

Stapled versus sutured gastrointestinal anastomoses in the trauma patient: a multicenter trial.

BACKGROUND: Construction of gastrointestinal anastomoses utilizing stapling devices has become a familiar procedure. In elective surgery, studies have shown no significant differences in complications between stapled and sutured anastomoses. Controversy has recently arisen regarding the accurate incidence of complications associated with anastomoses in the trauma patient. The objective of this multi-institutional study was to determine whether the incidence of postoperative complications differs between stapled and sutured anastomoses following the emergent repair of traumatic bowel injuries. METHODS: Using a retrospective cohort design, all trauma registry records from five Level I trauma centers over a period of 4 years were reviewed. RESULTS: A total of 199 patients with 289 anastomoses were identified. A surgical stapling device was used to create 175 separate anastomoses, while a hand-sutured method was employed in 114 anastomoses. A complication was defined as an anastomotic leak verified at reoperation, an intra-abdominal abscess, or an enterocutaneous fistula. The mean abdominal Abbreviated Injury Scale score and Injury Severity Score were similar in the two cohort groups. Stapling and suturing techniques were evenly distributed in both small and large bowel repairs. Seven of the total 175 stapled anastomoses and none of the 114 hand-sewn anastomoses resulted in a clinically significant leak requiring reoperation (RR = undefined, 95% CI 1.08-infinity, p = 0.04). Each anastomotic leak occurred in a separate individual. Nineteen stapled anastomoses and four sutured anastomoses were associated with an intra-abdominal abscess (RR = 2.7, 95% CI 0.96-7.57, p = 0.04). Enterocutaneous fistula formation was not statistically associated with either type of anastomoses (stapled cohort = 3 of 175 and sutured cohort = 2 of 114). Overall, 22 (13%) stapled anastomoses and 6 (5%) sutured anastomoses were associated with an intra-abdominal complication (RR = 2.08, 95% CI 0.89-4.86, p = 0.076). CONCLUSION: Anastomotic leaks and intra-abdominal abscesses appear to be more likely with stapled bowel repairs compared with sutured anastomoses in the injured patient. Caution should be exercised in deciding to staple a bowel anastomosis in the trauma patient.

Use of vascularized fibular grafts as a salvage procedure for previously failed spinal arthrodesis.

STUDY DESIGN: A case series of spinal arthrodesis performed with vascularized fibular grafts is presented. OBJECTIVES: The use of vascularized fibular grafts to obtain anterior spinal fusion in patients with complex spinal disorders and poor fusion environments is described. SUMMARY OF BACKGROUND DATA: The fusion success of spinal arthrodesis is dependent on numerous factors, such as the substrate used for arthrodesis (i.e., graft), the biology of the fusion bed, and local host factors. Vascularized grafts have higher success rates for union and can better overcome a poor fusion bed than nonvascular grafts. However, they are associated with higher donor site morbidity and greater technical difficulty. METHODS: Three patients with complex medical histories portending a difficult spinal fusion were treated with anterior arthrodesis using vascularized fibular autografts. Vascular patency was confirmed by bone scintigraphy, and osseous union by radiography and computed tomography. RESULTS: All patients had successful osseous fusion in 3 to 6 months. Deformity was improved. Patients reported decreased pain and resumption to previous activities at 24 months follow-up. There were no complications. CONCLUSIONS: A vascularized fibular graft is a useful alternative to standard grafts for spinal arthrodesis. Vascularized fibular grafts provide high fusion rates, rapid incorporation, and increased mechanical strength, and thus heal better in a suboptimal graft bed. The procedure is technically demanding, often requiring the expertise of a microvascular surgeon for obtaining the graft and achieving anastomosis. It is best suited in cases where significant difficulty in obtaining a spinal fusion is anticipated.

Structural characterization of MAO and related aluminum complexes. 1. Solid-state (27)Al NMR with comparison to EFG tensors from ab initio molecular orbital calculations.

