Search Results (1,204)

Introduction: Concussions are a growing concern in professional football due to their potential short- and long-term neurological consequences. Despite increasing global awareness, data on the epidemiology and clinical management of concussions in Portuguese football remain scarce. This preliminary exploratory study aimed to characterize the incidence, mechanisms, symptomatology, and medical response to concussions in Portugal’s Professional Football Leagues during the 2023/2024 season, based on reported cases. Methods: A retrospective observational analysis was conducted on head injuries reported by club medical teams during official matches in Liga Portugal First and Second Leagues. Collected variables included player position, time of injury, mechanism, symptoms, medical interventions and hospital referral. Results: Only six concussions were reported during official matches, with an overall incidence of 0.60 per 1000 player-hours. Most occurred in defenders, primarily due to head-to-head collisions, followed by ball impact, falls, and maxillofacial trauma. Injuries were more frequent during the final third of matches. Common symptoms included loss of consciousness, headache, and amnesia. Half of the players were referred to hospital care and underwent cranial CT scans. Among all variables analyzed, a statistically significant association was found between mechanism of injury and occurrence of amnesia (p = 0.014), with non-head-to-head impacts more frequently associated with amnesia. However, given the extremely limited sample size, this finding should be interpreted with extreme caution and requires replication in larger cohorts. Conclusions: This preliminary study suggests that defenders face a higher risk of head injuries, particularly from head-to-head impacts occurring late in matches. The prevalence of severe symptoms and the potential association between non-head-to-head impacts and amnesia highlight the need for more robust injury surveillance systems and underscore the importance of improved sideline assessment and return-to-play protocols. The findings emphasize the urgent need for comprehensive, standardized reporting mechanisms for concussions. Further research should explore long-term neurological effects and the effectiveness of preventive measures such as rule modifications, protective measures, and enhanced concussion management protocols, supported by more extensive and systematically collected data. Full article

Accurate spleen segmentation in abdominal CT scans remains a critical challenge in medical image analysis due to variable morphology, low tissue contrast, and proximity to similar anatomical structures. This paper presents an enhanced U-Net architecture that addresses these challenges through multi-slice contextual integration and interpretable deep learning. Our approach incorporates three-channel inputs from adjacent CT slices, implements a hybrid loss function combining Dice and binary cross-entropy terms, and integrates Grad-CAM visualization for enhanced model interpretability. Comprehensive evaluation on the Medical Decathlon dataset demonstrates superior performance, with a Dice similarity coefficient of 0.923 ± 0.04, outperforming standard 2D approaches by 3.2%. The model exhibits robust performance across varying slice thicknesses, contrast phases, and pathological conditions. Grad-CAM analysis reveals focused attention on spleen–tissue interfaces and internal vascular structures, providing clinical insight into model decision-making. The system demonstrates practical applicability for automated splenic volumetry, trauma assessment, and surgical planning, with processing times suitable for clinical workflow integration. Full article

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

Objective: There is scarce reporting of radial head fracture epidemiology and patient characteristics beyond age and sex. This study aimed to describe demographic, socioeconomic, and injury pattern characteristics for people sustaining a radial head fracture admitted to trauma centers over a 15-year period. Methods: Analysis of Victorian Orthopaedic Trauma Outcomes Registry data was conducted to describe the demographic and case characteristics of patients with radial head fractures admitted to collaborating hospitals. Cohort and case characteristics were compared by center type (Level 1 vs. other trauma centers). Results: A total of 991 cases with a unilateral radial head fracture were recorded over 15 years, with 827 admitted to Level 1 trauma centers and 164 admitted to other centers. The mean age at time of injury was 48.7 years (SD 19.7), with male predominance (n = 621, 62.7%). Most patients resided in major cities (n = 824, 85.2%), were treated under the universal healthcare system (n = 546, 56.1%), and had no Charlson Comorbidity Index conditions (n = 738, 74.5%). A higher proportion of patients managed at Level 1 centers were male (65.7% vs. 47.6%), younger (mean 47.7 vs. 53.7 years), living in major cities (86.6% vs. 78.5%), and working prior to injury (71.3% vs. 57.1%). Over 85% of the cohort sustained concomitant injuries, with Level 1 centers receiving a higher proportion of multiple injury cases (87.8% vs. 73.2%). Elbow dislocations constituted the largest proportion of concomitant injuries (n = 257, 25.9%). Conclusions: This study has provided new insights into the demographic characteristics, comorbidity status, and associated injuries of radial head fracture populations admitted to Level 1 and other trauma centers, using long-established registry data. Full article

