Search Results (212)

Background/Objectives: This study aimed to investigate the effect of tibolone (TIB) on the expression of the NOX2 and NOX4 isoforms and their co-localization in neurons and astrocytes using an animal model of spinal cord injury (SCI). Methods: Male Sprague Dawley rats were subjected to contusive SCI at T9 and treated with TIB (1 or 2.5 mg/kg/day). The expression of NOX2 and NOX4, and their co-localization in neurons and astrocytes, were evaluated at 3, 7, and 15 days post-SCI. Oxidative stress markers and motor recovery were also assessed. Results: SCI induced a time-dependent increase in NOX2 protein expression at 15 days compared to 3 days (0.192 ± 0.012 vs. 0.013 ± 0.0007) and in NOX4 protein expression (0.027 ± 0.002 vs. 0.958 ± 0.088), displaying differential cell-specific localization patterns in neurons and astrocytes across time points. TIB treatment significantly attenuated SCI-induced oxidative stress (15,391.8 ± 1047.6 vs. 21,264.4 ± 2669.8) and decreased NOX2 and NOX4 co-localization in both neurons and astrocytes in a dose- and time-dependent manner. Furthermore, TIB-treated animals exhibited a modest but significant restoration of motor function at 15 days post-SCI. Conclusions: Our findings indicate that TIB administration reduces oxidative stress, modifies NOX2 and NOX4 immunoreactivity patterns in neurons and astrocytes, and promotes partial functional recovery following SCI. Full article

Sports-related oral and maxillofacial trauma exhibits distinct injury mechanisms depending on the type of sport; however, comprehensive analyses integrating these characteristics remain limited. This study aimed to elucidate the clinical features of sports-related oral and maxillofacial trauma. This single-center retrospective study included 1615 patients (mean age 41.04 years; 64.8% male) treated between 2012 and 2025 in Shimane University Hospital, Department of Oral and Maxillofacial Surgery/Maxillofacial Trauma Center, Shimane, Japan. Among them, 239 (14.8%) had sports-related injuries and were significantly younger and more frequently male (p < 0.001). Multivariable analysis showed that nasal bone (odds ratio [OR] 5.900, 95% confidence interval [CI] 3.309–10.521), orbital wall (OR: 8.044, 95% CI: 4.664–13.874), zygomatic and zygomatic arch (OR: 3.239, 95% CI: 1.455–7.213), and naso-orbito-ethmoidal fractures (OR: 6.507, 95% CI: 1.971–21.483), as well as contusions (OR: 2.601, 95% CI: 1.385–4.885), were positively associated, whereas mucosal lacerations (OR: 0.485, 95% CI: 0.290–0.811) and referral from dental/medical clinics (OR: 0.312, 95% CI: 0.178–0.546) were negatively associated (all p < 0.01). However, panfacial fractures occurred less frequently. Sports-related trauma was primarily associated with nasal, orbital wall, zygoma and zygomatic arch, and naso-orbito-ethmoidal fractures. These findings indicate that sports-related oral and maxillofacial trauma is characterized by distinct and predominantly midfacial fracture patterns. Full article

Background and Forensic Significance: Intimate partner violence (IPV) is a major public health concern that can result in intimate partner homicide (IPH). While most reported cases involve female victims, fatal violence against men, particularly older adults, remains under-recognized. We report an atypical case of IPH involving an elderly male victim who was killed by his female partner. This case highlights the importance of comprehensive medico-legal investigation to accurately reconstruct the mechanism of injury and exclude alternative causes of death. Case Presentation: A 76-year-old man was found dead in his home after his 72-year-old wife reported that she found him unresponsive. He had a history of asthma and chronic alcohol use, was reportedly intoxicated, and had been involved in a longstanding conflict with his spouse. Autopsy revealed multiple patterned abrasions and contusions with extensive intramuscular hemorrhage involving the extremities. Internal examination demonstrated generalized visceral pallor. Fatal acute asthma and alcohol intoxication were excluded. Overall, the cause of death was determined to be hemorrhagic shock resulting from repeated blunt force trauma, and the manner of death was classified as homicide. Conclusions: This case demonstrates that a sustained blunt force assault can lead to fatal intramuscular blood pooling. Furthermore, it illustrates the rare demographic and mechanism patterns of IPH, underscoring the importance of comprehensive medico-legal evaluation and awareness of such occurrences. Full article

