Search Results (1,135)

Background: This cross-sectional observational study examined the relationship between caregivers’ adverse childhood experiences (ACEs), their perceived COVID-19-related burden, child psychopathology, and changes in family relationships during the pandemic. Methods: The final sample included 285 children (M = 10.19, SD = 3.36) from clinical settings and their caregivers. Caregivers reported their own ACEs and their children’s psychopathology. Perceived caregiver COVID-19 burden and changes in family relationships were also assessed. Correlational analyses, regressions, and mediation models were conducted to test direct and indirect associations. Results: Caregivers reported an average of 1.63 ACEs, with 18.4% reporting four or more. Children of caregivers who reported four or more ACEs exhibited significantly elevated psychopathology scores. However, caregiver ACEs did not directly predict the perceived COVID-19 burden. A mediation analysis revealed that child psychopathology mediated the association between caregiver ACEs and caregiver COVID-19 burden. Unexpectedly, higher caregiver ACEs were associated with less negative perceived changes in family relationships, particularly in 2023, indicating heterogeneous family adjustment trajectories. Conclusions: These findings highlight that child psychopathology is a key mechanism in the intergenerational transmission of caregiver burden linked to childhood adversity. They also suggest that support systems, resilience, or differing expectations among high-ACE caregivers may help buffer changes in family relationship. Early identification and trauma-informed, family-centered interventions beyond acute crisis are essential. However, limitations include the reliance on caregiver self-report and cross-sectional design. Further, longitudinal, multi-informant research is needed to clarify these dynamics and inform targeted support strategies. Full article

Non-suicidal self-injury (NSSI) has become an increasingly salient mental health concern among adolescents, and it commonly co-occurs with depression, anxiety, borderline personality disorder, substance use, and childhood maltreatment, forming a complex psychological risk structure. Despite a growing body of literature, a systematic understanding of the structural links between NSSI and psychiatric comorbidities remains limited. This study uses bibliometric and visualization methods to map the developmental trajectory and knowledge structure of the field and to identify research hotspots and frontiers. Drawing on the Web of Science Core Collection, we screened 1562 papers published between 2005 and 2024 on adolescent NSSI and comorbid psychological problems. Using CiteSpace 6.3.R1, VOSviewer 1.6.20, and R 4.3.3, we constructed knowledge graphs from keyword co-occurrence, clustering, burst-term detection, and co-citation analyses. The results show an explosive growth of research in recent years. Hotspots center on comorbidity mechanisms of mood disorders, the impact of childhood trauma, and advances in dynamic assessment. Research has evolved from describing behavioral features toward integrative mechanisms, with five current emphases: risk factor modeling, diagnostic standard optimization, cultural sensitivity, stratified intervention strategies, and psychological risks in special populations. With big data and AI applications, the field is moving toward dynamic prediction and precision intervention. Future work should strengthen cross-cultural comparisons, refine comorbidity network theory, and develop biomarker-informed differentiated interventions to advance both theory and clinical practice. Full article

Memory consolidation is the process by which newly acquired experiences are stabilized into long-term memory, involving coordinated cellular and network-level activity across brain regions such as the hippocampus and prefrontal cortex. Dysregulation of this process has been implicated in psychiatric disorders including post-traumatic stress disorder (PTSD), which is characterized by the over-consolidation of traumatic memories. LIM kinase 1 (LIMK1), a key regulator of synaptic plasticity, is believed to play an important role in memory consolidation across hippocampal–cortical circuits. In this study, we investigated the function of LIMK1 using Limk1 knockout mice. Behavioral tests such as the novel object location memory task revealed significant memory impairments in knockout animals. In vivo recordings during sleep showed disrupted communication between the hippocampus and prefrontal cortex, suggesting impaired systems-level consolidation. Furthermore, in an underwater trauma exposure model, pharmacological inhibition of LIMK1 with LIMK-i3 alleviated trauma-induced behavioral abnormalities. These findings highlight LIMK1 as a critical mediator of hippocampal–cortical memory consolidation and provide experimental evidence that LIMK1 inhibition can modulate maladaptive memory processes associated with PTSD-like symptoms. Full article