Background/Objectives: Paramedics frequently encounter potentially traumatic events and workplace violence, increasing their risk of burnout. Resilience may attenuate these effects. We examined the pathways through which post-traumatic stress (PTS) and workplace violence influence burnout and clarified the role of resilience among Korean paramedics. Methods: We studied duty-related trauma and violence experienced by 208 Busan Fire Department paramedics using standardized measures of PTS, workplace violence, resilience, and burnout. Using structural equation modeling, we tested the direct and indirect effects; covariates included sex, nursing license, and intention to stay. Results: PTS was most strongly associated with burnout, whereas workplace violence was indirectly associated with burnout through PTS. Resilience reduced PTS, yielding an indirect protective effect on burnout; however, it had no direct effect on burnout. Holding a nursing license and lack of intention to stay were significantly associated with burnout, and female sex and lack of intention to stay were indirectly associated with burnout via PTS. Conclusions: Burnout is primarily driven by PTS, and workplace violence amplifies PTS and indirectly exacerbates burnout. Strengthening violence prevention/response systems, early PTS screening/treatment, and resilience-building programs is warranted, with targeted support for vulnerable subgroups. Full article

Background/Objectives: The spinal cord is a critical component of the central nervous system that transmits neural signals between the brain and the body’s peripheral regions through its nerve roots. Despite being partially protected by the vertebral column, the spinal cord remains highly vulnerable to trauma, tumors, infections, and degenerative or inflammatory disorders. These conditions can disrupt neural conduction, resulting in severe functional impairments, such as paralysis, motor deficits, and sensory loss. Therefore, accurate and comprehensive spinal cord segmentation is essential for characterizing its structural features and evaluating neural integrity. Methods: In this study, we propose a fully automated method for segmentation of the cervical spinal cord in sagittal magnetic resonance (MR) images. This method facilitates rapid clinical evaluation and supports early diagnosis. Our approach uses a Swin-Unet architecture, which integrates vision transformer blocks into the U-Net framework. This enables the model to capture both local anatomical details and global contextual information. This design improves the delineation of the thin, curved, low-contrast cervical cord, resulting in more precise and robust segmentation. Results: In experimental studies, the proposed Swin-Unet model (SWU1), which uses transformer blocks in the encoder layer, achieved Dice Similarity Coefficient (DSC) and Hausdorff Distance 95 (HD95) scores of 0.9526 and 1.0707 mm, respectively, for cervical spinal cord segmentation. These results confirm that the model can consistently deliver precise, pixel-level delineations that are structurally accurate, which supports its reliability for clinical assessment. Conclusions: The attention-enhanced Swin-Unet architecture demonstrated high accuracy in segmenting thin and complex anatomical structures, such as the cervical spinal cord. Its ability to generalize with limited data highlights its potential for integration into clinical workflows to support diagnosis, monitoring, and treatment planning. Full article

Emerging evidence highlights oxidative stress and its biomarkers as potential factors in the onset and maintenance of Post-Traumatic Stress Disorder (PTSD) and co-occurring sleep disturbances. The study concerns the profile of biomarkers including glutamine, glutathione (GSH), caspase-1 and Brain-Derived Neurotrophic Factor (BDNF) levels in three groups (PTSD with a current diagnosis lasting ≤ 5 years, PTSD with a current diagnosis lasting > 5 years, and no PTSD), classified into two age groups. In addition, sleep disturbances were analyzed using the Pittsburgh Sleep Quality Index Addendum (PSQI-A). The study revealed mutual correlations between the examined biomarkers, which may confirm a coordinated antioxidant response. Furthermore, a relationship was observed between biomarkers and PSQI-A; trauma-related domains (e.g., Trauma Nightmares with Terror Episodes) were more pronounced in the case of PTSD ≤ 5 years, while PTSD > 5 years emphasized trauma-unrelated anxiety. The study results suggest that individuals with PTSD exhibit increased sensitivity to trauma, which may manifest through immune system activation and sleep disturbances. Patients with a longer history of PTSD and co-occurring dysfunctions require a personalized approach to trauma treatment and prevention of recurrence. Full article

