Background: Exposure of children and young people to potentially traumatic events is common. There is a need for increased access to early interventions following a potentially traumatic event.Objective: This review aimed to identify early psychotherapeutic interventions which attempted to decrease posttraumatic stress responses and/or reduce the risk of developing persistent posttraumatic stress disorder.Method: We included papers that outlined a psychotherapeutic intervention delivered to children and young people in the acute (within 1 month) and early-post-trauma period (2 to 6 months), following a potentially traumatic event. Four databases were searched, including PubMed, PsycINFO, Web of Science, and ASSIA.Results: Twenty-one papers met the inclusion criteria. The most frequent technique identified was psychoeducation, often combined with other techniques. Interventions were typically delivered by highly experienced clinical professionals. Two interventions were delivered either by lay counsellors or community facilitators. Most interventions were delivered within 1 month of exposure.Discussion: All interventions delivered beyond 1 month after the event showed significant reductions in posttraumatic stress symptoms, whereas those delivered within a month yielded mixed results. Conclusions: There remains a scarcity of evidence on early interventions following potentially traumatic events. We identified interventions delivered by community professionals with less clinical experience, which could inform how we increase access to support following potentially traumatic events.
Venous fat emboli are uncommon but important radiological findings in patients with long-bone fractures, and direct visualization on computed tomography (CT) is rarely reported. We report the case of a 34-year-old man with polytrauma, reported to be hemodynamically stable, admitted after a motorcycle road traffic accident. Initial radiography demonstrated a complete, displaced fracture of the proximal third of the left femoral shaft. Whole-body trauma CT revealed a fat-attenuation intravascular lesion within the distal left external iliac vein extending into the proximal left common femoral vein, with an attenuation value of approximately -81 Hounsfield units, consistent with a venous fat embolus. The lesion persisted in the same venous location across the available non-contrast, arterial-phase, and portal venous-phase images. Thoracic CT angiography showed no pulmonary arterial filling defect or acute pulmonary parenchymal abnormality on the available images. Abdominopelvic CT also demonstrated a superior polar splenic laceration measuring more than 3 cm in depth, associated with perisplenic hemoperitoneum, consistent with grade III splenic injury according to the American Association for the Surgery of Trauma classification. No definite active contrast extravasation was identified on the available arterial, portal venous, and delayed-phase images. Orthopedic fixation of the femoral fracture was subsequently performed; however, detailed follow-up data, including respiratory evolution, neurological status, laboratory data, splenic injury management, and discharge outcome, were not documented in the available medical record. This case highlights the importance of systematic venous assessment on whole-body trauma CT in patients with long-bone fractures and emphasizes the distinction between a CT-visible venous fat embolus and fat embolism syndrome, which remains a clinical diagnosis requiring appropriate clinical correlation.
Traumatic brain injury is a major cause of death and disability in children, and early identification of high-risk cases is critical for improving clinical outcomes. This study aimed to develop and validate a clinical prediction model to estimate the 30-day in-hospital mortality in pediatric patients with moderate-to-severe traumatic brain injury (msTBI). A retrospective analysis was conducted on 289 pediatric patients admitted with msTBI. Independent risk factors were identified using the least absolute shrinkage and selection operator regression and multivariable logistic regression analysis to construct a clinical nomogram. Model performance was assessed using ROC curves, bootstrap validation, and decision curve analysis. The median age of the cohort was 5.17 (IQR, 2.75-9.33) years. There were 101 females and 188 males. Four independent predictors were identified: Glasgow Coma Scale score, lactic acid, albumin, and trauma-induced coagulopathy. The model showed AUC of 0.898 (95% CI: 0.896, 0.899) and good agreement between predicted and observed outcomes. Hosmer-Lemeshow test yielded a non-significant P-value (P = 0.475), supporting good model calibration. Clinical decision analysis demonstrated that the threshold probability ranged from 0 to 0.95. This study developed a reliable clinical tool to predict 30-day in-hospital mortality in children with msTBI. It may support early risk stratification and assist clinicians in making informed treatment decisions.
