Search Results (470)

Spinal cord injury (SCI) is a devastating neurological state that could lead to motor, sensory, and autonomic dysfunction. In addition to its direct impact on the central nervous system, SCI exerts systemic effects, including disruption of gut homeostasis and alterations in the gut microbiota, which can contribute to sustained inflammation and hinder functional recovery. While antibiotic administration during the acute phase of SCI is clinically indicated, it may exacerbate microbial dysbiosis. In this study, we investigate the combined effects of SCI and cefazolin treatment on the gut microbiome of female rats. Animals were assigned to three groups: NAÏVE (no intervention), SHAM (cefazolin only), and INJURY (T10 spinal cord contusion plus cefazolin). Cefazolin was administered for seven days after the injury, fecal samples were collected at baseline (day 0), and on days 7, 14, 21, and 28 post-SCI. DNA was extracted and subjected to 16S rRNA gene amplicon sequencing, followed by bioinformatic analysis. Our findings revealed significant microbial dysbiosis in the INJURY group, including reduced alpha diversity and distinct shifts in microbial composition. These changes were most prominent during the acute phase post-SCI. Our findings highlight the compounding effects of spinal trauma and antibiotic exposure on the gut microbiome and suggest that maintaining microbial stability may represent a promising avenue to support recovery after SCI. Full article

Background: Posttraumatic growth (PTG) refers to positive psychological change following trauma. While its psychological aspects are well-documented, the biological mechanisms remain unclear. Epigenetic changes, such as DNA methylation (DNAm), may offer insight into PTG’s neurobiological basis. Aims: This study aimed to identify epigenetic markers associated with PTG using an epigenome-wide association study (EWAS), the first of its kind in a trauma-exposed population. Methods: A longitudinal EWAS design was used to assess DNAm before and after trauma exposure in first-year paramedicine students (n = 39). Genome-wide methylation data were analyzed for associations with PTG, applying epigenome-wide and gene-wise statistical thresholds. Pathway enrichment analysis was also conducted. Results: The study identified two CpGs (cg09559117 and cg05351447) within the PCDHA1/PCDHA2 and PDZD genes significantly associated with PTG at the epigenome-wide threshold (p < 9.42 × 10^–8); these were replicated in an independent sample. DNAm in 5 CpGs across known PTSD candidate genes ANK3, DICER1, SKA2, IL12B and TPH1 were significantly associated with PTG after gene-wise Bonferroni correction. Pathway analysis revealed that PTG-associated genes were overrepresented in the Adenosine triphosphate Binding Cassette (ABC) transporters pathway (p = 2.72 × 10⁻⁴). Conclusions: These results identify genes for PTG, improving our understanding of the neurobiological underpinnings of PTG. Full article

Background/Objectives: Adolescents aged 13–18 are exposed to traumatic content even without direct experience, owing to the increasing media coverage of disasters. Such indirect exposure can result in post-traumatic stress symptoms, including intrusion, avoidance, and hyperarousal, as well as associated emotions such as sadness, anger, and guilt. These effects may persist for months, reflecting the vulnerability of adolescents during cognitive and emotional development. This study examined resilience and social support as protective predictors against indirect trauma. Methods: A cross-sectional correlational design was employed, with middle- and high-school students aged 13–18 years in Seoul, South Korea, as participants. Indirect trauma, resilience, and perceived social support were assessed using validated self-report instruments. Correlation analyses were conducted, followed by stepwise regression. Owing to multicollinearity, resilience was retained as the sole predictor in the final model. Results: The average indirect trauma score was 1.20 out of 4, and 59.2% of participants exhibited partial or full post-traumatic stress disorder. The mean resilience and social support scores were 3.47 and 3.82 out of 5, respectively. Resilience was positively correlated with social support (r = 0.60, p = 0.001). The regression analysis indicated that resilience significantly predicted indirect trauma (β = 0.82, p < 0.001), accounting for 66.4% of the variance, whereas social support showed no direct effect. Conclusions: Resilience emerged as a key predictor of indirect trauma, underscoring its importance in mitigating distress. Although social support did not directly predict trauma, its positive correlation with resilience suggests potential indirect effects. These findings highlight the need to strengthen resilience and expand school-based counseling and support systems to help adolescents deal with indirect trauma. Full article