Background and Objectives: The objective of this study was to construct and validate a novel, clinically practical risk-stratification score, PEARL (Pelvic and Acetabular Adverse-event Risk Level), integrating established preoperative and intraoperative predictors, to accurately estimate the likelihood of major postoperative complications in patients undergoing open reduction and internal fixation for pelvic and/or acetabular fractures. Materials and Methods: We retrospectively analyzed 200 adult patients treated surgically between January 2019 and January 2024 at two tertiary trauma centers. Demographic, injury-related, and perioperative data were collected. Major complications were defined as postoperative adverse events occurring within 30 days after surgery or during hospitalization, whereas delayed union and nonunion were evaluated as secondary long-term outcomes. Multivariable logistic regression identified independent risk factors, which were weighted to create the PEARL score (range: 0–6). Predictive performance was assessed using ROC (Receiver Operating Characteristic) analysis. We randomly split the sample into a 70% derivation and a 30% validation cohort. A multivariable LASSO-penalized logistic model identified independent predictors, which were weighted to construct the PEARL score. Discrimination (AUC) and calibration (Brier score, calibration curve) were assessed. Results: Major complications occurred in 29% of patients. Four independent predictors were identified: age ≥ 60 years, BMI ≥ 30 kg/m², severe associated injury, and operative time ≥ 180 min. The score showed good discrimination (derivation AUC = 0.82) and acceptable external validation (validation AUC = 0.78), with Brier scores of 0.19 and 0.21, respectively. PEARL demonstrated good discriminative ability, AUC (Area Under the Curve) = 0.82. Complication rates increased across risk strata: low (7.5%), moderate (30%), and high risk (62%). Conclusions: The PEARL score is a simple, reliable tool to stratify the risk of major postoperative complications after pelvic and acetabular fracture surgery. Early identification of high-risk patients may facilitate targeted preventive strategies and improve outcomes. Further multicenter prospective validation is warranted. Full article

Today, the engineering of load-bearing bone tissue after severe trauma still relies on metal-based (Ti, CoCrMo alloys or stainless steel) permanent implants. Such artificial scaffolds are typically applied in the body and come into direct contact with the recipient’s cells, whose adhesion affects the patient’s implant acceptance or rejection. The present study aims to create a nano-rough texture by means of ultra-short femtosecond laser (fs)-induced periodicity in the form of laser induced periodic surface structures (LIPSS) on the surface of a stainless steel implant model, which is additionally functionalized via magnetron-sputtering with a thin Cu layer, thus providing the as-created implants with a stable antimicrobial interface. Calcium phosphate (CaP) crystal growth was additionally applied due to the strong bioactive interface bond that CaPs provide to the bone connective tissue, as well as for the strong interface bond they create between the artificial implant and the surrounding bone tissue, thereby stabilizing the implanted structure within the body. The bioactive properties in the as-created antimicrobial hybrid topographical design, achieved through femtosecond laser-induced nanoscale surface structuring and micro-sized CaP crystal growth, have the potential for subsequent practical applications in bone tissue engineering. Full article

Background: Accurate reconstruction of the orbit after trauma or oncological resection requires reliable anatomical references. In unilateral cases, the contralateral orbit can guide repair, but bilateral injuries or pathologies remove this option. To address this problem, we developed a new morphological classification of orbits based on three linear dimensions. Methods: A total of 499 orbits from patients of Caucasian descent (age 8–88 years) were analyzed using three-dimensional models generated from cone-beam and fan-beam CT scans. Orbital depth (D), height (H), and width (W) were measured, and proportional indices were calculated. K-means clustering (k = 3) identified recurring morphotypes, validated by linear discriminant analysis (LDA) and supported by ANOVA, Kruskal–Wallis, and correlation tests (age and sex). Results: Three morphotypes were identified: Tall & Broad (type A, 33.5%), Deep & Broad (type B, 30.2%), and Compact (type C, 36.2%). All dimensions differed significantly between groups (ANOVA, p < 1 × 10⁻¹⁶; η² = 0.40–0.51). Male orbits were significantly deeper and wider than female ones (p < 0.001). LDA demonstrated excellent separation with 97.5% accuracy. A simplified decision algorithm achieved 82.1% classification accuracy. In situations where only orbital depth could be measured, an alternative cut-off-based method reached 61.5% accuracy, with type B and C better distinguished than type A. Conclusions: The proposed classification provides a reproducible framework for describing orbital morphology. It may serve as a reference in cases where local anatomy is disrupted or the contralateral orbit is unavailable. Even millimeter-scale differences in orbital dimensions may correspond to clinically relevant changes in orbital volume and globe position, underlining the potential usefulness of this system in surgical planning. Full article

