Chronic pain and disability following acute orthopedic trauma are not only physical concerns but also deeply intertwined with psychological well-being.The recent retrospective cohort study by Yang et al,published,prov...Chronic pain and disability following acute orthopedic trauma are not only physical concerns but also deeply intertwined with psychological well-being.The recent retrospective cohort study by Yang et al,published,provides compelling evidence of significant associations between depression,anxiety,and postoperative recovery.These findings align with an expanding body of literature that confirms the need for orthopedic rehabilitation to adopt a biopsychosocial perspective.This letter contextualizes Yang et al’s study within current evidence,highlighting the roles of sleep disturbance,catastrophizing,stress,neurobiological mechanisms,and coping strategies in shaping recovery.It further emphasizes the importance of integrating nursing-led and multidisciplinary interventions to address both physical and psychological domains,ultimately promoting holistic recovery.展开更多
<strong>Purpose of Review:</strong> The management of eye injuries is both difficult and argumentative. This study attempts to highlight the management of ocular trauma using currently available informatio...<strong>Purpose of Review:</strong> The management of eye injuries is both difficult and argumentative. This study attempts to highlight the management of ocular trauma using currently available information in the literature and author experience. This review presents a workable framework from the first presentation, epidemiology, classification, investigations, management principles, complications, prognostic factors, final visual outcome and management debates. <strong>Review Findings:</strong> Mechanical ocular trauma is a leading cause of monocular blindness and possible handicap worldwide. Among several classification systems, the most widely accepted is Birmingham Eye Trauma Terminology (BETT). Mechanical ocular trauma is a topic of unsolved controversy. Patching for corneal abrasion, paracentesis for hyphema, the timing of cataract surgery and intraocular lens implantation are all issues in anterior segment injuries. Regarding posterior segment controversies, the timing of vitrectomy, use of prophylactic cryotherapy, the necessity of intravitreal antibiotics in the absence of infection, the use of vitrectomy vs vitreous tap in traumatic endophthalmitis is the issues. The pediatric age group needs to be approached by a different protocol due to the risk of amblyopia, intraocular inflammation, and significant vitreoretinal adhesions. The various prognostic factors have a role in the final visual outcome. B scan is used to exclude R.D, Intraocular foreign body (IOFB), and vitreous haemorrhage in hazy media. Individual surgical strategies are used for every patient according to the classification and extent of the injuries. <strong>Conclusion:</strong> This article examines relevant evidence on the management challenges and controversies of mechanical trauma of the eye and offers treatment recommendations based on published research and the authors’ own experience.展开更多
BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU ad...BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.展开更多
Case Letter Severe trauma has high morbidity and mortality rates,being the leading cause of death in young adults.Among all traumas,tra ffi c injuries are particularly lethal.^([1-2]) The injury severity score(ISS) ca...Case Letter Severe trauma has high morbidity and mortality rates,being the leading cause of death in young adults.Among all traumas,tra ffi c injuries are particularly lethal.^([1-2]) The injury severity score(ISS) can be used to assess trauma severity,with ISS of<9,9–15,16–24,and≥25 indicating minor,moderate,severe,and critical trauma,respectively.The ISS is correlated with mortality,morbidity,and hospitalization duration after injury.^([3-4]) Here,we report one patient who was admitted to our emergency intensive care unit(EICU) due to traumatic liver rupture and traumatic myocardial infarction complicated with inferior vena cava(IVC) thrombosis.展开更多
Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack o...Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack of a standard classification, investigations, and treatment guidelines related to the outcome, with considerable debate regarding predictive models. We review the predictors of visual outcome following surgical treatment of traumatic cataracts, which may act as a guide to clinicians.展开更多
Jovani et al’s study contributes important evidence linking childhood trauma(CT)and parental socialization with at-risk mental state(ARMS)in non-clinical adolescents,demonstrating the mediating role of low levels of ...Jovani et al’s study contributes important evidence linking childhood trauma(CT)and parental socialization with at-risk mental state(ARMS)in non-clinical adolescents,demonstrating the mediating role of low levels of parental affection and communication in this relationship.This letter commends the study’s strengths while also identifying key issues that warrant further attention,including the limitations of cross-sectional design,potential perceptual biases,conceptual overlap between CT and parenting,and limited cultural generalizability.We advocate for longitudinal,culturally sensitive,and multi-informant approaches to further refine ARMS risk models,strengthen theoretical distinctions between CT and parenting,and inform targeted prevention strategies across diverse populations.We also extend the discussion by highlighting promising directions for future research.展开更多
The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingcl...The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingclose to the aorta and mediastinal organs.^([1])These patientsnot only suffer direct injuries to the sternoclavicularjoint,but also frequently experience severe injuries toother body parts.The systemic physiological disordersand multi-organ dysfunction caused by severe traumaincrease the surgery di?culty and mortality risk.^([2])展开更多
BACKGROUND:The lack of a stable,easy-to-operate animal model for severe trauma has hindered the research progress.The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of ...BACKGROUND:The lack of a stable,easy-to-operate animal model for severe trauma has hindered the research progress.The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of severe trauma,providing a reliable research tool.METHODS:Male C57BL/6J mice(aged 8-10 weeks and weighting approximately 20 g)were used to establish the severe trauma model.Under anesthesia,a midshaft femoral fracture was created and packed with sterile cotton.A midline incision was made from the inguinal region to the sternum,exposing the abdominal organs for 30 min.The right femoral artery was cannulated to induce controlled blood loss at 30%,35%,40%,and 50%of the total blood volume.Survival rates were monitored for 24 h post-induction.In the mice that experienced 30%blood loss,the mean arterial pressure,body temperature,blood gas parameters,peripheral blood inflammatory markers,and major organ pathological changes were assessed.RESULTS:Mice with femoral fractures,soft tissue injuries,abdominal organ exposure,and 30%blood loss exhibited stable survival rates.Increased blood loss significantly reduced survival rates.Mean arterial pressure decreased initially,recovering within 0-15 min and returning to baseline by 50 min.Similarly,the body temperature decreased initially and gradually recovered to baseline within 50 min.Levels of peripheral blood inflammatory markers remained elevated for 12 h post-injury.Distant organs,including intestines,lungs,liver,spleen and kidneys,displayed varying degrees of injury.CONCLUSION:The established mouse model replicates the pathophysiological responses to severe trauma,indicating stability and reproducibility,which could be an useful tool for further trauma research.展开更多
Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) a...Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) and investigates its mechanism of action.Methods:A grade Ⅲ PT model consisting of 15 beagle dogs with severed main pancreatic ducts was created and treated with cephalic vein injection of gabexate mesylate(GM)(1.54mL/10kg,TID) and peripancreatic injection of GMTI(4.63 mL/10 kg,QD) guided by CEUS within 24h post-surgery.Ascites and serum levels of amylase(AMY),lipase(LPS),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,and urinary trypsinogen activating peptide(TAP) were detected by ELISA.Histopathological changes in the canine pancreas were observed by Hematoxylin and Eosin staining.Results:CEUS accurately displayed pancreatic lesions and guided catheterisation.Compared to the control group,the ascites was significantly reduced after treatment(p<0.01).AMY and LPS ascites significantly decreased on post-operative 1st and 2nd day(p<0.01).The levels of AMY,LPS,CRP,IL-6,and TNF-α in serum were decreased(p<0.05 or p <0.01).Urinary TAP was decreased 1 and 2 days after treatment(p<0.05or p<0.01,respectively).In the control group,pancreatic tissue necrosis was evident in the wound area.Normal glandular cell structures and fibrous tissue hyperplasia were observed in the wound area after GMTI treatment.The GMTI group performed better than the GM group in improving pancreatic histology and reducing AMY levels in the early post-operative period.Conclusion:Guided by CEUS,daily peripancreatic injections of GMTI in Beagles effectively inhibit pancreatic enzyme activity and aid in the adjuvant treatment of pancreatic trauma.展开更多
Objective Accurately identifying the key influencing factors of psychological birth trauma in primiparous women is crucial for implementing effective preventive and intervention measures.This study aimed to develop an...Objective Accurately identifying the key influencing factors of psychological birth trauma in primiparous women is crucial for implementing effective preventive and intervention measures.This study aimed to develop and validate an interpretable machine learning prediction model for identifying the key influencing factors of psychological birth trauma in primiparous women.Methods A multicenter cross-sectional study was conducted on primiparous women in four tertiary hospitals in Sichuan Province,southwestern China,from December 2023 to March 2024.The Childbirth Trauma Index was used in assessing psychological birth trauma in primiparous women.Data were collected and randomly divided into a training set(80%,n=289)and a testing set(20%,n=73).Six different machine learning models were trained and tested.Training and prediction were conducted using six machine learning models included Linear Regression,Support Vector Regression,Multilayer Perceptron Regression,eXtreme Gradient Boosting Regression,Random Forest Regression,and Adaptive Boosting Regression.The optimal model was selected based on various performance metrics,and its predictive results were interpreted using SHapley Additive exPlanations(SHAP)and accumulated local effects(ALE).Results Among the six machine learning models,the Multilayer Perceptron Regression model exhibited the best overall performance in the testing set(MAE=3.977,MSE=24.832,R2=0.507,EVS=0.524,RMSE=4.983).In the testing set,the R2 and EVS of the Multilayer Perceptron Regression model increased by 8.3%and 1.2%,respectively,compared to the traditional linear regression model.Meanwhile,the MAE,MSE,and RMSE decreased by 0.4%,7.3%,and 3.7%,respectively,compared to the traditional linear regression model.The SHAP analysis indicated that intrapartum pain,anxiety,postpartum pain,resilience,and planned pregnancy are the most critical influencing factors of psychological birth trauma in primiparous women.The ALE analysis indicated that higher intrapartum pain,anxiety,and postpartum pain scores are risk factors,while higher resilience scores are protective factors.Conclusions Interpretable machine learning prediction models can identify the key influencing factors of psychological birth trauma in primiparous women.SHAP and ALE analyses based on the Multilayer Perceptron Regression model can help healthcare providers understand the complex decision-making logic within a prediction model.This study provides a scientific basis for the early prevention and personalized intervention of psychological birth trauma in primiparous women.展开更多
Trauma is a major cause of morbidity and mortality across the globe accounting for significant health burden.Relevance of trauma care revolves round prevention,planning and execution of safety regulations.Acquisition ...Trauma is a major cause of morbidity and mortality across the globe accounting for significant health burden.Relevance of trauma care revolves round prevention,planning and execution of safety regulations.Acquisition of the actual data regarding the type of trauma,affected age group,timings of trauma occurrence,involved part of the body constitute the initial steps in the building of the composite overview of the epidemiology of trauma.In succession,would be the measures directed towards avoidance of trauma and capacity building of trauma center.展开更多
The care of a patient involved in major trauma with exsanguinating haemorrhage is time-critical to achieve definitive haemorrhage control,and it requires coordinated multidisciplinary care.During initial resuscitation...The care of a patient involved in major trauma with exsanguinating haemorrhage is time-critical to achieve definitive haemorrhage control,and it requires coordinated multidisciplinary care.During initial resuscitation of a patient in the emergency department(ED),Code Crimson activation facilitates rapid decisionmaking by multi-disciplinary specialists for definitive haemorrhage control in operating theatre(OT)and/or interventional radiology(IR)suite.Once this decision has been made,there may still be various factors that lead to delay in transporting the patient from ED to OT/IR.Red Blanket protocol identifies and addresses these factors and processes which cause delay,and aims to facilitate rapid and safe transport of the haemodynamically unstable patient from ED to OT,while minimizing delay in resuscitation during the transfer.The two processes,Code Crimson and Red Blanket,complement each other.It would be ideal to merge the two processes into a single protocol rather than having two separate workflows.Introducing these quality improvement strategies and coor-dinated processes within the trauma framework of the hospitals/healthcare systems will help in further improving the multi-disciplinary care for the complex trauma patients requiring rapid and definitive haemorrhage control.展开更多
Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies.ECMO allows blood to b...Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies.ECMO allows blood to be extracted from a patient and introduced to a machine that oxygenates blood and removes carbon dioxide.This blood is then reintroduced into the patient’s circulatory system.This process makes ECMO essential for treating various medical conditions,both as a standalone therapy and as adjuvant therapy.Veno-venous(VV)ECMO primarily supports respiratory function and indicates respiratory distress.Simultaneously,veno-arterial(VA)ECMO provides hemodynamic and respiratory support and is suitable for cardiac-related complications.This study reviews recent literature to elucidate the evolving role of ECMO in trauma care,considering its procedural intricacies,indications,contraindications,and associated complications.Notably,the use of ECMO in trauma patients,particularly for acute respiratory distress syndrome and cardiogenic shock,has demonstrated promising outcomes despite challenges such as anticoagulation management and complications such as acute kidney injury,bleeding,thrombosis,and hemolysis.Some studies have shown that VV ECMO was associated with significantly higher survival rates than conventional mechanical ventilation,whereas other studies have reported that VA ECMO was associated with lower survival rates than VV ECMO.ECMO plays a critical role in managing trauma patients,particularly those with acute respiratory failure.Further research is necessary to explore the full potential of ECMO in trauma care.Clinicians should have a clear understanding of the indications and contraindications for the use of ECMO to maximize its benefits in treating trauma patients.展开更多
Purpose: To evaluate open lower limb trauma management in children. Me-thod: We conducted a twelve-month cross-sectional prospective study. Results: Open trauma of lower limb had 7.9% of hospital frequency. Mean age w...Purpose: To evaluate open lower limb trauma management in children. Me-thod: We conducted a twelve-month cross-sectional prospective study. Results: Open trauma of lower limb had 7.9% of hospital frequency. Mean age was 8 years with a sex ratio of 2.45. In 68.4% of cases, trauma occurred in road traffic accidents. Average consultation time was 2.4 hours. Trauma mainly affected the leg in 39.5% of cases, and the thigh in 34.2%. Soft tissue wounds occurred in 52.6% of cases, and open fractures in 47.4%. Average response time was one hour. Wound trimming and suturing were performed in 76.3% of cases and combined with bone nailing in 15.8%. The outcome was favorable in 92.1% of cases. Average hospital stay was 4.37 days. Conclusion: Open trauma to the lower limb is a frequent and occurs mainly in road traffic accidents. Management was early, with a favorable outcome for most patients and a short hospital stay.展开更多
Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th)version,due to be published,two decades after its ...Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th)version,due to be published,two decades after its first initiation.It is described as an enhanced version of the current definition of PTSD,with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation,negative self-cognitions and interpersonal hardship,thus resembling the clinical features commonly encountered in borderline personality disorder(BPD).Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context,generally interpersonal in nature.In this manuscript,we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them,along with their clinical features.Furthermore,we suggest that besides the present distinct clinical diagnoses(PTSD;Complex PTSD;BPD),there is a cluster of these comorbid disorders,that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such.More studies are needed to confirm or reject this hypothesis,particularly in clinical terms and how they correlate to clinical entities'biological background,endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.展开更多
BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleedi...BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleeding and hypovolemic shock which entails significant clinical attention during initial resuscitation.AIM To assess whether an initial episode of prehospital or emergency department hypotension is associated with an increased risk of morbidity and mortality in trauma patients.METHODS A retrospective analysis was performed to include all trauma patients hospitalized between 2011 and 2021.Hypotension was defined as a systolic blood pressure≤90 mmHg in the prehospital setting or upon arrival to the hospital.Patients were classified into normotensive vs hypotensive and survivors vs nonsurvivors.Data was analyzed and compared,and multivariable logistic regression analysis was performed to identify the predictors of mortality.RESULTS Over the ten years,17341 trauma admissions were analyzed,of which 1188(6.9%)patients had hypotension episodes either at the scene or upon hospital arrival.Patients with hypotension were two years younger(P=0.001)in age and were more likely to have higher pulse rate(P=0.001),elevated shock index(P=0.001),sustained more severe injuries,frequently required blood transfusion and laparotomy,and had higher complications and mortality rates.Multivariable regression analysis identified hypotension[adjusted odds ratio(aOR)=2.505;95% confidence interval(95%CI)=1.798-3.489;P=0.001]and acute respiratory distress syndrome(ARDS;aOR=5.482;95%CI=3.297-9.116;P=0.001)as independent predictors of mortality.Among hypotensive trauma patients,only ARDS(aOR=3.518;95%CI=1.385-7.204;P=0.006)was significantly associated with mortality.CONCLUSION Hypotensive episodes following trauma are associated with higher severity and mortality.The development of ARDS is an independent predictor of mortality in hypotensive trauma patients.A hypotensive episode is a warning sign and calls for aggressive,timely management following trauma.展开更多
This paper explores the concept of crisis from a critical and interdisciplinary perspective,arguing that many contemporary crises-such as the coronavirus crisis and the climate crisis-are socially constructed and misu...This paper explores the concept of crisis from a critical and interdisciplinary perspective,arguing that many contemporary crises-such as the coronavirus crisis and the climate crisis-are socially constructed and misunderstood.Drawing from Thomas Kuhn’s paradigm shift theory,Nassim Nicholas Taleb’s Black Swan concept,and complexity science,it contends that crises are a normal part of systemic evolution rather than extraordinary disruptions.The paper critiques the shift in agency from individuals to macro-level institutions,which has led to crises being perceived as indefinite rather than finite.The work also examines how crises are often framed through memetics rather than physical reality.By analyzing historical and contemporary crises,the paper illustrates how crisis narratives shape societal behavior and policy.The role of antifragility,memetic warfare,and evolutionary stable strategies(ESS)is discussed,demonstrating how resilience emerges through localized,rather than globalized,responses.The study concludes by advocating for a shift away from progressivist macro-level interventions and toward individual agency as the fundamental unit of societal adaptation.This perspective reframes crises as necessary transitions within evolutionary progress,arguing that societal sustainability depends on decentralization and adaptation rather than centralized control and panic-driven reactions.展开更多