Background/Objectives: The purpose of this study was to analyze the demographics and injury patterns of children with transportation-related non-fatal injuries occurring on public roads, streets and highways using a nationwide emergency department (ED) database. Methods: Data from the National Electronic Injury Surveillance System (NEISS) All Injury Program (AIP) 2005–2021 was used. Five transportation methods (motor vehicle occupant, bicyclist, pedestrian, motorcyclist, other) occurring on a public highway, street, or road were analyzed. Statistical analyses were performed with SUDAAN 11.0.01™ software to obtain national estimates. Results: There were an estimated 8,188,810 ED visits for traffic-related injuries in children; the median age is 14.3 years. Sex distribution was equal; 93.4% were discharged from the ED, and the head/neck was the most injured area (51.9%). The most common diagnoses were contusion (35.7%), strain/sprain (28.0%), internal organ injuries (13.3%), fracture (8.4%), lacerations (7.4%) and concussions (4.1%). Predictor variable of not being discharged from the ED was the presence of a fracture (OR = 119.7 [71.3, 200.7], p < 0.0001), injury to the trunk (OR = 3.2 [2.7, 3.8], p < 0.0001), a pedestrian (OR = 3.9 [2.8, 5.3], p < 0.0001), those <1.5 years old (OR = 4.3 [2.8, 6.6], p < 0.001), and males (OR 1.5 [1.4, 1.6], p < 0.0001). The greatest prevalence of head/neck fractures was in motor vehicle occupants (23.3%), upper extremity fractures in bicyclists (73.1%) and motorcyclists (49.2%), and lower extremity fractures in pedestrians (56.6%). Conclusions: This detailed study can be used to compare/contrast these injuries to other countries regarding road traffic injuries in children. This data can be used to assess the outcomes of prevention strategies introduced in the future. Full article

The current lack of effective treatments for traumatic spinal cord injury (SCI) presents a significant challenge in managing the complex microenvironmental alterations that follow the initial trauma. This study developed an injectable alginate hydrogel dynamically cross-linked by tannic acid–zinc nanoparticles (TA@Zn NPs), which exerts neuroprotective effects through the sustained release of zinc ions (Zn²⁺) and antioxidant TA@Zn NPs. TA@Zn NPs were cross-linked with phenylboronic acid-modified sodium alginate (SA) to form an injectable gel system. In response to the acidic and ROS-rich microenvironment characteristic of SCI, the hydrogel undergoes degradation, thereby triggering the disintegration of TA@Zn NPs and the concomitant release of Zn²⁺, enabling sustained therapeutic delivery. In a rat model of contusion injury, the degradation of TA@Zn NPs and the sustained release of Zn²⁺ significantly reduced oxidative damage and promoted axonal regeneration, which in turn inhibited scar formation and enhanced the tissue’s antioxidant capacity. Consequently, the group treated with the Zn²⁺-releasing hydrogel exhibited significant recovery of motor function. Collectively, these results validate the dual-function integration of Zn²⁺ as a dynamic cross-linker and neuroprotective agent within injectable hydrogels as a robust strategy for SCI repair, presenting a clinically translatable paradigm for neural regeneration. Full article

Background: Left ventricular (LV) thrombosis after blunt trauma is uncommon and is most often attributed to traumatic coronary artery injury; however, it can also arise from severe myocardial contusions. Here, we report a case of LV thrombosis due to severe myocardial contusion without coronary artery injury. Case Presentation: A 36-year-old man struck by industrial fan fragments presented with hemorrhagic shock. Focused Assessment with Sonography for Trauma revealed cardiac tamponade. An emergent sternotomy was performed under cardiopulmonary bypass via the femoral vessels, which exposed severe contusion-associated hemorrhage with epicardial–myocardial dissection at the LV apex. On postoperative day (POD) 5, transthoracic echocardiography showed apical akinesia with mural thrombi; prophylactic anticoagulation was escalated and later transitioned to warfarin. Coronary computed tomography on POD 21 and invasive angiography at 6 months revealed negative findings. The thrombi resolved within 3 months; however, apical akinesia persisted. After discontinuing anticoagulation, a transient ischemic event occurring at 9 months prompted direct oral anticoagulant therapy. Apical akinesia persisted for over 7 years without recurrent thrombosis. Conclusions: This case underscores the importance of vigilance for intracardiac thrombosis in severe contusions, as well as the value of stepwise imaging (contrast echocardiography) and cautious, individualized discontinuation of anticoagulation when regional dysfunction persists. Full article