Background: Blast-induced spinal cord injuries (bSCI) account for 75% of all combat-related spinal trauma and are associated with long-term functional impairments. However, limited studies have evaluated the neuropathological outcomes in the spinal cord following blast exposure. Objectives In this study, we aimed to determine the acute and sub-acute neuropathological changes in the spinal cord of ferrets after blast exposure. Methods: An advanced blast simulator was used to expose ferrets to tightly coupled repeated blasts. The Catwalk XT system was used to detect gait performances in ferrets at 24 h and 1 month post-blast exposure. After euthanasia, the cervical spinal cord samples were collected at 24 h or 1 month post-blast. A quantitative real-time polymerase chain reaction was performed to evaluate changes in the gene expression of multiple Toll-like Receptors (TLR), Cyclooxygenase (COX-1 and COX-2) enzymes and cytokines. Western blotting was performed to investigate markers of axonal injury (Phosphorylated-Tau, pTau; Phosphorylated Neurofilament Heavy Chain, pNFH; and Neurofilament Light Chain present in degenerating neurons, NFL-degen) and neuroinflammation (Glial Fibrillary Acidic Protein, GFAP; and Ionized Calcium Binding Adaptor Molecule, Iba-1). Results: Blast exposure significantly affected the gait performances in ferrets, especially at 24 h post-blast. Multiple TLRs, COX-2, Interleukin-1-beta (IL-1β), Interleukin-6 (IL-6), and Tumor Necrosis Factor-α (TNF-α) were significantly upregulated in the spinal cord at 24 h after blast exposure. Although only TLR3 was significantly upregulated at 1 month, non-significant increases in TLR1 and TLR2 were observed in the spinal cord at 1 month post-blast. Phosphorylation of Tau at serine (Ser396 and Ser404) and threonine (Thr205) increased in the spinal cord at 24 h and 1 month post-blast exposure. The increased expression of pNFH and NFL-degen proteins was evident at both time points. The expression of GFAP, but not Iba-1, significantly increased at 24 h and 1 month following blast exposure. Conclusions: Our results indicate that blast exposure causes acute and sub-acute neuroinflammation and associated axonal injury in the cervical spinal cord. These data further suggest that inhibition of TLRs and/or COX-2 enzyme might offer protection against blast-induced injuries to the spinal cord. Full article

Acute kidney injury (AKI) is a frequent and severe complication in trauma patients, affecting up to 28% of intensive care unit (ICU) admissions and contributing significantly to morbidity, mortality, and long-term renal impairment. Trauma-related AKI (TRAKI) arises from diverse mechanisms, including hemorrhagic shock, ischemia–reperfusion injury, systemic inflammation, rhabdomyolysis, nephrotoxicity, and complex organ crosstalk involving the brain, lungs, and abdomen. Pathophysiologically, TRAKI involves early disruption of the glomerular filtration barrier, tubular epithelial injury, and renal microvascular dysfunction. Inflammatory cascades, oxidative stress, immune thrombosis, and maladaptive repair mechanisms mediate these injuries. Trauma-related rhabdomyolysis and exposure to contrast agents or nephrotoxic drugs further exacerbate renal stress, particularly in patients with pre-existing comorbidities. Traditional markers such as serum creatinine (sCr) are late indicators of kidney damage and lack specificity. Emerging structural and stress response biomarkers—such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), liver-type fatty acid-binding protein (L-FABP), interleukin-18 (IL-18), C-C motif chemokine ligand 14 (CCL14), Dickkopf-3 (DKK3), and the U.S. Food and Drug Administration (FDA)-approved tissue inhibitor of metalloproteinases-2 × insulin-like growth factor-binding protein 7 (TIMP-2 × IGFBP-7)—allow earlier detection of subclinical AKI and better predict progression and the need for renal replacement therapy. Together, functional indices like urinary sodium and fractional potassium excretion reflect early microcirculatory stress and add clinical value. In parallel, risk stratification tools, including the Renal Angina Index (RAI), the McMahon score, and the Haines model, enable the early identification of high-risk patients and help tailor nephroprotective strategies. Together, these biomarkers and risk models shift from passive AKI recognition to proactive, personalized management. A new paradigm that integrates biomarker-guided diagnostics and dynamic clinical scoring into trauma care promises to reduce AKI burden and improve renal outcomes in this critically ill population. Full article