Background:Poor sleep quality has been associated with changes in brain volume among veterans,particularly those who have experienced mild traumatic brain injury(mTBI)and post-traumatic stress disorder(PTSD).This stud...Background:Poor sleep quality has been associated with changes in brain volume among veterans,particularly those who have experienced mild traumatic brain injury(mTBI)and post-traumatic stress disorder(PTSD).This study sought to investigate:1)whether poor sleep quality is associated with decreased cortical thickness in Iraq and Afghanistan war veterans,and 2)whether these associations differ topographically depending on the presence or absence of mTBI and PTSD.Methods:A sample of 440 post-9/11 era U.S.veterans enrolled in the Translational Research Center for Traumatic Brain Injury and Stress Disorders study at VA Boston,MA from 2010 to 2022 was included in the study.We examined the relationship between sleep quality,as measured by the Pittsburgh Sleep Quality Index(PSQI),and cortical thickness in veterans with mTBI(n=57),PTSD(n=110),comorbid mTBI and PTSD(n=129),and neither PTSD nor mTBI(n=144).To determine the topographical relationship between subjective sleep quality and cortical thickness in each diagnostic group,we employed a General Linear Model(GLM)at each vertex on the cortical mantle.The extent of topographical overlap between the resulting statistical maps was assessed using Dice coefficients.Results:There were no significant associations between PSQI and cortical thickness in the group without PTSD or mTBI(n=144)or in the PTSD-only group(n=110).In the mTBI-only group(n=57),lower sleep quality was significantly associated with reduced thickness bilaterally in frontal,cingulate,and precuneus regions,as well as in the right parietal and temporal regions(β=-0.0137,P<0.0005).In the comorbid mTBI and PTSD group(n=129),significant associations were observed bilaterally in frontal,precentral,and precuneus regions,in the left cingulate and the right parietal regions(β=-0.0094,P<0.0005).Interaction analysis revealed that there was a stronger relationship between poor sleep quality and decreased cortical thickness in individuals with mTBI(n=186)compared with those without mTBI(n=254)specifically in the frontal and cingulate regions(β=-0.0077,P<0.0005).Conclusions:This study demonstrates a significant relationship between poor sleep quality and lower cortical thickness primarily within frontal regions among individuals with both isolated mTBI or comorbid diagnoses of mTBI and PTSD.Thus,if directionality is established in longitudinal and interventional studies,it may be crucial to consider addressing sleep in the treatment of veterans who have sustained mTBI.展开更多
This editorial discusses a recent article published by Li et al in 2024,which highlights a critical yet underexplored dimension of chronic wound care:The impact of psychological factors such as depression and anxiety ...This editorial discusses a recent article published by Li et al in 2024,which highlights a critical yet underexplored dimension of chronic wound care:The impact of psychological factors such as depression and anxiety on treatment outcomes.With the increasing prevalence of chronic wounds in China,driven by population aging,traffic accidents,and chronic diseases,chronic wounds have emerged as a significant public health concern.They not only pose serious threats to individual health but also impose considerable social and economic burdens on healthcare systems.Against this backdrop,the study by Li et al aimed to explore how psychological distress affects the management and recovery of patients with chronic wounds.In their research,chronic wound patients were meticulously evaluated for depression and anxiety using validated psychological assessment scales and blood biomarkers.The findings reveal a stark reality:Individuals with severe depression and anxiety exhibit markedly lower treatment adherence,slower recovery rates,and diminished post-treatment quality of life.These psychological challenges hinder patients’active engagement with their care plans and may directly impede physiological healing processes.Importantly,the study underscored that factors such as wound size,anxiety,and depression significantly influence therapeutic outcomes in chronic wound patients.This insight calls for a more holistic approach to wound care,where addressing psychological well-being becomes an integral component of treatment protocols.As such,the study highlighted the necessity of early identification and targeted intervention for depression and anxiety in chronic wound patients. By prioritizing psychological support alongside medicaltreatment, healthcare providers can enhance therapeutic efficacy and improve patients’ long-term quality of life.This integrative approach can not only optimize clinical outcomes but also alleviate the broader societal andeconomic impact of chronic wounds.展开更多
BACKGROUND The occurrence of chronic pain and disability after acute orthopedic trauma is significantly correlated with psychological factors,particularly depression and anxiety.As such,assessment of these factors is ...BACKGROUND The occurrence of chronic pain and disability after acute orthopedic trauma is significantly correlated with psychological factors,particularly depression and anxiety.As such,assessment of these factors is crucial for postoperative rehabilitation.AIM To investigate the correlation between chronic pain,disability,and psychological factors(depression and anxiety)after acute orthopedic trauma surgery.METHODS Data from 120 patients,who underwent surgery for acute orthopedic trauma at Xi’an Traditional Chinese Medicine Hospital(Shaanxi Province,China)between June 2022 and June 2024,were retrospectively analyzed.Basic information and postoperative pain metrics[visual analog scale(VAS)],disability rating index(DRI),Hamilton anxiety rating scale(HAMA)and Hamilton depression rating scale(HAMD)were collected from electronic medical records.Pearson’s correlation analysis was used to examine associations between chronic pain VAS,DRI,HAMD,and HAMA scores.RESULTS Among the 120 patients[79(65.8%)males and 41(34.2%)females],postoperative VAS scores were significantly associated with HAMD and HAMA scores,with correlation coefficients of 0.625(P=0.027)and 0.568(P<0.001),respectively.Postoperative DRI scores were also significantly associated with HAMD and HAMA scores,with correlation coefficients of 0.683 and 0.557,respectively(both P<0.001).CONCLUSION Chronic pain and disability after surgery for acute orthopedic trauma are significantly correlated with psychological factors(depression and anxiety).Multidisciplinary teams should integrate mental health services to improve patient outcomes.展开更多
文摘Chronic pain and disability following acute orthopedic trauma are not only physical concerns but also deeply intertwined with psychological well-being.The recent retrospective cohort study by Yang et al,published,provides compelling evidence of significant associations between depression,anxiety,and postoperative recovery.These findings align with an expanding body of literature that confirms the need for orthopedic rehabilitation to adopt a biopsychosocial perspective.This letter contextualizes Yang et al’s study within current evidence,highlighting the roles of sleep disturbance,catastrophizing,stress,neurobiological mechanisms,and coping strategies in shaping recovery.It further emphasizes the importance of integrating nursing-led and multidisciplinary interventions to address both physical and psychological domains,ultimately promoting holistic recovery.