Background/Objectives: Extremity trauma represents a significant proportion of battlefield injuries and is prevalent in polytraumatized patients from accidents. Delayed antibiotic treatment and surgical intervention can lead to wound infections, contributing to preventable mortality. This preliminary study aimed to develop a conscious swine model of complex extremity trauma that induces systemic inflammatory response syndrome (SIRS). Methods: All surgical procedures were conducted under anesthesia with sufficient analgesia. All swine were instrumented with a telemetry device and catheters at least 3 days prior to any injury. In phase 1 of model development, a complex extremity injury was performed that consisted of skin and muscle loss, bone defect, severe hemorrhage, and 2 h tourniquet application. In phase 2, multi-drug resistant Gram-positive and Gram-negative bacteria were inoculated topically at the injury site to exacerbate pathophysiological changes towards SIRS. Post-injury, conscious animals were assessed a minimum of twice daily, including pain assessment, neurological response, and vital signs. Blood samples were collected for microbiological testing, complete blood cell counts, and biochemical analysis. Results: After establishing SIRS criteria for Sinclair swine, we developed a model of severe extremity trauma leading to SIRS. During phase 1, resuscitative fluids were reduced and discontinued, with animals surviving 24 h and maintaining SIRS for up to 4 h post-recovery. Phase 2 showed that Gram-negative and Gram-positive pathogens can exacerbate and prolong SIRS. After 72 h, localized infection at the injury site was observed in all animals. Conclusions: We established a new swine model of complex extremity trauma with SIRS. Our model is consistent, reproducible, and relevant to prolonged care scenarios, providing a platform for future research into the evaluation of preventative and therapeutic strategies. Full article

Adolescents diagnosed with pediatric-onset multiple sclerosis (POMS) face a distinct set of challenges as they cope with a chronic neuroinflammatory disease during a formative stage of life. This review examines the growing body of literature on the psychosocial and cognitive consequences of POMS, from the trauma of diagnosis to disruptions in identity development, academic difficulties, and increased vulnerability to mental health issues. Many young people with MS experience fatigue, cognitive decline, depression, and anxiety, all of which can significantly interfere with their daily lives and overall well-being, even if physical symptoms of the disease remain limited. Yet, current care systems often fall short in addressing their needs, and interventions tailored to adolescents remain scarce. There is a pressing need for developmentally sensitive, family-centered, and integrated models of care. Targeted research and policy action are essential to better support this underserved group. This review builds on prior research by integrating recent findings with adolescent-development frameworks and by proposing a multicomponent health-promotion intervention model specific to POMS. The review describes relevant evidence-based approaches including cognitive behavioral therapy, mindfulness, peer-based interventions, and cognitive rehabilitation that were validated in adults with MS and chronically ill adolescents. The objective is to synthesize evidence and translate it into actionable recommendations for clinical care and research. Full article

Background/Objective: Healthcare accessibility remains a critical challenge in medically underserved regions, particularly for specialized care such as trauma treatment and hyperbaric oxygen therapy (HBOT). This study aims to develop and empirically evaluate the Dr. LINK platform, a remote collaborative care system designed to bridge healthcare gaps in geographically isolated or resource-limited areas through real-time interdisciplinary medical collaboration. Methods: Dr. LINK platform employs a SaaS-based infrastructure with Zero Trust security architecture, supporting structured data exchange, automated notifications, and dynamic consultation transfer. Patients completed a modified Telehealth Usability Questionnaire on a 7-point Likert scale, evaluating usefulness, ease of use, interface quality, interaction quality, reliability, and overall satisfaction. Results: Dr. LINK successfully facilitated real-time collaborative consultations for emergency medicine and HBOT, supporting multiple concurrent consultations while maintaining data security and system performance. Overall usability scores were high (mean 6.71–6.83/7), with HBOT patients consistently reporting higher satisfaction across all domains. The platform enabled timely, structured, and coordinated care, reducing unnecessary patient transfers and enhancing multidisciplinary decision-making. Conclusions: Dr. LINK represents a significant advancement in addressing healthcare disparities by enabling structured, secure, and scalable remote collaborative care. The platform effectively overcomes geographic and infrastructural barriers, providing a practical framework for future telemedicine implementations in specialized care domains. Continued refinement and evaluation will be essential to fully realize its potential in transforming healthcare delivery models toward greater equity and accessibility. Full article