Jurors play a critical role in the administration of justice, yet their compulsory exposure to graphic and distressing evidence during criminal trials is often overlooked in discussions of mental health and legal reform. This paper investigates the psychological impact of jury service in trials involving murder, domestic violence, sexual assault, and child abuse, where laypeople are required to view autopsy photographs, listen to emergency calls, and assess disturbing testimonies without any formal training or mandatory psychological support. While vicarious trauma, secondary traumatic stress, and moral injury are recognised in research on law enforcement, social work, and healthcare, there is limited acknowledgement that no professional group consistently receives adequate trauma prevention or recovery support. This gap is particularly concerning for jurors, who are laypeople compelled to participate in the justice process. Drawing on legal case studies, psychiatric research, and international precedent, this paper argues that the justice system imposes an invisible emotional burden on jurors while offering limited, inconsistent, and mostly reactive support. Although applicable to many countries, particular attention is given to Australian jurisdictions, where counselling services are sparse and optional, and where juror confidentiality laws restrict therapeutic disclosures. This research also considers the legal and ethical implications of exposing untrained civilians to traumatic material and explores whether the state could, or should, bear legal liability for post-trial psychological harm. Ultimately, this paper calls for the introduction of clearly defined trauma-informed jury procedures, including pre-trial psychological briefings, structured debriefings, and systemic reform, to acknowledge juror well-being as a necessary component of fair and ethical justice. Full article

Background: Heroin addiction is associated with profound dysregulation of the endogenous opioid and stress response systems, yet current diagnostic frameworks may inadequately capture the traumatising aspects of this condition. This perspective proposes the concept of post-heroin post-traumatic stress spectrum (pH-PTSD/S) as a clinical syndrome emerging from chronic opioid-induced neurobiological and psychosocial dysregulation, even in the absence of Criterion A trauma. Methods: The authors review evidence from neuroendocrinology, behavioural neuroscience, and clinical psychopathology to support a sensitisation-based model of trauma vulnerability in heroin use disorder (HUD). Results: Findings suggest that HUD patients frequently exhibit PTSD-spectrum symptoms, including hyperarousal, avoidance, emotional dysregulation, and altered stress reactivity. Opioid agonist treatment (OAT) may mitigate these symptoms by stabilising HPA axis function and reducing exposure to trauma-related contexts. The pH-PTSD/S construct, measured through a dedicated instrument, identifies patients with subthreshold trauma-related symptoms and greater psychopathological burden. Conclusions: Heroin dependence may constitute a traumatising condition, requiring dimensional diagnostic tools and trauma-informed treatment strategies. Further research is needed to validate the nosological status of pH-PTSD/S, clarify its distinction from protracted withdrawal or complex PTSD, and determine its implications for OAT duration and integrated care pathways. Full article