We present a rare case of post-traumatic ascending aortic dissection along with a sternal fracture. The patient underwent a successful surgical procedure involving excision of the aorta affected by dissection, replacement of the ascending aorta, and repair of the sternal fracture. Although traumatic injuries to the aorta are considered a common cause of death, reports on successful surgery for ascending aortic (Stanford type A) dissection with sternal fracture are scarce. To the best of our knowledge, this is the first such case reported from India, and only a few similar cases of traumatic ascending aortic dissection with solid viscus injuries of rib fractures have been reported from other countries. This case indicates that successful outcomes could be anticipated if diagnosed early and treated aggressively with replacement or repair of the ascending aorta on cardiopulmonary bypass (CPB).
Lower extremity numbness, pain, and weakness after trauma are often attributed to neurological causes such as lumbar disc herniation or spinal injury. However, vascular injuries may present with similar symptoms and lead to diagnostic confusion. We report a 61-year-old woman who developed progressive numbness and weakness of the right lower extremity after a traffic-related fall onto the right hip. Lumbar magnetic resonance imaging showed L5 endplate fracture and degenerative spinal changes, initially suggesting a neurogenic cause. However, physical examination revealed pallor, coldness, and absent distal pulses in the affected limb, raising suspicion of arterial occlusion. Computed tomography angiography confirmed complete occlusion of the right common iliac artery. The patient underwent endovascular angioplasty with stent placement, which restored arterial flow and resulted in rapid symptom resolution. This case highlights an important diagnostic pitfall and emphasizes the importance of careful pulse examination when post-traumatic neurological symptoms are accompanied by limb ischemia.
Corneal scars develop during the regenerative process following traumatic injuries. Verteporfin (VP), a Yes-associated protein (YAP) inhibitor, has shown promise as an antifibrotic agent, but its application to the ocular surface is limited by unfavorable physicochemical properties. Here, we developed the hyaluronic acid-verteporfin nanoparticles (HA-VP NPs) to increase the apparent solubility of VP and prolong residence on the eye, aiming to promote corneal regeneration and prevent scar formation following injuries. The HA-VP NPs effectively prevented not only the transformation of corneal stromal cells into myofibroblasts, but also the epithelial-mesenchymal transition of epithelial cells by inhibiting the translocation of YAP into the nucleus. HA-VP NPs interacted with CD44 receptors, facilitating endocytosis in corneal stromal cells and contributing to prolonged residence time in corneal defects. In a rat anterior lamellar keratoplasty model, the HA-VP NPs were retained on corneal defects for at least 4 h, resulting in excellent corneal regeneration and significant reduction in scarring.
暂无摘要（点击查看详情）
Inferior vena cava (IVC) thrombosis is a rare but serious complication. We report a case of delayed presentation of abdominal compartment syndrome (ACS) secondary to IVC thrombosis, which contributed to progressive multi-organ dysfunction syndrome. Increased intra-abdominal pressure further resulted in venous stasis and thrombus formation, exacerbating systemic deterioration. Despite supportive care and attempted interventions, the patient developed refractory organ failure and expired. This case underscores the critical importance of early diagnosis and timely management of ACS to prevent vascular complications and fatal outcomes.
We present a case of a 60-year-old female patient who presented to a community hospital emergency department after a motor vehicle collision with car intrusion, with left eye proptosis, ecchymosis, decreased left-sided extraocular movement, and progressive eye pain. Clinical findings were consistent with orbital wall fracture and retrobulbar hematoma leading to orbital compartment syndrome (OCS). Lateral canthotomy was performed in the emergency department of an acute-care hospital without on-site ophthalmology prior to transfer to a tertiary care center. This case highlights the importance of recognizing OCS, which requires time-sensitive intervention to prevent permanent vision loss, and the ability of emergency physicians to perform the procedure in a suboptimal setting.