Injuries in elite youth football may disrupt training continuity and long-term development, particularly during the post-peak height velocity (post-PHV) period when training and match demands increase. Therefore, the aim of this study was to determine injury incidence and describe injury patterns in elite U17 football players across six consecutive competitive seasons, including injury type, anatomical location, mechanism, recurrence, and severity. A prospective longitudinal injury-surveillance design was implemented in one elite football academy from 2016/2017 to 2021/2022. Injuries were recorded in the club’s medical database using the international consensus time-loss definition. Injury incidence per 1000 h was calculated for overall exposure, training, and matches, and injuries were analyzed by diagnosis, mechanism, recurrence, and severity. Across the study period, 331 injuries were recorded. Overall injury incidence was 6.95/1000 h, with markedly higher incidence in matches (20.61/1000 h) than training (5.82/1000 h). Seasonal incidence ranged from 4.49/1000 h in 2019/2020 to 9.31/1000 h in 2021/2022. The proportion of injured players ranged from 48% to 76% per season. The most frequent injuries were contusions and muscle cramps/DOMS, followed by ligament injuries, tendinosis, and muscle ruptures. Knee, thigh, ankle, and hip/groin were the most affected regions. Most diagnoses showed a predominantly non-contact pattern. These findings support targeted prevention and load-management strategies in elite youth football. Full article

Spinal cord injury (SCI) triggers a secondary injury cascade characterized by persistent innate immune activation, chronic neuroinflammation, and progressive tissue loss that limits functional recovery. Here, we evaluated a systemic combination treatment using propentofylline (PPF), a glial modulator, together with interleukin-4 (IL-4), a cytokine associated with repair-related myeloid responses. In vitro, PPF enhanced IL-4-dependent induction of arginase-1 (ARG1) in TNFα-primed BV2 microglia. In vivo, adult Fischer rats of both sexes received vehicle, PPF, IL-4, or combined PPF + IL-4 beginning within 1 h after moderate T8 contusive SCI and continuing daily for 14 days. Locomotor recovery was assessed longitudinally for 8 weeks, followed by histological and immunohistochemical analyses. Combined PPF + IL-4 treatment produced the greatest improvement in gross and skilled locomotor recovery compared with vehicle, or either monotherapy. At 8 weeks post-SCI, the combined therapy aligned with a reduction in chronic lesion-associated p-p38 MAPK, decreased pP65 NFkB (RelA) activation, increased expression of reparative factors ARG1 and CD206, as well as reduced lesion cavitation and trends toward greater gray and white matter preservation. Stratification of functional data by sex showed BBB improvements with combined PPF + IL-4 in both males and females after SCI. Together, these findings show that combined systemic PPF and IL-4 treatment was associated with improved functional recovery, reduced lesion cavitation, and changes in lesion-associated molecular and histological endpoints after SCI, supporting further preclinical investigation. Full article