文摘<strong>Purpose of Review:</strong> The management of eye injuries is both difficult and argumentative. This study attempts to highlight the management of ocular trauma using currently available information in the literature and author experience. This review presents a workable framework from the first presentation, epidemiology, classification, investigations, management principles, complications, prognostic factors, final visual outcome and management debates. <strong>Review Findings:</strong> Mechanical ocular trauma is a leading cause of monocular blindness and possible handicap worldwide. Among several classification systems, the most widely accepted is Birmingham Eye Trauma Terminology (BETT). Mechanical ocular trauma is a topic of unsolved controversy. Patching for corneal abrasion, paracentesis for hyphema, the timing of cataract surgery and intraocular lens implantation are all issues in anterior segment injuries. Regarding posterior segment controversies, the timing of vitrectomy, use of prophylactic cryotherapy, the necessity of intravitreal antibiotics in the absence of infection, the use of vitrectomy vs vitreous tap in traumatic endophthalmitis is the issues. The pediatric age group needs to be approached by a different protocol due to the risk of amblyopia, intraocular inflammation, and significant vitreoretinal adhesions. The various prognostic factors have a role in the final visual outcome. B scan is used to exclude R.D, Intraocular foreign body (IOFB), and vitreous haemorrhage in hazy media. Individual surgical strategies are used for every patient according to the classification and extent of the injuries. <strong>Conclusion:</strong> This article examines relevant evidence on the management challenges and controversies of mechanical trauma of the eye and offers treatment recommendations based on published research and the authors’ own experience.
文摘BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.
文摘Case Letter Severe trauma has high morbidity and mortality rates,being the leading cause of death in young adults.Among all traumas,tra ffi c injuries are particularly lethal.^([1-2]) The injury severity score(ISS) can be used to assess trauma severity,with ISS of<9,9–15,16–24,and≥25 indicating minor,moderate,severe,and critical trauma,respectively.The ISS is correlated with mortality,morbidity,and hospitalization duration after injury.^([3-4]) Here,we report one patient who was admitted to our emergency intensive care unit(EICU) due to traumatic liver rupture and traumatic myocardial infarction complicated with inferior vena cava(IVC) thrombosis.
文摘Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack of a standard classification, investigations, and treatment guidelines related to the outcome, with considerable debate regarding predictive models. We review the predictors of visual outcome following surgical treatment of traumatic cataracts, which may act as a guide to clinicians.
文摘Jovani et al’s study contributes important evidence linking childhood trauma(CT)and parental socialization with at-risk mental state(ARMS)in non-clinical adolescents,demonstrating the mediating role of low levels of parental affection and communication in this relationship.This letter commends the study’s strengths while also identifying key issues that warrant further attention,including the limitations of cross-sectional design,potential perceptual biases,conceptual overlap between CT and parenting,and limited cultural generalizability.We advocate for longitudinal,culturally sensitive,and multi-informant approaches to further refine ARMS risk models,strengthen theoretical distinctions between CT and parenting,and inform targeted prevention strategies across diverse populations.We also extend the discussion by highlighting promising directions for future research.
文摘The clinical treatment of severe trauma withsternoclavicular joint injury is challenging,primarilydue to the irregular shape of the bones surrounding thesternoclavicular joint,as well as the posterior clavicle beingclose to the aorta and mediastinal organs.^([1])These patientsnot only suffer direct injuries to the sternoclavicularjoint,but also frequently experience severe injuries toother body parts.The systemic physiological disordersand multi-organ dysfunction caused by severe traumaincrease the surgery di?culty and mortality risk.^([2])
基金supported by the National Natural Science Foundation of China(82102315).
文摘BACKGROUND:The lack of a stable,easy-to-operate animal model for severe trauma has hindered the research progress.The aim of this study is to develop a mouse model that replicates the pathophysiological conditions of severe trauma,providing a reliable research tool.METHODS:Male C57BL/6J mice(aged 8-10 weeks and weighting approximately 20 g)were used to establish the severe trauma model.Under anesthesia,a midshaft femoral fracture was created and packed with sterile cotton.A midline incision was made from the inguinal region to the sternum,exposing the abdominal organs for 30 min.The right femoral artery was cannulated to induce controlled blood loss at 30%,35%,40%,and 50%of the total blood volume.Survival rates were monitored for 24 h post-induction.In the mice that experienced 30%blood loss,the mean arterial pressure,body temperature,blood gas parameters,peripheral blood inflammatory markers,and major organ pathological changes were assessed.RESULTS:Mice with femoral fractures,soft tissue injuries,abdominal organ exposure,and 30%blood loss exhibited stable survival rates.Increased blood loss significantly reduced survival rates.Mean arterial pressure decreased initially,recovering within 0-15 min and returning to baseline by 50 min.Similarly,the body temperature decreased initially and gradually recovered to baseline within 50 min.Levels of peripheral blood inflammatory markers remained elevated for 12 h post-injury.Distant organs,including intestines,lungs,liver,spleen and kidneys,displayed varying degrees of injury.CONCLUSION:The established mouse model replicates the pathophysiological responses to severe trauma,indicating stability and reproducibility,which could be an useful tool for further trauma research.