Anatomical variations in the brachial plexus can significantly affect upper-extremity surgical procedures. This report highlights a rare case where both pectoralis muscles receive accessory innervation. The pectoralis major exhibited three additional branches stemming directly from the anterior divisions of the superior and middle trunks, effectively bypassing the lateral cord. The pectoralis minor likewise demonstrated variant innervation, receiving two additional branches. One was an unexpected confluence in which a branch destined for the pectoralis major coursed through and innervated the pectoralis minor, despite the pectoralis minor typically receiving its own independent branch. The other branch originated from the anterior division of the middle trunk. Furthermore, a variant ansa pectoralis was identified, originating from the anterior division of the middle trunk and medial cord, and giving rise to the medial and lateral pectoral nerves. This unique configuration may present clinical implications for surgeons, particularly during procedures involving the proximal upper limb and supraclavicular pectoral region. Identifying these variations can help minimize the risk of iatrogenic nerve injury and enhance surgical planning.
暂无摘要（点击查看详情）
Since 2011, the Syrian conflict has generated one of the largest displacement crises globally, with most Syrian refugees hosted in neighboring Middle Eastern countries. These host settings differ substantially in legal, social, settlement, and service conditions, which shapes both refugee experiences and the interpretation of mental health evidence. Protracted displacement, cumulative trauma, and post- migration adversity have contributed to a substantial burden of psychological distress, yet distress may be expressed not only through post-traumatic stress, depression, and anxiety symptoms, but also through culturally embedded experiences such as somatic complaints, grief, family disruption, role loss, stigma, uncertainty, and reduced dignity. This scoping review mapped prevalence patterns of psychological distress and associated risk and protective factors among Syrian refugees residing in Middle Eastern host countries, including Jordan, Lebanon, Turkey, Iraq, and Egypt. Following the Arksey and O'Malley framework and reported in accordance with PRISMA ScR, we searched PubMed, Web of Science Core Collection, and Scopus for peer-reviewed English language studies published between 2011 and 2025, with searches last updated in December 2025. Records were screened at title and abstract and full text stages using predefined criteria. Screening and data extraction were conducted by a single reviewer using standardized forms, with decisions and extracted data reviewed and discussed with a second author to enhance consistency. Eighteen studies met inclusion criteria, most conducted in Jordan, Lebanon, and Turkey, with fewer in Iraq and Egypt. Psychological distress was consistently substantial, most commonly reflected in elevated post-traumatic stress, depressive, and anxiety symptoms, while reported prevalence patterns varied widely by host country context, living setting, subgroup, sampling frame, and instruments or cut offs. Distress was repeatedly associated with trauma exposure and post-migration living difficulties, including economic hardship, legal insecurity, and daily stressors, whereas social connectedness and perceived support emerged as protective correlates. Findings highlight the need for scalable, culturally responsive psychosocial interventions and service models that reduce structural barriers to access, address stigma, and account for culturally embedded expressions of distress in protracted displacement settings. https://osf.io/vmju8/overview.
Heparin-binding protein (HBP) is an inflammatory protein released by activated polymorphonuclear white cells. It has been suggested as a predictor of sepsis progression and organ dysfunction and plays a role in the pathophysiology of endothelial dysfunction. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor with pro-inflammatory effects, and high levels are found in patients with sepsis and acute respiratory distress syndrome. We investigated HBP and ET-1 plasma levels in critical COVID-19 disease with the aim of evaluating whether they were associated with 60-day mortality or the need for invasive mechanical ventilation (IMV). These levels were compared with those of a cohort of post-trauma intensive care unit (ICU) patients. We included 96 patients with critical COVID-19 disease in 2020 and ten post-trauma ICU patients. Blood samples were collected at ICU admission, and plasma levels of HBP and ET-1 were measured. Clinical and laboratory data were collected until ICU discharge or death. In COVID-19 patients, plasma levels of HBP were markedly increased, with a median level of 150 ng/ml (IQR 47-299), compared to 13.3 ng/ml (IQR 8.8-62.1), p < 0.0001 in the trauma ICU patients. There was no association between HBP levels and 60-day mortality or need for IMV. The levels of ET-1 were 1.6 pg/ml (IQR 1.2-1.9) in the COVID-19 cohort and 2.0 pg/ml (IQR 1.2-2.8), p = 0.25 in the trauma ICU cohort. COVID-19 patients requiring IMV hade higher ET-1 levels than those who did not require such treatment; however, no association was found in a logistic regression model when adjusted for age, sex and body mass index. There was no correlation between plasma HBP and ET-1 levels. Inflammatory parameters such as C-reactive protein, procalcitonin, ferritin, and interleukin-6, were elevated but did not distinguish survivors from non-survivors. While HBP levels are markedly elevated in critical COVID-19, they do not predict outcomes at ICU admission. ET-1 levels were also not linked to mortality or the need for IMV.