In recent years, psychological research has increasingly focused on the impact of media exposure on mental health, identifying young adults as particularly vulnerable due to their high levels of media engagement. To explore these effects, the construct of Media Vicarious Traumatization (MVT) has been introduced as an extension of vicarious traumatization, aimed at capturing the psychological impact of emotionally intense media content. MVT offers a relevant framework for understanding the mental health risks of media exposure, especially in relation to socially significant issues like war, now central in contemporary media discourse. This study aims to culturally adapt and psychometrically validate the Media Vicarious Traumatization Scale (MVTS) within the Italian context, and to investigate the relationship between the war-related MVT construct, generalized anxiety, and future anxiety among young adults. Study I, conducted on a sample of 250 participants (M = 22.40, SD = 2.63), explored the latent structure of the MVTS using Parallel Analysis and Exploratory Factor Analysis (EFA), yielding promising psychometric properties in terms of reliability and factorial stability. An independent sample of 553 participants (M = 22.43, SD = 2.37) was recruited for Study II to confirm the MVTS’s latent structure via Confirmatory Factor Analysis (CFA), which indicated good model fit. This study also evaluated measurement invariance across gender, internal consistency, and convergent, discriminant, and predictive validity, alongside psychometric properties assessed through Item Response Theory (IRT). The results of both studies confirm the stable and robust psychometric properties of the scale. Furthermore, Study II provides novel insights into the predictive role played not only by the war-related MVT but also by the recently introduced construct of Worry about War in exacerbating both generalized anxiety and future anxiety among Italian young adults. Full article

Transgenerational epigenetic inheritance has emerged as a compelling mechanism by which early-life stress can shape behavior in descendants with no direct exposure to trauma. However, whether such heritable modifications affect subtle behavioral phenotypes, like processing of social and emotional stimuli, remains poorly understood. In this study, we investigated the behavioral profile of fourth-generation heterozygous dopamine-transporter (DAT-HET) rats. Compared to control (SX) rats, our experimental group (labelled SIKK) consisted of animals (at G4, F3) born from MIK sires (at G3, F2), who descended from grand-dams (at G2, F1) who were in turn exposed to early-life maltreatment by their own DAT-KO mothers (the great-grand-dams, at G1, F0). To probe inhibitory control and social cognition, we employed the signaled licking / avoidance of punishment (SLAP) task, the elicited preference test (EPT), and the social recognition test (SRT). In the SLAP task, SIKK rats exhibited slower acquisition of passive avoidance, suggesting dampened sensitivity to predictive aversive cues. In the EPT, wild-type focal rats displayed a clear preference for SX over SIKK conspecifics, indicating reduced social appeal of epigenetically altered animals. In the SRT, SX rats successfully discriminated between a novel and a familiar DAT-KO conspecific, while SIKK rats failed to do so, revealing impaired social cognition. Together, these findings indicate that, despite the absence of direct trauma in their infancy, SIKK rats exhibit a distinct behavioral phenotype characterized by increased reactivity to threat and deficits in social preferences and cognition. These alterations reflect inherited dysfunctions in limbic dopaminergic circuits, particularly within PFC. Our study highlights how an ancestor’s adversity can shape adaptive behavior in future generations, providing a powerful model for understanding the biological basis of vulnerability to psychiatric disorders. Full article

Background: Disasters, although predictable, often occur unexpectedly, and efforts must be directed towards reducing their impact. Emergency healthcare workers, key players in disaster response, should maintain a high level of preparedness to act in catastrophic situations. Data on knowledge, attitude, and disaster preparedness among emergency healthcare workers is scarce, particularly for developed countries in Europe. This study aimed to measure the perceived preparedness of various health practitioners in emergency care in Iași county (Romania) and identify factors that influence it. Materials and methods: A self-assessment web-based questionnaire was developed to measure knowledge (K), attitude (A), and preparedness (P). Nonparametric tests compared measurements between demographic groups. Spearman correlation, linear univariate, and multivariate regression models were used to test the effect of perceived knowledge, attitude, and other work-related factors (such as experience, training, and leadership) on disaster preparedness. Results: 211 valid entries were recorded (114 female and 97 male), of which 33.6% were doctors, 25.1% were nurses, and 23.7% were paramedics. There were differences in exposure to training across health professions for disasters and trauma management (p = 0.03 and p = 0.009). The sample’s overall scores for the three primary domains assessed were moderate. Univariate analyses identified a significant effect of knowledge and attitude on preparedness (B = 0.9, 95% CI: 0.79–1.01, p < 0.001, and B = 0.81, 95% CI: 0.66–0.97, p < 0.001, respectively), which was maintained in multivariate regression. Workplace factors (disaster plans and institutional collaboration), along with experience in disaster management and emergency care, were determinants of preparedness, while the effect of training was insignificant. Conclusions: Most healthcare workers displayed moderate preparedness for disasters, while exposure to training and practice was found to be inadequate. Focus should be placed on identifying barriers and enhancing training delivery, strengthening institutional involvement in staff preparedness, and improving inter-professional collaborations. Adequate training methods must be developed and validated in further studies. Full article