文摘Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) and investigates its mechanism of action.Methods:A grade Ⅲ PT model consisting of 15 beagle dogs with severed main pancreatic ducts was created and treated with cephalic vein injection of gabexate mesylate(GM)(1.54mL/10kg,TID) and peripancreatic injection of GMTI(4.63 mL/10 kg,QD) guided by CEUS within 24h post-surgery.Ascites and serum levels of amylase(AMY),lipase(LPS),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,and urinary trypsinogen activating peptide(TAP) were detected by ELISA.Histopathological changes in the canine pancreas were observed by Hematoxylin and Eosin staining.Results:CEUS accurately displayed pancreatic lesions and guided catheterisation.Compared to the control group,the ascites was significantly reduced after treatment(p<0.01).AMY and LPS ascites significantly decreased on post-operative 1st and 2nd day(p<0.01).The levels of AMY,LPS,CRP,IL-6,and TNF-α in serum were decreased(p<0.05 or p <0.01).Urinary TAP was decreased 1 and 2 days after treatment(p<0.05or p<0.01,respectively).In the control group,pancreatic tissue necrosis was evident in the wound area.Normal glandular cell structures and fibrous tissue hyperplasia were observed in the wound area after GMTI treatment.The GMTI group performed better than the GM group in improving pancreatic histology and reducing AMY levels in the early post-operative period.Conclusion:Guided by CEUS,daily peripancreatic injections of GMTI in Beagles effectively inhibit pancreatic enzyme activity and aid in the adjuvant treatment of pancreatic trauma.
基金supported by the Sichuan Province Nursing Scientific Research Project Plan(H23022)the 2022 Municipal-University Science and Technology Strategic Cooperation Special Fund of Nanchong Science and Technology Bureau(22SXQT0222)。
文摘Objective Accurately identifying the key influencing factors of psychological birth trauma in primiparous women is crucial for implementing effective preventive and intervention measures.This study aimed to develop and validate an interpretable machine learning prediction model for identifying the key influencing factors of psychological birth trauma in primiparous women.Methods A multicenter cross-sectional study was conducted on primiparous women in four tertiary hospitals in Sichuan Province,southwestern China,from December 2023 to March 2024.The Childbirth Trauma Index was used in assessing psychological birth trauma in primiparous women.Data were collected and randomly divided into a training set(80%,n=289)and a testing set(20%,n=73).Six different machine learning models were trained and tested.Training and prediction were conducted using six machine learning models included Linear Regression,Support Vector Regression,Multilayer Perceptron Regression,eXtreme Gradient Boosting Regression,Random Forest Regression,and Adaptive Boosting Regression.The optimal model was selected based on various performance metrics,and its predictive results were interpreted using SHapley Additive exPlanations(SHAP)and accumulated local effects(ALE).Results Among the six machine learning models,the Multilayer Perceptron Regression model exhibited the best overall performance in the testing set(MAE=3.977,MSE=24.832,R2=0.507,EVS=0.524,RMSE=4.983).In the testing set,the R2 and EVS of the Multilayer Perceptron Regression model increased by 8.3%and 1.2%,respectively,compared to the traditional linear regression model.Meanwhile,the MAE,MSE,and RMSE decreased by 0.4%,7.3%,and 3.7%,respectively,compared to the traditional linear regression model.The SHAP analysis indicated that intrapartum pain,anxiety,postpartum pain,resilience,and planned pregnancy are the most critical influencing factors of psychological birth trauma in primiparous women.The ALE analysis indicated that higher intrapartum pain,anxiety,and postpartum pain scores are risk factors,while higher resilience scores are protective factors.Conclusions Interpretable machine learning prediction models can identify the key influencing factors of psychological birth trauma in primiparous women.SHAP and ALE analyses based on the Multilayer Perceptron Regression model can help healthcare providers understand the complex decision-making logic within a prediction model.This study provides a scientific basis for the early prevention and personalized intervention of psychological birth trauma in primiparous women.
文摘Trauma is a major cause of morbidity and mortality across the globe accounting for significant health burden.Relevance of trauma care revolves round prevention,planning and execution of safety regulations.Acquisition of the actual data regarding the type of trauma,affected age group,timings of trauma occurrence,involved part of the body constitute the initial steps in the building of the composite overview of the epidemiology of trauma.In succession,would be the measures directed towards avoidance of trauma and capacity building of trauma center.
文摘The care of a patient involved in major trauma with exsanguinating haemorrhage is time-critical to achieve definitive haemorrhage control,and it requires coordinated multidisciplinary care.During initial resuscitation of a patient in the emergency department(ED),Code Crimson activation facilitates rapid decisionmaking by multi-disciplinary specialists for definitive haemorrhage control in operating theatre(OT)and/or interventional radiology(IR)suite.Once this decision has been made,there may still be various factors that lead to delay in transporting the patient from ED to OT/IR.Red Blanket protocol identifies and addresses these factors and processes which cause delay,and aims to facilitate rapid and safe transport of the haemodynamically unstable patient from ED to OT,while minimizing delay in resuscitation during the transfer.The two processes,Code Crimson and Red Blanket,complement each other.It would be ideal to merge the two processes into a single protocol rather than having two separate workflows.Introducing these quality improvement strategies and coor-dinated processes within the trauma framework of the hospitals/healthcare systems will help in further improving the multi-disciplinary care for the complex trauma patients requiring rapid and definitive haemorrhage control.