Eating disorders (ED) and psychosis/psychotic-spectrum disorders (PSD) have overlapping symptoms and may co-occur in a variety of presentations. Due to its debilitating and life-threatening risk, it is important for clinicians to be aware of how catatonia may present within these co-occurrences. A narrative review was conducted of catatonic presentations in individuals with co-occurring EDs and psychosis, using the databases Google Scholar, ScienceDirect, PubMed, ProQuest and PsychInfo. This article reviews and summarises the 10 cases found in the literature, and explores critical considerations within ED-psychosis co-occurrence, including the author's lived experience insight into experiencing catatonia within co-occurring ED-psychosis. In 9 out of 10 cases, catatonia occurred during adolescence (ages 13-24). Fifty percent of cases involved stressful or traumatic events as a precipitant to catatonia emergence. Autistic individuals with EDs may be particularly vulnerable to catatonic symptoms. In most cases, catatonic symptoms responded to lorazepam treatment or a combination of lorazepam and other medications such as antipsychotics, although tube-feeding was also required in some cases. This review discusses key factors and intersections that are highly relevant to individuals vulnerable to EDs and psychosis (i.e., malnutrition, trauma, autism, bipolar disorder, OCD). Catatonic symptoms may be mistaken for ED symptoms, delaying early treatment in individuals with ED. Consideration of catatonic presentations and trauma-informed and neurodivergent-affirming treatment practices are recommended.
Abdominal trauma with bleeding is a leading cause of post-traumatic death, and detecting free fluid in the abdomen or hemoperitoneum can provide critical guidance for clinical management. Rapid and accurate diagnosis of abdominal bleeding using ultrasound is significant for making decisions regarding the need for surgical intervention. This study introduces a multi-task network for the segmentation and classification of ascites in ultrasound images. The network utilizes a U-Net backbone with a ResNext encoder as the basic architecture for the segmentation and classification models. The segmentation network includes a Frequency Channel Attention (FCA) attention module, which effectively broadens the range of captured information and enhances the robustness of channel representation. Furthermore, an Enhanced Channel Attention Multi Feature Fusion (EMFF) was used to extract the interdependencies between feature channels by combining high-order and low-order feature mappings, thereby improving segmentation accuracy. Lastly, a classification branch was created to classify ascites by sharing encoder features. Experiments on the collected ascites ultrasound dataset demonstrated that the proposed method achieved a segmentation Dice of 85.28% and a classification accuracy of 86.18%. It outperformed the leading multi-task SOTA method by 0.7% in Dice and 2.03% in accuracy, establishing a new benchmark for simultaneous ascites assessment. This study showed that the proposed network is valuable for the preliminary diagnosis of ascites in ultrasound and can serve as a potential auxiliary tool for clinical ascites examination in emergency situations.