Background: Brain computed tomography (CT) is the primary imaging modality for patients with acute neurological complaints in emergency departments, despite having a low diagnostic yield for many conditions. This study aimed to assess the common indications for brain CT, evaluate the prevalence of acute pathologies, and explore whether certain patient groups may be overexposed to unnecessary scans, impacting both patient safety and healthcare costs. Methods: We conducted a retrospective review of brain CT requests from the General Emergency Department in a single center over a one-month period. We recorded patient demographics (sex, age), scan indications, presence of focal neurological symptoms, acute pathology on CT, and final diagnoses. Descriptive statistics, including means ± SEM, were calculated using GraphPad Prism version 10.4.1. Results: A total of 584 brain CT scans were requested, of which 532 (91.1%) were normal, and 52 (8.9%) showed acute pathology. The age of all included patients were 70.8 ± 0.7 years with women (n = 304, 52.1%) being 71.9 ± 1.0 years old and men (n = 280, 47.9%) 69.7 ± 1.0 years old (p > 0.1). The most common indication for CT was head trauma (265, 45.4%) followed by ischemic stroke (130, 22.3%). The most frequent pathologies were ischemic stroke (2.7%), subdural hematoma (1.7%), and other traumatic bleeds (1.7%). Of the 52 patients with acute pathology, 42 (80.8%) exhibited focal neurological deficits. Conclusions: 91.1% of the brain CT scans in the emergency department were normal and did not lead to further intervention. While this may indicate a low diagnostic yield in certain patient groups—particularly those presenting with mild or nonspecific neurological symptoms—it does not alone confirm overuse. These findings highlight the importance of careful clinical evaluation to optimize imaging decisions. Reducing potentially unnecessary brain CT scans could lower healthcare costs and minimize radiation exposure, but the health-economic impact depends on balancing the savings with the potential costs of missing critical diagnoses and the associated societal consequences. Full article

Background/Objectives: Infant feeding is critical for health and development, yet the influence of maternal psychosocial factors on its timing is not fully understood. While maternal adverse childhood experiences (ACEs) are known to affect perinatal outcomes, their impact on the specific timing of initiating formula and complementary foods remains under-investigated. We hypothesized that maternal ACEs are associated with delayed initiation of infant formula and complementary foods and that this association is mediated by postpartum depression (PPD). This study aimed to examine the link between maternal ACEs and delayed infant feeding, and to assess the mediating role of PPD using data from a large nationwide Japanese database. Methods: This cross-sectional study utilized data from the Japan COVID-19 and Society Internet Survey (JACSIS), conducted between July and August 2021. The analysis included 3446 postpartum mothers. Maternal ACEs were assessed using a 9-item questionnaire, and a cumulative score was categorized as high (≥4 ACEs) versus low (0–3 ACEs). The primary outcomes were infant feeding behavior including breastfeeding, formula feeding and complementary foods. We used logistic regression analysis with inverse probability of treatment weighting (IPTW) to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). A mediation analysis was conducted to evaluate the role of smoking, alcohol and PPD. Results: High ACE exposure (≥4) was present in 221 mothers (6.4%). A high maternal ACE score was significantly associated with delayed initiation of formula feeding (≥7 days) (Adjusted OR: 2.12, 95% CI: 1.12–4.01, p = 0.02) and late initiation of complementary foods (≥7 months) (Adjusted OR: 2.27, 95% CI: 1.38–5.01, p = 0.03); no significant associations were observed for ever/late/continued breastfeeding or ever/continued formula feeding. These associations attenuated to non-significance after adjusting for PPD. Conclusions: Maternal ACEs are associated with delayed initiation of complementary foods and formula, largely through PPD. Perinatal services should combine ACE/PPD screening with trauma-informed mental health and nutrition support to promote timely infant feeding. Full article