文摘Extracorporeal membrane oxygenation(ECMO)has emerged as a vital circulatory life support measure for patients with critical cardiac or pulmonary conditions unresponsive to conventional therapies.ECMO allows blood to be extracted from a patient and introduced to a machine that oxygenates blood and removes carbon dioxide.This blood is then reintroduced into the patient’s circulatory system.This process makes ECMO essential for treating various medical conditions,both as a standalone therapy and as adjuvant therapy.Veno-venous(VV)ECMO primarily supports respiratory function and indicates respiratory distress.Simultaneously,veno-arterial(VA)ECMO provides hemodynamic and respiratory support and is suitable for cardiac-related complications.This study reviews recent literature to elucidate the evolving role of ECMO in trauma care,considering its procedural intricacies,indications,contraindications,and associated complications.Notably,the use of ECMO in trauma patients,particularly for acute respiratory distress syndrome and cardiogenic shock,has demonstrated promising outcomes despite challenges such as anticoagulation management and complications such as acute kidney injury,bleeding,thrombosis,and hemolysis.Some studies have shown that VV ECMO was associated with significantly higher survival rates than conventional mechanical ventilation,whereas other studies have reported that VA ECMO was associated with lower survival rates than VV ECMO.ECMO plays a critical role in managing trauma patients,particularly those with acute respiratory failure.Further research is necessary to explore the full potential of ECMO in trauma care.Clinicians should have a clear understanding of the indications and contraindications for the use of ECMO to maximize its benefits in treating trauma patients.
文摘Purpose: To evaluate open lower limb trauma management in children. Me-thod: We conducted a twelve-month cross-sectional prospective study. Results: Open trauma of lower limb had 7.9% of hospital frequency. Mean age was 8 years with a sex ratio of 2.45. In 68.4% of cases, trauma occurred in road traffic accidents. Average consultation time was 2.4 hours. Trauma mainly affected the leg in 39.5% of cases, and the thigh in 34.2%. Soft tissue wounds occurred in 52.6% of cases, and open fractures in 47.4%. Average response time was one hour. Wound trimming and suturing were performed in 76.3% of cases and combined with bone nailing in 15.8%. The outcome was favorable in 92.1% of cases. Average hospital stay was 4.37 days. Conclusion: Open trauma to the lower limb is a frequent and occurs mainly in road traffic accidents. Management was early, with a favorable outcome for most patients and a short hospital stay.
文摘Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th)version,due to be published,two decades after its first initiation.It is described as an enhanced version of the current definition of PTSD,with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation,negative self-cognitions and interpersonal hardship,thus resembling the clinical features commonly encountered in borderline personality disorder(BPD).Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context,generally interpersonal in nature.In this manuscript,we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them,along with their clinical features.Furthermore,we suggest that besides the present distinct clinical diagnoses(PTSD;Complex PTSD;BPD),there is a cluster of these comorbid disorders,that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such.More studies are needed to confirm or reject this hypothesis,particularly in clinical terms and how they correlate to clinical entities'biological background,endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.
文摘BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleeding and hypovolemic shock which entails significant clinical attention during initial resuscitation.AIM To assess whether an initial episode of prehospital or emergency department hypotension is associated with an increased risk of morbidity and mortality in trauma patients.METHODS A retrospective analysis was performed to include all trauma patients hospitalized between 2011 and 2021.Hypotension was defined as a systolic blood pressure≤90 mmHg in the prehospital setting or upon arrival to the hospital.Patients were classified into normotensive vs hypotensive and survivors vs nonsurvivors.Data was analyzed and compared,and multivariable logistic regression analysis was performed to identify the predictors of mortality.RESULTS Over the ten years,17341 trauma admissions were analyzed,of which 1188(6.9%)patients had hypotension episodes either at the scene or upon hospital arrival.Patients with hypotension were two years younger(P=0.001)in age and were more likely to have higher pulse rate(P=0.001),elevated shock index(P=0.001),sustained more severe injuries,frequently required blood transfusion and laparotomy,and had higher complications and mortality rates.Multivariable regression analysis identified hypotension[adjusted odds ratio(aOR)=2.505;95% confidence interval(95%CI)=1.798-3.489;P=0.001]and acute respiratory distress syndrome(ARDS;aOR=5.482;95%CI=3.297-9.116;P=0.001)as independent predictors of mortality.Among hypotensive trauma patients,only ARDS(aOR=3.518;95%CI=1.385-7.204;P=0.006)was significantly associated with mortality.CONCLUSION Hypotensive episodes following trauma are associated with higher severity and mortality.The development of ARDS is an independent predictor of mortality in hypotensive trauma patients.A hypotensive episode is a warning sign and calls for aggressive,timely management following trauma.
文摘This paper explores the concept of crisis from a critical and interdisciplinary perspective,arguing that many contemporary crises-such as the coronavirus crisis and the climate crisis-are socially constructed and misunderstood.Drawing from Thomas Kuhn’s paradigm shift theory,Nassim Nicholas Taleb’s Black Swan concept,and complexity science,it contends that crises are a normal part of systemic evolution rather than extraordinary disruptions.The paper critiques the shift in agency from individuals to macro-level institutions,which has led to crises being perceived as indefinite rather than finite.The work also examines how crises are often framed through memetics rather than physical reality.By analyzing historical and contemporary crises,the paper illustrates how crisis narratives shape societal behavior and policy.The role of antifragility,memetic warfare,and evolutionary stable strategies(ESS)is discussed,demonstrating how resilience emerges through localized,rather than globalized,responses.The study concludes by advocating for a shift away from progressivist macro-level interventions and toward individual agency as the fundamental unit of societal adaptation.This perspective reframes crises as necessary transitions within evolutionary progress,arguing that societal sustainability depends on decentralization and adaptation rather than centralized control and panic-driven reactions.