Background: Polytrauma remains a leading cause of mortality and disability worldwide. Although trauma-related deaths have declined in recent decades, the drivers of this trend remain incompletely understood. Traumatic brain injury (TBI) is the principal cause of death and long-term disability in polytrauma, making it a critical determinant of outcomes. This study aimed to examine long-term trends in clinical characteristics, management strategies, and outcomes of polytraumatized patients with TBI (PTBI), with a particular focus on factors influencing overall and cause-specific mortality. Methods: We conducted a retrospective observational study of a prospectively maintained trauma registry over a 25-year period (1993–2018) at the Gregorio Marañón University General Hospital (Madrid, Spain). Adult patients with PTBI were included. Epidemiological, clinical, and outcome data were analyzed globally and across four time periods. Results: Among 768 patients with PTBI, mean age was 43 years (±20), and 29% were female. Most sustained closed TBIs (96%) with concomitant severe injuries to the head, chest, and extremities (median Injury Severity Score [ISS] 27; median New Injury Severity Score [NISS] 34). Emergency surgery was required in 51%, and 84% were admitted to intensive care. Over time, the incidence of polytrauma decreased, mainly reflecting fewer traffic-related injuries following advances in prevention and legislation. Despite an increasingly older and comorbid population, ISS/NISS and early mortality declined, largely due to improvements in prehospital care and hemorrhage control. Although crude TBI-related mortality appeared unchanged (28%), this pattern likely reflects offsetting influences, including an older and more comorbid patient population, a higher relative burden of severe cases, and the limitations of mortality alone to capture gains in functional outcomes. Conclusions: Advances in trauma systems and preventive policies have substantially reduced the burden of polytrauma and improved survival. However, severe TBI remains the principal unresolved challenge, highlighting the urgent need for innovative neuroprotective strategies and greater emphasis on functional recovery. Full article

Traumatic brain injury (TBI) results in a cascade of neuropathological events, which can significantly disrupt synaptic integrity. This review explores the acute, subacute and chronic phases of synaptic dysfunction and loss in trauma which commence post-TBI, and their contribution to the subsequent neurological sequelae. Central to these disruptions is the loss of dendritic spines and impaired synaptic plasticity, which compromise neuronal connectivity and signal transmission. During the acute phase of TBI, mechanical injury triggers presynaptic glutamate secretion and Ca²⁺ ion-mediated excitotoxic injury, accompanied by cerebral edema, mitochondrial dysfunction and the loss of the mushroom-shaped architecture of the dendritic spines. The subacute phase is marked by continued glutamate excitotoxicity and GABAergic disruption, along with neuroinflammatory pathology and autophagy. In the chronic phase, long-term structural remodeling and reduced synaptic densities are evident. These chronic alterations underlie persistent cognitive and memory deficits, mood disturbances and the development of post-traumatic epilepsy. Understanding the phase-specific progression of TBI-related synaptic dysfunction is essential for targeted interventions. Novel therapeutic strategies primarily focus on how to effectively counter acute excitotoxicity and neuroinflammatory cascades. Future approaches may benefit from boosting synaptic repair and modulating neurotransmitter systems in a phase-specific manner, thereby mitigating the long-term impact of TBI on neuronal function. 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

Dural arteriovenous fistulas (dAVFs) are a heterogeneous group of intracranial vascular anomalies characterized by abnormal arteriovenous shunting within the dura mater. While they are often considered acquired lesions—associated with trauma, surgery, venous sinus stenosis, or thrombosis—their precise etiology remains unclear in many cases. The clinical presentation of dAVFs varies widely depending on location and venous drainage patterns. Benign forms may manifest as pulsatile tinnitus or headache, whereas lesions with retrograde venous drainage and cortical venous reflux are considered aggressive and carry a heightened risk of hemorrhage and progressive neurological decline. Multiple classification systems, primarily based on angioarchitecture and venous outflow characteristics, have been developed to stratify risk and guide treatment strategies, as these features largely determine the natural history and clinical course of dAVFs. Endovascular embolization, microsurgical disconnection, and stereotactic radiosurgery (SRS) represent the mainstays of treatment, aiming to prevent hemorrhage or rebleeding and to alleviate symptoms related to venous congestion. Over the past two decades, advances in endovascular techniques have driven a paradigm shift in management, positioning embolization as the first-line therapy for most dAVFs. This review begins with a comprehensive overview of dAVF pathogenesis, classification systems, and angioarchitecture. It then focuses on the endovascular management of dAVFs, offering a detailed appraisal of current and emerging techniques, key technical considerations, and lesion-specific treatment strategies. Finally, we discuss the role of microsurgery and SRS. Full article

Sedation is an essential component of the anesthesia process. Inadequate sedation during anesthesia increases the risk of patient discomfort, intraoperative awareness, and psychological trauma. Conventional electroencephalography (EEG) based depth of anesthesia monitoring is often impractical in out-of-hospital settings due to equipment limitations and signal artifacts. Alternative non-EEG-based approaches are therefore required. In this study, we developed a machine learning model to detect inadequate sedation using 27 feature parameters, including demographics, vital signs, and heart rate variability metrics, from the open-access VitalDB database. Patient states were defined as inadequate sedation when the bispectral index (BIS) > 60. We systematically evaluated four temporal windows and four algorithms, and assessed model interpretability using Shapley Additive Explanations (SHAP). The Light Gradient Boosting Machine (LGBM) achieved the best performance, with an area under the receiver operating characteristic curve (AUC) of 0.825 and an accuracy (ACC) of 0.741 using a 2 s time window. Extending the time window to 20 s improved both metrics by approximately 0.012. Feature selection identified 12 key parameters that maintained comparable accuracy, confirming robustness with reduced complexity. These findings demonstrate the feasibility of using non-EEG-based physiological data for real-time detection of inadequate sedation. The developed model is interpretable, resource-efficient, scalable, and shows strong potential for integration into portable monitoring systems in prehospital, emergency, and low-resource surgical settings. Full article