Experimental and ab initio molecular orbital techniques are developed for study of aluminum species with large quadrupole coupling constants to test structural models for methylaluminoxanes (MAO). The techniques are applied to nitrogen- and oxygen-containing complexes of aluminum and to solid MAO isolated from active commercial MAO preparations. (Aminato)- and (propanolato)aluminum clusters with 3-, 4-, and 6-coordinate aluminum sites are studied with three (27)Al NMR techniques optimized for large (27)Al quadrupole coupling constants: field-swept, frequency-stepped, and high-field MAS NMR. Four-membered (aminato)aluminum complexes with AlN(4) coordination yield slightly smaller C(q) values than similar AlN(2)C(2) sites: 12.2 vs 15.8 MHz. Planar 3-coordinate AlN(2)C sites have the largest C(q) values, 37 MHz. In all cases, molecular orbital calculations of the electric field gradient tensors yields C(q) and eta values that match with experiment, even for a large hexameric (aminato)aluminum cage. A D(3d) symmetry hexaaluminum oxane cluster, postulated as a model for MAO, yields a calculated C(q) of -23.7 MHz, eta = 0.7474, and predicts a spectrum that is too broad to match the field-swept NMR of methylaluminoxane, which shows at least three sites, all with C(q) values greater than 15 MHz but less than 21 MHz. Thus, the proposed hexaaluminum cluster, with its strained four-membered rings, is not a major component of MAO. However, calculations for dimers of the cage complex, either edge-bridged or face-bridged, show a much closer match to experiment. Also, MAO preparations differ, with a gel form of MAO having significantly larger (27)Al C(q) values than a nongel form, a conclusion reached on the basis of (27)Al NMR line widths in field-swept NMR spectra acquired from 13 to 24 T.

Multiinstitutional experience with the management of superior mesenteric artery injuries.

BACKGROUND: Superior mesenteric artery (SMA) injuries are rare and often lethal injuries incurring very high morbidity and mortality. The purposes of this study are to review a multiinstitutional experience with these injuries; to analyze Fullen's classification based on anatomic zone and ischemia grade for its predictive value; to correlate the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) for abdominal vascular injury with mortality; and to identify independent risk factors predictive of mortality, describing current trends for the management of this injury in America. DESIGN: We performed a retrospective multiinstitutional study of patients sustaining SMA injuries involving 34 trauma centers in the US over 10 years. Outcomes variables, both continuous and dichotomous, were analyzed initially with univariate methods. For the subsequent multivariate analysis, stepwise logistic regression was used to identify a set of risk factors significantly associated with mortality. RESULTS: There were 250 patients enrolled, with a mean Revised Trauma Score (RTS) of 6.44 and a mean Injury Severity Score (ISS) of 25. Surgical management consisted of ligation in 175 of 244 patients (72%), primary [corrected] repair in 53 of 244 patients (22%), autogenous grafts were used in 10 of 244 (4%), and prosthetic grafts of PTFE in 6 of 244 patients (2%). Overall mortality was 97 of 250 patients (39%). Mortality versus Fullen's zones: zone I, 39 of 51 (76.5%); zone II, 15 of 34 (44.1%); zone III, 11 of 40 (27.5%); and zone IV, 25 of 108 (23.1%). Mortality versus Fullen's ischemia grade: grade 1, 22 of 34 (64.7%). Mortality versus AAST-OIS for abdominal vascular injury: grade I, 9 of 55 (16.4%); grade II, 13 of 51 (25.5%); grade III, 8 of 20 (40%); grade IV, 37 of 69 (53.6%); and grade V, 17 of 19 (89.5%). Logistic regression analysis identified as independent risk factors for mortality the following: transfusion of greater than 10 units of packed RBCs, intraoperative acidosis, dysrhythmias, injury to Fullen's zone I or II, and multisystem organ failure. CONCLUSION: SMA injuries are highly lethal. Fullen's anatomic zones, ischemia grade, and AAST-OIS abdominal vascular injuries correlate well with mortality. Injuries to Fullen's zones I and II, Fullen's maximal ischemia grade, and AAST-OIS injury grades IV and V, high-intraoperative transfusion requirements, and presence of acidosis and disrhythmias are significant predictors of mortality. All of these predictive factors for mortality must be taken into account in the surgical management of these injuries.