Post-traumatic stress symptoms (PTSSs) are associated with an imbalanced time perspective (TP) as well as with unhealthy substance use. Although neurodevelopmental processes during adolescence may impact PTSS, most etiological models of post-traumatic stress disorder (PTSD) are derived from studies with adults and neglect possible distinctive characteristics in adolescent PTSD. This study examined possible direct and mediated relations between exposure to potentially traumatic experiences (EPTEs) and PTSS with TP as a potential mediator. In addition, the study investigated the direct and indirect effects of EPTE, TP, and PTSS on cannabis use. The aim of this study was to investigate whether findings from adult studies can be transferred to adolescent PTSD. One hundred and five patients between 14 and 20 years of age were recruited from child and adolescent psychiatric units. They answered questionnaires to assess EPTE, PTSS, TP, and cannabis use. Participants with clinically relevant PTSS showed imbalanced TP with a high orientation to negative past and a low orientation to positive past and future. Higher EPTE was associated with higher level of PTSS, but TP mediated the level of PTSS in this relation. PTSS predicted the frequency of cannabis use. It may therefore be beneficial to consider TP in PTSD therapy with the aim of reducing deviation from balanced TP and PTSS and preventing comorbid substance use. Full article

Introduction: Septic arthritis of the knee caused by the combination of Rothia mucilaginosa and Erysipelothrix rhusiopathiae is extremely rare. E. rhusiopathiae is a rare zoonotic pathogen that primarily affects individuals with occupational exposure to animals, while R. mucilaginosa can cause severe infections, particularly in immunocompromised patients. Case Presentation: A 59-year-old male underwent right knee arthroscopy in 2019 due to meniscal degeneration. Two weeks later, activity-related pain appeared. Magnetic resonance imaging showed proliferative synovitis, and joint aspiration revealed the presence of E. rhusiopathiae, which was treated with ciprofloxacin. As inflammation persisted, arthroscopic synovectomy was performed. Cultures revealed R. mucilaginosa and E. rhusiopathiae, prompting treatment with vancomycin and clindamycin. Despite repeated synovectomies, symptoms remained. After knee trauma in 2023, infection recurred. A two-stage total knee arthroplasty was performed in early 2024. At this time, another pathogen was isolated. At 12-month follow-up, the patient’s function and alignment had improved significantly. Conclusions: The described case highlights the importance of anamnesis, early diagnostics, and knowledge about the possible resistances of rare pathogens to ensure appropriate treatment of the illness. Full article

Background: Borderline Personality Disorder (BPD) is a complex psychiatric condition with multifactorial origins, with a high proportion of patients reporting early trauma. Stressors such as adverse childhood experiences (ACEs) can shape the epigenetic landscape including DNA methylation (DNAm) and act on gene expression. DNAm is increasingly being investigated as a molecular link between environmental exposures such as ACE and psychiatric outcomes. Differential DNAm of the gene PR domain zinc finger protein 8 (PRDM8), a histone methyltransferase, has recently been reported to be sensitive to early life trauma. Its role in BPD, especially in the context of ACE, remains to be elucidated. Methods: This study investigated DNAm patterns of PRDM8 in peripheral blood and saliva obtained from BPD patients undergoing Dialectic Behavioral Therapy (DBT) compared to healthy control (HC) participants. Associations with ACE and BPD symptom severity were assessed, and therapy-related changes in DNAm were examined. Results: At baseline, BPD patients demonstrated significant hypomethylation of PRDM8 in blood relative to the HC group. Following DBT, a nominally significant increase in DNAm was observed, aligning with inversely correlated symptom severity. No significant differences in saliva were detected. ACE was not associated with PRDM8 DNAm. Conclusions: Our findings suggest that PRDM8 DNAm might be associated with BPD and therapeutic intervention but not with ACE. Together with prior research, the results underscore the importance of future investigation of gene–environment interactions and the functional significance of PRDM8 regulation in the pathophysiology of BPD. Full article