Background: Acromioclavicular joint (ACJ) injuries frequently result from trauma to the shoulder girdle and are particularly common among young, physically active individuals. These injuries account for approximately 9% of all traumatic shoulder girdle injuries and often lead to functional impairment and pain. The TightRope^® system, LARS™ band, and Bosworth screw are among over 160 currently described surgical techniques for managing ACJ dislocations. However, there is no consensus regarding the optimal surgical approach, particularly for the management of moderate Rockwood Type III ACJ dislocations. Materials and Methods: In this retrospective study, data from 246 patients who underwent surgery for ACJ dislocation between 2010 and 2018 at the Department of Orthopedics and Trauma Surgery, Medical University of Vienna, were analyzed. Patients were divided into four cohorts based on the surgical technique used: Bosworth screw, LARS (acute), LARS (chronic), and TightRope. Clinical and radiological outcomes were assessed pre- and postoperatively using the Visual Analog Scale (VAS), Constant, Disability of the Arm, Shoulder and Hand Score (DASH), Simple Shoulder Test (SST), University of California—Los Angeles Shoulder Score (UCLA), Short Form Health Survey (SF-36), and American Shoulder and Elbow Surgeons score (ASES), as well as radiographic analysis. Radiological measurements of the acromioclavicular (AC) and coracoclavicular (CC) joint spaces were taken on both the injured and uninjured shoulders to analyze and compare the reduction in joint gaps. Results: All surgical methods resulted in significant reductions in AC and CC joint gaps. The TightRope and LARS acute groups showed the greatest reductions, with minimal complication rates. Complication analysis revealed significant differences in clavicular elevation (p < 0.001) and CC-ligament ossification (p = 0.006), which were most frequent in the Bosworth group and least common in TightRope^® patients, with LARS showing intermediate values. AC joint arthrosis was uncommon in all four groups and did not differ significantly (p = 0.13). Overall, TightRope^® was associated with the most favorable complication profile. The postoperative VAS score in the TightRope group was 1.52 ± 2.06, and the Constant score was 96.83 ± 5.41, reflecting high patient satisfaction. Conclusions: All systems led to satisfactory radiological and clinical outcomes, with the LARS™ band showing particular effectiveness in chronic ACJ dislocations. While all techniques provided good results, the TightRope^® system demonstrated the most favorable overall profile in our cohort and may therefore be considered a promising contemporary option. Further studies are needed to determine the optimal treatment for moderate ACJ dislocations and to assess the cost-effectiveness of these surgical techniques. Full article

Prognostic uncertainty and missed diagnoses of sepsis remain frequent after cardiopulmonary bypass (CPB) surgery, where systemic inflammatory response (SIRS) arises from surgical trauma, blood activation in the extracorporeal circuit, ischemia/reperfusion injury, and endotoxin release. Among innovative biomarkers, pro-adrenomedullin (pro-ADM), particularly its stable fragment mid-regional pro-adrenomedullin (MR-proADM), has shown promise for detecting endothelial dysfunction and predicting organ failure in sepsis. SeptiCyte^® RAPID (Seattle, WA, USA) also represents a novel diagnostic tool that assesses the host immune response by quantifying PLA2G7 and PLAC8 gene expression in whole blood, offering potential for early differentiation between sepsis and sterile inflammation. We analyzed traditional and innovative biomarkers within 24 h post-CPB in a pilot group of patients admitted to the cardiac Intensive Care Unit of the “Città della Salute e della Scienza” University Hospital (Turin, Italy) between June and November 2023. Data from the following 14 patients were collected: 7 undergoing surgery for infective endocarditis (IE, Group 1) and 7 having standard elective cardiac surgery (Group 2). Procalcitonin (PCT), lactate, and pro-ADM increased in Group 1 but not in Group 2. SeptiCyte^® RAPID showed a moderate, borderline increase in Group 1. The innovative biomarkers had a good performance in patients exhibiting signs of organ dysfunction and in subjects demonstrating at least cardiovascular and/or pulmonary damage and under vasopressor and inotropic support. Although limited by the small sample, our preliminary data suggest no biomarker alterations in patients with standard elective cardiac surgery, unlike in those with IE. 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