Oral fiberoptic-guided intubation can be challenging in anesthetized patients due to loss of pharyngeal muscle tone, resulting in posterior displacement of the tongue, soft palate, and epiglottis. Maneuvers such as jaw thrust can improve patency, but their effectiveness may vary with patient position. Semi-sitting positioning has been shown to reduce upper airway collapsibility. This study compared airway clearance obtained by jaw thrust in the semi-sitting versus supine position during oral fiberoptic intubation. This prospective randomized comparative study included adult American Society of Anesthesiologists (ASA) I-II patients aged 18-60 years undergoing elective surgery with orotracheal intubation. Patients were randomized into two groups: semi-sitting at 25° with jaw thrust (Group SS) and supine with jaw thrust (Group S). Airway clearance at the soft palate level (primary outcome) and at the epiglottis, time to visualize the vocal cords and carina, attempts required for tube advancement, total intubation time, and post-extubation airway trauma were assessed. Statistical analysis used chi-square and Student's t-test, with p<0.05 considered significant. Sixty patients completed the study (30 per group). Airway clearance at the soft palate was significantly better in the semi-sitting group (p<0.001). Clearance at the epiglottis was comparable between groups (p=0.100). Time to visualize the vocal cords (12.35±6.68 vs. 15.99±5.37 s; p=0.024) and carina (19.92±7.10 vs. 25.05±7.03 s; p=0.007) was significantly shorter in the semi-sitting group. Tube advancement attempts, time for tube passage, total intubation time, and incidence of trauma or postoperative sore throat were similar across groups. No intubation failures or desaturation occurred. Jaw thrust in the 25° semi-sitting position provides superior airway clearance at the soft palate and allows faster visualization of the vocal cords and carina during oral fiberoptic intubation. Overall intubation time and tube advancement characteristics remain similar between positions. Semi-sitting positioning may therefore be a useful adjunct to improve pharyngeal patency and facilitate fiberoptic-guided intubation in anesthetized patients.
Penetrating injuries to the left thoracoabdominal (LTA) region pose significant diagnostic challenges due to the diaphragm's anatomical location. Early diaphragmatic injuries may be clinically silent and radiologically occult, whereas delayed diagnosis can result in visceral herniation and life-threatening complications. No studies have investigated the role of individualized anatomical parameters, specifically the distance from the entry wound to the diaphragm and diaphragm area, in predicting injury risk. Recognizing this gap, we aimed to introduce and assess a novel parameter, the Diaphragmatic Penetration Index (DPI), that incorporates both factors. This retrospective study included 67 adult patients with single-entry LTA penetrating trauma who underwent laparoscopic or open surgical exploration between 2010 and 2025. Patients with multiple wounds, blunt trauma, cardiopulmonary resuscitation, missing CT scans, or loss to follow-up were excluded. DPI was defined as the ratio of diaphragm area (DA) (mm²) to entry wound-to-diaphragm distance (EHD) (mm), both measured from preoperative CT using 3D Slicer and Medseg.ai. Receiver operating characteristic (ROC) curve analysis was applied to evaluate DPI's diagnostic performance. The mean patient age was 29.37 ± 11.80 years; 94.0% were male. Diaphragmatic injury was intraoperatively confirmed in 37.3% (n = 25) of patients. Median EHD was 82.48 mm, median DA was 32,450 mm², and median DPI was 394.9. ROC analysis demonstrated that EHD alone did not reach statistical significance (AUC 0.567, 95% CI: 0.415-0.716; p = 0.184), while DA (AUC 0.664, 95% CI: 0.530-0.791; p = 0.013) and DPI (AUC 0.654, 95% CI: 0.516-0.787; p = 0.018) achieved statistical significance but only modest discriminatory ability. Pairwise comparison revealed no significant difference between DA and DPI (p = 0.900), indicating that DA is the principal contributor to DPI performance. At the optimal DPI cut-off of 266.96 (Youden's index), sensitivity was 48.0% and specificity was 83.3%; retrospective simulation showed that applying this threshold prospectively would have spared 35 patients (83.3% of non-injured patients) unnecessary surgical exploration, while 13 diaphragmatic injuries (52.0%) would have remained undetected. Neither DA, EHD, nor DPI demonstrated sufficient individual discriminatory performance to reliably predict diaphragmatic injury in penetrating left thoracoabdominal trauma. EHD was not independently associated with injury likelihood, and DPI offered no significant discriminatory advantage over DA alone. These findings suggest that anatomical parameters derived from CT-based measurements are inadequate as standalone triage tools, and that the high false negative rate at any clinically applicable threshold precludes their use as rule-out criteria. The quantification of this limitation is itself a clinically meaningful contribution, establishing a benchmark for future research. Prospective studies incorporating multiparametric models that combine anatomical, clinical, and radiological variables are required before any of these parameters can be considered for clinical adoption.