Background/Objectives: Lithocarpus litseifolius (Hance) Chun, also known as sweet tea, is a traditional Chinese tea-making plant. Acute lung injury (ALI), a life-threatening syndrome with symptoms like hypoxemia and dyspnea, can be triggered by infection or trauma, with high morbidity and mortality. Whether the water extract of Lithocarpus litseifolius (WEL) has therapeutic effects on ALI remains unclear. This study aimed to analyze WEL’s components, establish in vitro cellular inflammation and mouse ALI models, and investigate WEL’s protective effects against LPS-induced ALI. Methods: LC-MS analysis identified 42 compounds in WEL and quantified three key ones. In an LPS-induced mouse ALI model, WEL significantly reduced lung injury severity, lung wet-to-dry ratio, pulmonary edema, and levels of NO, ROS, IL-1β, TNF-α, and MPO in lung tissues and bronchial alveolar lavage fluid. Immunohistochemical analysis showed WEL pretreatment inhibited the upregulation of NLRP3, Caspase-1, and GSDMD-NT expression, mitigated tissue oxidative stress and cell pyroptosis, and alleviated ALI severity in mice. Cellular experiments confirmed WEL’s protective effects via anti-inflammatory, antioxidant actions, and inhibiting cell pyroptosis, with phlorizin and trilobatin as potential key active ingredients. Conclusions: This research demonstrates sweet tea’s significant protective effects against ALI and its potential to alleviate inflammation by inhibiting pyroptosis, providing a theoretical basis for developing new health-promoting functions of sweet tea. Full article

Objective: This pilot study assessed the psychological and physical impact of the COVID-19 pandemic on postpartum women that gave birth during the pandemic, and evaluated the feasibility of remote monitoring for maternal mental health. The study also proposes a conceptual framework to strengthen remote maternal care in future public health emergencies. Methods: Conducted between 2020 and 2021 in Reggio Emilia, one of Italy’s ten hardest-hit provinces during the early COVID-19 outbreak, this study enrolled 21 pregnant women (10 COVID-19-positive at delivery, 11 COVID-19-negative controls). Psychological and physical health were assessed using validated instruments: the Beck Depression Inventory (BDI) and Edinburgh Postnatal Depression Scale (EPDS) for depression, the State-Trait Anxiety Inventory (STAI) for anxiety, the Impact of Event Scale–Revised (IES-R) for trauma-related stress, and the SF-36 for physical functioning. Additional measures included breastfeeding experience and resilience. Remote assessments were conducted between 6 and 12 months postpartum to evaluate psychological recovery and satisfaction with perinatal care. C test was used to compare the two groups of women. Results: COVID-19-positive women reported significantly higher depressive symptoms (BDI: 13.50 ± 8.14 vs. 6.73 ± 4.73; U = 27, p = 0.048), and elevated state anxiety levels (STAI-S: 41.60 ± 10.23 vs. 33.64 ± 10.15; U = 27, p = 0.048) compared to controls. Post-traumatic stress symptoms were also higher among COVID-positive participants (IES-R total: 41.10 ± 19.33 vs. 30.64 ± 7.99; U = 24.5, p = 0.029). No significant differences emerged in EPDS or trait anxiety scores. Conclusions: Remote data collection proved feasible for postpartum women during the pandemic and highlighted elevated depressive, anxiety, and trauma-related symptoms in COVID-19-positive mothers. These findings support the development of flexible digital care frameworks for maternal well-being in crises. The introduction of the “10 Gold Rules for Remote Maternal Healthcare in Critical Situations” offers a forward-looking, expert-informed conceptual framework to guide the development of scalable, trust-based digital care models that go beyond monitoring to include proactive, patient-centred support. Full article

The complexity of adverse responses from radiation injury (RI) followed by physical trauma, namely, radiation combined injury (RCI), is unique and more pronounced than either insult alone due to a poor understanding of the integration of these insults at the molecular/cellular/tissue and/or organ levels. It was shown that mice receiving ⁶⁰Co γ-photon RCI with wounding had a lower LD_50/30 than RI alone. This survival synergism was observed in bone marrow and the gastrointestinal system, as evidenced by an increase in γ-H2AX expression in bone marrow cell DNA, loss of circulatory blood cells, elevation of serum cytokine concentration, and activation of nuclear factor-κB/inducible nitric oxide synthase, and an earlier onset of bacterial infection and sepsis after RCI than after RI was detected. Dysbiosis (imbalance of the gut microbiota) was observed. There remains a pressing need for both prophylactic countermeasures and therapeutic remedies to deal with RCI threats. Investigations of how RCI can affect this important network of communication between the gut microbiota and other organs, including the brain, lung, heart, liver, kidney, and skin, could lead to new and critical interventions and prevention strategies. This review provides an update on new RCI animal models, dynamic changes in cytokine expression, dysbiosis, as well as links between the gut microbiome and other organs after RCI. Full article