The 15-year evolution of an urban trauma center: what does the future hold for the trauma surgeon?

BACKGROUND: Safer cars, decreased violence, and nonoperative management have changed the trauma patient's nature. We evaluated changes in a Level I trauma center over 15 years and considered their effect on trauma surgeons. METHODS: From January 1985 through August 1999, 16,799 trauma registry patients were analyzed for mechanism of injury, Injury Severity Score, and procedures. RESULTS: Mean Injury Severity Score decreased from 15.9 to 10.7 and length of stay fell from 8.0 days to 5.9 days. There were significant decreases in penetrating trauma admissions and percentage of patients with Abbreviated Injury Scale score > 3 for head, chest, and abdomen. Frequency of craniotomy, thoracotomy, and laparotomy dropped dramatically. CONCLUSION: Significant decreases in injury severity, penetrating violence, and operations have occurred over 15 years. These changes will have profound effects on the practice of trauma surgeons and on surgical education.

Structure of a BRCA1-BARD1 heterodimeric RING-RING complex.

The RING domain of the breast and ovarian cancer tumor suppressor BRCA1 interacts with multiple cognate proteins, including the RING protein BARD1. Proper function of the BRCA1 RING domain is critical, as evidenced by the many cancer-predisposing mutations found within this domain. We present the solution structure of the heterodimer formed between the RING domains of BRCA1 and BARD1. Comparison with the RING homodimer of the V(D)J recombination-activating protein RAG1 reveals the structural diversity of complexes formed by interactions between different RING domains. The BRCA1-BARD1 structure provides a model for its ubiquitin ligase activity, illustrates how the BRCA1 RING domain can be involved in associations with multiple protein partners and provides a framework for understanding cancer-causing mutations at the molecular level.

Hypertonicity rescues T cells from suppression by trauma-induced anti-inflammatory mediators.

Trauma causes the release of anti-inflammatory factors thought to cause infections by inhibiting T cells. We have found that hypertonic saline (HS) enhances functions of normal T cells. Here we studied if HS can rescue T cells from suppression by costimulating interleukin (IL)-2 production. Human peripheral blood mononuclear cells were treated with the immunosuppressive factors IL-4, IL-10, transforming growth factor (TGF)-beta(1), and PGE(2) and with serum of trauma patients and stimulated with phytohemagglutinin, and IL-2 production was measured. Costimulation with HS tripled IL-2 production of normal cells. IL-4, IL-10, TGF-beta(1), and PGE(2) suppressed IL-2 production with IC(50) of 500, 1, 36,000, and 0.01 pg/ml, respectively. Costimulation of suppressed cells with HS restored IL-2 production and increased IC(50) values >70-fold. Serum from trauma patients could completely suppress normal cells; however, costimulation with HS restored IL-2 production by up to 80% of the control response. These findings show that HS can restore the function of suppressed T cells, suggesting that HS resuscitation of trauma patients could reduce posttraumatic sepsis.

The effects of a high-risk environment on the sexual victimization of homeless and runaway youth.

Based on the structural-choice theory of victimization, the current study examines the effects of a high-risk environment on the sexual victimization of 311 homeless and runaway youth. Results from logistic regression revealed that survival sex, gender, and physical appearance were significantly associated with sexual victimization. Results from a series of interactions also revealed that the effects of deviant behaviors on sexual victimization varied by gender and age. Although males and females engaged in similar activities, young women were more likely to be victims of sexual assault. These findings suggest that engaging in high-risk behaviors predispose some people to greater risks but it is the combination of these behaviors with gender and/or age that determines who will become victimized.

Severe traumatic brain injury from unmotorized scooter.

The popularity and use of unmotorized, foot-propelled scooters has risen dramatically in the last few years. Increasing reports of traumatic injuries from these scooters have paralleled their commercial sales and success in this country and worldwide. We report a case of a previously healthy 48-year-old woman who suffered a severe traumatic brain injury while riding one of these scooters, resulting in a devastating neurologic outcome and permanent vegetative state. This case emphasizes the importance of public awareness regarding the potential dangers and the need for appropriate precautions and protective gear when riding these recreational devices.