基金supported by the U.S.Department of Veterans Affairs through the Translational Research Center for TBI and Stress Disorders(TRACTS B3001-C),a VA Rehabilitation Research and Development Traumatic Brain Injury National Network Research Center,and the Boston University Chobanian&Avedisian School of Medicine’s Medical Student Summer Research Program,with funding from the Gabriel Family Foundation CTE Research Fund(MA).
文摘Background:Poor sleep quality has been associated with changes in brain volume among veterans,particularly those who have experienced mild traumatic brain injury(mTBI)and post-traumatic stress disorder(PTSD).This study sought to investigate:1)whether poor sleep quality is associated with decreased cortical thickness in Iraq and Afghanistan war veterans,and 2)whether these associations differ topographically depending on the presence or absence of mTBI and PTSD.Methods:A sample of 440 post-9/11 era U.S.veterans enrolled in the Translational Research Center for Traumatic Brain Injury and Stress Disorders study at VA Boston,MA from 2010 to 2022 was included in the study.We examined the relationship between sleep quality,as measured by the Pittsburgh Sleep Quality Index(PSQI),and cortical thickness in veterans with mTBI(n=57),PTSD(n=110),comorbid mTBI and PTSD(n=129),and neither PTSD nor mTBI(n=144).To determine the topographical relationship between subjective sleep quality and cortical thickness in each diagnostic group,we employed a General Linear Model(GLM)at each vertex on the cortical mantle.The extent of topographical overlap between the resulting statistical maps was assessed using Dice coefficients.Results:There were no significant associations between PSQI and cortical thickness in the group without PTSD or mTBI(n=144)or in the PTSD-only group(n=110).In the mTBI-only group(n=57),lower sleep quality was significantly associated with reduced thickness bilaterally in frontal,cingulate,and precuneus regions,as well as in the right parietal and temporal regions(β=-0.0137,P<0.0005).In the comorbid mTBI and PTSD group(n=129),significant associations were observed bilaterally in frontal,precentral,and precuneus regions,in the left cingulate and the right parietal regions(β=-0.0094,P<0.0005).Interaction analysis revealed that there was a stronger relationship between poor sleep quality and decreased cortical thickness in individuals with mTBI(n=186)compared with those without mTBI(n=254)specifically in the frontal and cingulate regions(β=-0.0077,P<0.0005).Conclusions:This study demonstrates a significant relationship between poor sleep quality and lower cortical thickness primarily within frontal regions among individuals with both isolated mTBI or comorbid diagnoses of mTBI and PTSD.Thus,if directionality is established in longitudinal and interventional studies,it may be crucial to consider addressing sleep in the treatment of veterans who have sustained mTBI.
基金Supported by Research Project of Nantong Health and Health Commission,No.MS2023041 and No.MA2021017Science and Technology Program of Nantong City,No.Key03 and No.JCZ2022040+1 种基金Kangda College of Nanjing Medical University,No.KD2021JYYJYB025,No.KD2022KYJJZD019,and No.KD2022KYJJZD022Nantong Young Medical Expert,No.46.
文摘This editorial discusses a recent article published by Li et al in 2024,which highlights a critical yet underexplored dimension of chronic wound care:The impact of psychological factors such as depression and anxiety on treatment outcomes.With the increasing prevalence of chronic wounds in China,driven by population aging,traffic accidents,and chronic diseases,chronic wounds have emerged as a significant public health concern.They not only pose serious threats to individual health but also impose considerable social and economic burdens on healthcare systems.Against this backdrop,the study by Li et al aimed to explore how psychological distress affects the management and recovery of patients with chronic wounds.In their research,chronic wound patients were meticulously evaluated for depression and anxiety using validated psychological assessment scales and blood biomarkers.The findings reveal a stark reality:Individuals with severe depression and anxiety exhibit markedly lower treatment adherence,slower recovery rates,and diminished post-treatment quality of life.These psychological challenges hinder patients’active engagement with their care plans and may directly impede physiological healing processes.Importantly,the study underscored that factors such as wound size,anxiety,and depression significantly influence therapeutic outcomes in chronic wound patients.This insight calls for a more holistic approach to wound care,where addressing psychological well-being becomes an integral component of treatment protocols.As such,the study highlighted the necessity of early identification and targeted intervention for depression and anxiety in chronic wound patients. By prioritizing psychological support alongside medicaltreatment, healthcare providers can enhance therapeutic efficacy and improve patients’ long-term quality of life.This integrative approach can not only optimize clinical outcomes but also alleviate the broader societal andeconomic impact of chronic wounds.
文摘BACKGROUND The occurrence of chronic pain and disability after acute orthopedic trauma is significantly correlated with psychological factors,particularly depression and anxiety.As such,assessment of these factors is crucial for postoperative rehabilitation.AIM To investigate the correlation between chronic pain,disability,and psychological factors(depression and anxiety)after acute orthopedic trauma surgery.METHODS Data from 120 patients,who underwent surgery for acute orthopedic trauma at Xi’an Traditional Chinese Medicine Hospital(Shaanxi Province,China)between June 2022 and June 2024,were retrospectively analyzed.Basic information and postoperative pain metrics[visual analog scale(VAS)],disability rating index(DRI),Hamilton anxiety rating scale(HAMA)and Hamilton depression rating scale(HAMD)were collected from electronic medical records.Pearson’s correlation analysis was used to examine associations between chronic pain VAS,DRI,HAMD,and HAMA scores.RESULTS Among the 120 patients[79(65.8%)males and 41(34.2%)females],postoperative VAS scores were significantly associated with HAMD and HAMA scores,with correlation coefficients of 0.625(P=0.027)and 0.568(P<0.001),respectively.Postoperative DRI scores were also significantly associated with HAMD and HAMA scores,with correlation coefficients of 0.683 and 0.557,respectively(both P<0.001).CONCLUSION Chronic pain and disability after surgery for acute orthopedic trauma are significantly correlated with psychological factors(depression and anxiety).Multidisciplinary teams should integrate mental health services to improve patient outcomes.