Background: Traumatic head injury (THI) includes a diverse range of hemorrhagic brain lesions (HBL), which are distinct phenotypes with characteristic pathophysiological mechanisms. Computed tomography (CT) is the cornerstone of the initial assessment and diagnosis; however, its sensitivity is limited, especially in mild head injury. Blood-derived biomarkers, including Neuron-Specific Enolase (NSE) and S-100B, have been extensively studied; however, their efficacy in distinguishing HBL subtypes remains unclear. We evaluated whether circulating serum levels of S-100B and NSE can discriminate between distinct intracranial HBLs and extracranial hemorrhagic lesions (ECH). Methods: This is an interim analysis of a prospective, randomized, double-blind clinical trial including 434 adult patients with blunt THI. HBL phenotypes identified by CT scan included subarachnoid hemorrhage (SAH), subdural hematoma (SDH), epidural hematoma (EDH), and brain contusion (BC). Unique lesions were considered while overlapping lesions were excluded. Subgaleal hematoma (SGH) was included as an example of ECH. Serum S-100B was assessed within 6 h post-injury, while serum NSE was evaluated at admission, 24 h, and 48 h thereafter. Serum NSE and inflammatory cytokines were quantified in duplicates using a Human Magnetic Luminex 5-plex assay, while serum S-100B concentrations were measured separately. Serum epinephrine concentrations were quantified using an ELISA. Biomarker profiles were analyzed based on lesion phenotype, lesion multiplicity, injury pattern, and clinical outcomes, including hospital length of stay (HLOS) and the Glasgow Outcome Scale—Extended (GOSE). Results: Admission median S-100B levels were higher in patients with SAH (495 pg/mL) and lower in those with SGH (191 pg/mL); however, they did not show statistically significant difference among HBL phenotypes. They were significantly higher in patients with polytrauma TBI (420 pg/mL) compared to isolated TBI (258 pg/mL). Baseline and 48 h NSE concentrations were significantly higher in SDH (25,089 and 28,438 pg/mL) than in other THI lesions (p = 0.04). There were no statistically significant changes in NSE values over time across all THI lesions except for SDH in which they raised more after 48 h (p = 0.02). They had a significant drop in polytrauma over the time (p = 0.001). Compared to intracranial lesions, S-100 B levels were significantly lower in SGH and in skull fractures without intracranial hematomas. Both S-100B and NSE levels were elevated in individuals with unfavorable GOSE scores. Conclusions: In this secondary exploratory analysis, elevated serum NSE and S-100B levels discriminate between extra- and intracranial lesions and appear to represent distinct but complementary aspects of THI, indicating neuronal damage and its temporal evolution, and predicting clinical and functional outcomes. The present findings reflect association and not causation. Future studies incorporating larger or multicenter cohorts, volumetric imaging, and long-term outcomes are required to validate and refine biomarker-guided algorithms for personalized THI care. Full article

Background: Pancreatic trauma (PT) in children is rare and associated with significant morbidity. The optimal form of management—operative versus non-operative—remains controversial, particularly in the presence of acute post-traumatic peripancreatic fluid collection, which may later evolve into pancreatic pseudocysts. Isolated pancreatic injuries without associated organ damage are uncommon and pose diagnostic and therapeutic challenges. Case Presentation: We report a 5-year-old boy who sustained an isolated grade IB blunt pancreatic head contusion following blunt abdominal trauma after falling onto a wooden fence. He presented with epigastric pain, repeated emesis, and an abdominal wall bruise. Initial ultrasound (US) findings were subtle; however, serial imaging and contrast-enhanced computed tomography (CECT) revealed focal contusion of the pancreatic head/uncinate process with a small peripancreatic fluid collection. Pancreatic enzymes were markedly elevated, with peak serum lipase reaching approximately 6579 U/L. The child remained hemodynamically stable and was managed conservatively with bowel rest, intravenous fluids, octreotide, proton-pump inhibition, pancreatic enzyme replacement therapy (PERT), and antibiotics. Serial US demonstrated the dynamic evolution of an acute peripancreatic fluid collection (APFC) (~2 cm), which remained stable without complications. Clinical and biochemical parameters gradually improved, and no invasive intervention was required. The patient was discharged on hospital day 16 with planned outpatient imaging follow-up. Conclusions: This case demonstrates that isolated pediatric pancreatic contusions complicated by small, evolving peripancreatic fluid collections can be safely managed non-operatively in hemodynamically stable patients. Serial ultrasound plays a key role in monitoring lesion evolution and guiding management decisions. In accordance with current pediatric trauma guidelines, careful observation with structured follow-up may prevent unnecessary invasive interventions while achieving excellent clinical outcomes. Full article