The precise role of hypoxia-inducible factor-1α (HIF-1α) in osteoarthritis (OA) pathogenesis remains controversial, often debated between a protective compensatory factor and a disease mediator. Here, we demonstrate that sustained, uncoupled HIF-1α accumulation functions as a potent, compartment-specific pathogenic driver of joint destruction. Using genetically engineered mouse models, we reveal that chondrocyte-specific HIF-1α overexpression (AcanCreERT2; Hif1αdPAfl/fl) triggers spontaneous OA and exacerbates destabilization of the medial meniscus (DMM)-induced post-traumatic joint degeneration. Mechanistically, continuous HIF-1α activation drives pathological angiogenesis that physically dismantles the avascular, hypoxic cartilage niche, forcing a profound metabolic dysregulation that culminates in catastrophic matrix degradation. Conversely, sustained HIF-1α activation within the synovial and superficial cartilage compartments (Prg4- GFPCreERT2; Hif1αdPAfl/fl) drives a slowly progressive, late-onset spontaneous OA through chronic inflammatory accumulation that actively suppresses Col2a1 expression. Furthermore, this robust inflammatory priming establishes a highly vulnerable microenvironment, whereby DMM surgery significantly accelerates the progression of trauma-induced joint collapse. Finally, transient whole-joint HIF-1α induction via an intra-articular injection of lipid nanoparticles (LNP-mRNA) closely recapitulates these detrimental effects. Collectively, our study reconciles existing controversies by establishing sustained HIF-1α accumulation as a spatiotemporally dynamic, broad disease amplifier across the articular ecosystem, highlighting its targeted inhibition as a promising therapeutic strategy for OA.
Unstable pelvic ring injuries usually present with pubic symphysis and/or pubic rami disruption, in association with fractures or fracture-dislocations affecting the posterior iliac, sacroiliac joint, and/or the sacrum. Involvement of the strong posterior osteoligamentous complex with an intact anterior pelvic ring is extremely rare, with only a limited number of cases previously documented. We report the case of a 15-year-old male who sustained high-energy trauma after being struck in the back by a heavy metal structure. He presented with a unilateral posterior sacroiliac dislocation and an intact anterior pelvic ring, which is believed to represent a previously unreported injury. The patient underwent closed reduction with percutaneous fixation using a 7.0 mm partially threaded cannulated iliosacral screw. This case highlights an unusual pelvic injury pattern not fully addressed by current classification systems and emphasizes the importance of carefully assessing anterior ring integrity in high-energy posterior pelvic trauma.
Suicide caused by depression in adolescents is a major global public health challenge, but the assessment of suicide risk in this population remains inadequate. This study aims to use network analysis to examine the interrelationships between suicide risk, childhood abuse, depression, hopelessness, and social support in treatment-naïve adolescent depression patients. The study included 518 treatment-naïve adolescent depression patients aged 10-18 (393 females and 125 males). General patient information was collected, and assessments were conducted using the Suicidal Behavior Questionnaire, Childhood Trauma Questionnaire, Self-Rating Depression Scale, Adolescent Social Support Scale, Pittsburgh Sleep Quality Index, and Beck Hopelessness Scale. Network analysis was performed using R language to examine the correlations between various factors, and the centrality and stability of the network structure were tested. In this network structure, emotional abuse showed the strongest edge with suicide risk. Furthermore, hopelessness, sleep duration, and depression were also linked to suicide risk. Childhood trauma experiences, especially emotional abuse, are strongly associated with suicide risk in treatment-naïve adolescent depression patients. This study has been registered with the China Clinical Trials Registry in (Registration No. ChiCTR2200064623; Registration Status: Prospective registration)13/10/2022. URL: https://www.chictr.org.cn/bin/project/edit?pid=175865.