Motility disorders, particularly gastroparesis, are prevalent complications following solid organ transplantation, significantly impacting quality of life, nutritional status, graft survival, and mortality. This comprehensive review synthesises evidence from PubMed, Scopus, and Embase databases on pathophysiology, clinical manifestations, diagnosis, management, and prognostic factors across transplant types. Mechanisms include vagal nerve injury (highest in lung transplants, prevalence 40–91%), immunosuppressive effects (e.g., tacrolimus accelerates motility; mycophenolate impairs it), surgical trauma, microbiome dysbiosis (reduced Firmicutes/Bacteroidetes ratio), and metabolic factors like post-transplant diabetes (OR 5.17 in kidney recipients). Pediatric and thoracic recipients face the highest risks, with lung transplant gastroparesis conferring a 2.7-fold increased mortality/retransplantation hazard (p < 0.05). Diagnosis relies on gastric emptying scintigraphy (gold standard, sensitivity 85–95%) and wireless motility capsules (100% sensitivity for delay), while management encompasses prokinetics (60–80% response), endoscopic G-POEM (85% success), gastric electrical stimulation (100% quality-of-life improvement in series), and nutritional support. Prognostic factors include younger age (better intervention response), aetiology (anatomical worse than metabolic), and early therapy success. Outcomes vary: lung recipients experience severe impacts on chronic allograft dysfunction (83% oesophageal motility abnormalities correlate with 66–67% rejection). Future directions emphasise microbiome therapies, AI predictive models (AUC 0.85), and wearables for continuous monitoring. Multidisciplinary approaches are essential to balance immunosuppression with GI management, addressing ethical dilemmas like drug interactions and access disparities. Ultimately, early screening and personalised interventions can mitigate complications, enhancing long-term transplant success. Full article

Skull segmentation in magnetic resonance imaging (MRI) is essential for cranio-maxillofacial (CMF) surgery planning, yet manual approaches are time-consuming and error-prone. Computed tomography (CT) provides superior bone contrast but exposes patients to ionizing radiation, which is particularly concerning in pediatric care. This study presents an AI-based workflow that enables skull segmentation directly from routine MRI. Using 186 paired CT–MRI datasets, CT-based segmentations were transferred to MRI via multimodal registration to train dedicated deep learning models. Performance was evaluated against manually segmented CT ground truth using Dice Similarity Coefficient (DSC), Mean Surface Distance (MSD), and Hausdorff Distance (HD). AI achieved higher performance on CT (DSC 0.981) than MRI (DSC 0.864), with MSD and HD also favoring CT. Despite lower absolute accuracy on MRI, the approach substantially improved segmentation quality compared with manual MRI methods, particularly in clinically relevant regions. This automated method enables accurate skull modeling from standard MRI without radiation exposure or specialized sequences. While CT remains more precise, the presented framework enhances MRI utility in surgical planning, reduces manual workload, and supports safer, patient-specific treatment, especially for pediatric and trauma cases. Full article

Human rights frameworks have historically emphasised physical integrity, yet psychological integrity, the right to mental stability, identity, and emotional safety all remain neglected in health policy and law. This narrative review and commentary argues that psychological integrity is inseparable from ecological integrity, and that contemporary mental health crises are rooted in ruptured human–nature attachments. Drawing on Mother Nature Attachment Theory (MNAT) and supported by emerging empirical evidence, this review traces a trajectory from pre-attachment, through rupture via colonisation, displacement, and ecological collapse, to reconnection through cultural and ecological repair. Gaza exemplifies a contemporary site of deliberate ecological–psychological rupture, where environmental destruction compounds trauma and erodes cultural continuity. In contrast, Indigenous frameworks in Australasia, such as Te Whare Tapa Whā, provide culturally grounded models of reconnection that demonstrate how ecological repair and psychological restoration can proceed together. These contrasting cases illustrate MNAT’s trajectory and emphasise that safeguarding psychological integrity requires embedding ecological security into public health systems. The review concludes that planetary mental health depends on recognising healing of mind and Earth as an indivisible task. Healing mind and Earth must be understood as a single, urgent task within planetary public mental health. Full article