Reliable characterization of circulating extracellular vesicles (EVs) in rodents may be significantly influenced by how blood is collected, yet systematic comparisons of commonly used sampling methods remain limited. Here, we directly evaluate the effects of cardiac puncture and perfusate blood collection on EV yield and surface-marker profiles in naïve mice, as well as in mice subjected to neurotrauma using a contusion spinal cord injury (SCI) model. Using matched isolation procedures and MACSPlex immunophenotyping, we analyzed newly generated cardiac puncture plasma alongside previously published perfusate-derived datasets, with both cohorts matched for age, sex, weight, injury severity, and post-injury timepoint. Cardiac puncture produced substantially higher particle concentrations due to access to undiluted blood, whereas perfusate samples exhibited modest increases in select markers, such as CD9, consistent with method-associated influences on platelet-derived vesicles. Despite these quantitative differences, both approaches yielded broadly similar EV phenotypes, and SCI-associated marker patterns remained stable across sampling methods. The consistency between cardiac puncture and perfusate datasets validates the robustness of our earlier perfusate-based findings and demonstrates that key biological signatures are preserved regardless of collection technique. These results provide practical guidance for optimizing murine EV studies and underscore the importance of methodological transparency and standardization in preclinical EV research. Full article

Domestic violence against men remains significantly under-recognized, despite affecting 20–40% of men worldwide. Societal stigma, gender-normative expectations, and institutional biases often discourage help-seeking behaviors among male victims. This retrospective analysis characterizes domestic violence against adult men by examining victim–perpetrator dynamics, injury patterns, reporting behaviors, and behavioral barriers to help-seeking within an Italian emergency department setting. Overall, 80 adult male domestic violence victims presenting to the Emergency Department of Careggi University Hospital (Florence, Italy) between January 2017 and December 2022 were examined. Data included demographics, injury characteristics, perpetrator relationships, and formal reporting rates. Descriptive statistics and chi-square tests were used to examine associations between victim characteristics and help-seeking behaviors. The majority of victims were Italian men (age range 18–90 years, mean 44.2 ± 15.1); of these, 55% experienced IPV perpetrated by female partners. Physical injuries were predominantly minor (classified as minor according to ED prognosis ≤ 7 days) (78.8%), including abrasions and contusions affecting the head (52.5%), neck (28.8%), and upper limbs (41.3%). Formal reports were filed with judicial authorities in 58.8% of cases, yet only 15% accepted protective interventions. Visible facial injuries (OR = 3.85, 95% CI, p = 0.004) and female perpetrators (OR = 8.23, 95% CI, p < 0.001) were independent predictors of formal reporting. Documented behavioral barriers included stigma (68%), fear of disbelief (45%), and adherence to traditional masculine norms (52%). Our findings demonstrate that male domestic violence victims face substantial behavioral and systemic barriers that prevent help-seeking. Enhanced clinical–forensic training, gender-inclusive response protocols, and public awareness campaigns are essential to provide equitable support and reduce under-reporting. Full article

Background: Yoga has gained popularity worldwide and is generally considered a safe physical activity. However, injuries associated with yoga practice are increasingly reported, while data on cases requiring emergency care remain limited. Methods: A retrospective single-center study was conducted, analyzing cases of yoga-related injuries treated at a Swiss emergency department between 2013 and 2023. Medical records of 67 adult patients (aged ≥16 years) were reviewed for demographics, injury characteristics, management, and clinical outcomes. The study population consisted predominantly of females (76.1%), with a median age of 35 years. Results: Most injuries were musculoskeletal in nature and predominantly affected a single body region (95.5%). The most frequently involved areas were the head (29.9%), lower extremities (25.4%), and spine (19.4%). Soft tissue injuries, particularly muscle and tendon strains as well as contusions, were most common. Injury patterns differed across subgroups: older patients were more likely to sustain head injuries, whereas younger individuals more frequently presented with extremity injuries, including the rare cases of fractures and dislocations. Conservative treatment was sufficient in 94% of cases, although 20.9% of patients required hospitalization. Conclusion: Yoga-related injuries presenting to emergency care are generally minor and mainly involve soft tissues; however, injury patterns vary across demographic subgroups. Older adults appear more susceptible to balance-related and head injuries, while younger practitioners are more prone to acute extremity trauma. Recognizing these population-specific differences may support targeted prevention strategies and safer yoga practice. Full article

Background: Approximately two-thirds of individuals with spinal cord injury (SCI) become overweight or obese. Weight loss surgery, including vertical sleeve gastrectomy (VSG), is one of the most effective long-term treatments for obesity and type 2 diabetes. Introduction: The main objective of this study was to test in our diet induced obesity rat model whether subjects respond to VSG in the same way as subjects with or without SCI. Methods: To address this question, male Wistar rats underwent either T3 contusion injuries or sham spinal surgeries (Sham). Following recovery, all rats were fed a high-energy, high-fat diet (HFD) for six weeks before undergoing VSG. Taste responsivity and preferences were assessed at multiple time points. Results: Prior to HFD exposure, SCI rats exhibited significantly reduced lick responses for sucrose at higher concentrations and increased licking for low concentrations of sodium, although 2BC sucrose preference was unchanged. HFD feeding in SCI rats enhanced salt and sucrose licking overall. Importantly, VSG reduced sucrose licking, with SCI rats showing greater sensitivity to this effect. cFos immunohistochemistry further revealed enhanced neuronal activation to sucrose ingestion in the dorsal vagal complex, including the rostral subnucleus of the nucleus of the solitary tract. Discussion and Conclusions: Together, these findings support the hypothesis that SCI alters taste functions, thereby increasing vulnerability to diet-induced obesity and that VSG may restore sweet taste responsivity even more effectively in SCI-associated obesity than in non-SCI obesity. Future studies are needed to clarify the neural and hormonal mechanisms mediating these effects and to determine their translational relevance to human SCI populations. Full article

Background/Objectives: Acute respiratory distress syndrome (ARDS) represents a critical complication in polytrauma patients, characterized by diffuse lung inflammation and bilateral pulmonary infiltrates with mortality rates reaching 45% in intensive care units (ICU). The heterogeneous nature of ARDS and complex clinical presentation in severely injured patients poses substantial diagnostic challenges, necessitating early prediction tools to guide timely interventions. Machine learning (ML) algorithms have emerged as promising approaches for clinical decision support, demonstrating superior performance compared to traditional scoring systems in capturing complex patterns within high-dimensional medical data. Based on the identified research gaps in early ARDS prediction for polytrauma populations, our study aimed to: (i) develop a balanced random forest (BRF) ML model for early ARDS prediction in critically ill polytrauma patients, (ii) identify the most predictive clinical features using ANOVA-based feature selection, and (iii) evaluate model performance using comprehensive metrics addressing class imbalance challenges. Methods: This retrospective cohort study analyzed 407 polytrauma patients admitted to the ICU of the Center of Traumatology and Major Burns of Ben Arous, Tunisia, between 2017 and 2021. We implemented a comprehensive ML pipeline that incorporates Tomek Links undersampling, ANOVA F-test feature selection for the top 10 predictive variables, and SMOTE oversampling with a conservative sampling rate of 0.3. The BRF classifier was trained with class weighting and evaluated using stratified 5-fold cross-validation. Performance metrics included AUROC, PR-AUC, sensitivity, specificity, F1-score, and Matthews correlation coefficient. Results: Among 407 patients, 43 developed ARDS according to the Berlin definition, representing a 10.57% incidence. The BRF model demonstrated exceptional predictive performance with an AUROC of 0.98, a sensitivity of 0.91, a specificity of 0.80, an F1-score of 0.84, and an MCC of 0.70. Precision–recall AUC reached 0.86, demonstrating robust performance despite class imbalance. During stratified cross-validation, AUROC values ranged from 0.93 to 0.99 across folds, indicating consistent model stability. The top 10 selected features included procalcitonin, PaO₂ at ICU admission, 24-h pH, massive transfusion, total fluid resuscitation, presence of pneumothorax, alveolar hemorrhage, pulmonary contusion, hemothorax, and flail chest injury. Conclusions: Our BRF model provides a robust, clinically applicable tool for early prediction of ARDS in polytrauma patients using readily available clinical parameters. The comprehensive two-step resampling approach, combined with ANOVA-based feature selection, successfully addressed class imbalance while maintaining high predictive accuracy. These findings support integrating ML approaches into critical care decision-making to improve patient outcomes and resource allocation. External validation in diverse populations remains essential for confirming generalizability and clinical implementation. Full article