Injury Events Research Articles

Combining immunosuppressive therapy with low dosage eltrombopag in Chinese patients with severe aplastic anemia: mild aggravation of hepatic injury.

Eltrombopag (EPAG) is an oral thrombopoietin receptor agonist analog with the potential risk to induce liver injury. This prospective registry study evaluated the prevalence and severity of hepatic injury in Chinese patients with severe aplastic anemia undergoing low-dose EPAG treatment (75mg/day) in the context of standard immunosuppressive therapy (IST). The incidence of acute drug-induced liver injury was slightly higher in the IST + EPAG group than in the IST group at the 1st and 2nd month, but no statistically significant difference was observed: 10% vs 5% (p = 0.400), 9% vs 8% (p = 1.000). At the 1st month, the incidences of alanine aminotransferase, aspartate aminotransferase, and total bilirubin increased of grade 3 or higher in the IST + EPAG and the IST groups, were 5% vs 3% (p = 0.228), 2% vs 1% (p = 1.000), 2% vs 1% (p = 1.000), respectively. The logistic analysis indicated that serum ferritin level was associated with severe liver injury events. There was a slight increase in the incidence of severe hepatic injury events in the patients with SAA treated by EPAG, but it was insignificant.

Invasive Coronary Angiography versus Non-invasive CT Coronary Angiography as Preoperative Coronary Imaging for Valve Surgery

Coronary computed tomography angiography (CCTA) has emerged as a noninvasive alternative to invasive coronary angiography (ICA) for diagnosing coronary artery disease (CAD). Hence, the question of CCTA's ability to guide surgical decision-making moves into the center of attention. CCTA is specifically powerful in ruling out CAD. We, therefore, performed a meta-analysis and systematic review to compare the clinical end points between patients who received ICA or CCTA to rule out CAD before valve surgery. A total of 3 databases were assessed. The primary outcome was perioperative mortality. Secondary outcomes were acute kidney injury (AKI), myocardial infarction (MI), stroke, and major adverse cardiovascular events (MACEs). The odds ratio (OR) and the respective confidence interval (CI) was calculated. A random-effects model was performed. A total of 5 studies with 6,654 patients qualified for the analysis. There was no significant difference between the 2 groups regarding the primary end point (OR 1.20, 95% CI 0.67 to 2.15, p = 0.53). The secondary outcomes also did not show any significant differences in AKI (OR 1.14, 95% CI 1.14, 0.88 to 1.49, p = 0.32), MI (OR 0.89, 95% CI 0.65 to 1.22, p = 0.45), stroke (OR 1.12, 95% CI 0.48 to 2.60, p = 0.79), or MACEs (OR 1.17, 95% CI 0.86 to 1.59, p = 0.33) incidences. The analysis suggests that CCTA is a safe and reliable noninvasive alternative to ICA for coronary imaging before valve surgery. Conceivable differences in imaging modalities were not associated with increases in perioperative mortality, AKI, MI, stroke, or MACEs.

Surgeon Volumes of Endovascular Thoracoabdominal Aneurysm Repairs, but not Juxtarenal Repairs, are Associated with Outcomes following Endovascular Repair of Thoracoabdominal Aneurysms.

Endovascular thoracoabdominal aortic aneurysm (eTAAA) repair remains one of the more technically challenging aspect of vascular surgery, with significant risk of mortality, spinal cord ischemia (SCI), and end organ damage. Although fenestrated devices are available for juxtarenal aneurysms, there are no commercially available eTAAA devices on the US market currently. We therefore studied how the volume of juxtarenal repairs would translate to outcomes of these more complicated aneurysms. We studied all eTAAA repairs (Crawford type 1-3) in the Vascular Quality Initiative from 2014-2021 and categorized surgeons into quartiles based on their average annual eTAAA volume and endovascular juxtarenal volume. Our primary outcome was thoracoabdominal life altering events (TALE-composite of perioperative death, stroke, permanent SCI and dialysis). We employed mixed effects logistic regression clustering by center and surgeon. We identified 5335 repairs from 607 surgeons, with annual average eTAAA volumes of 2,629 from 400 surgeons. Quartile 1 involved <2 repairs and quartile 4 involved >12 repairs per year. Repairs at higher quartiles were for larger aneurysms, more commonly employed staged repairs, utilized spinal drains, and more frequently utilized physician modified endografts, whereas low volume surgeons most commonly employed parallel grafting. Higher volume surgeons had overall shorter procedural times, fluoroscopy time, and less total contrast. Technical success similarly increased as procedure volume increased. In adjusted analyses, rates of perioperative death, TALE, stroke, acute kidney injury and major adverse cardiac events were all lower in the highest volume quartile compared to the lowest. However, after accounting for eTAAA volume, surgeon volume of endovascular juxtarenal repairs was not associated with any postoperative outcome, and there was no significant interaction between juxtarenal and eTAAA volume. Medium term mortality was lowest in patients treated in the top two quartiles of volume (HR 0.77 [0.61-0.97], P = .024. Surgeon eTAAA experience shows a strong volume-outcome effect on outcomes in the immediate post operative period and in permanent patient-centered outcomes. However, experience in less extensive aneurysms did not directly translate to thoracoabdominal aneurysms. Further study is needed to evaluate the role that commercial graft availability and repair type contributes to these findings.

Morally injurious events and posttraumatic embitterment disorder in U.K. health and social care professionals during COVID-19: A longitudinal web survey.

To longitudinally estimate the prevalence and predictors of potentially morally injurious events (PMIEs) and posttraumatic embitterment disorder (PTED) and in U.K. health and social care workers (HSCWs) during the COVID-19 pandemic. Additionally, to investigate the mechanism by which PMIEs increase embitterment by lowering personal belief in procedural justice, that is, the belief that they experience fair processes. An online longitudinal survey was hosted on Qualtrics between September-October 2020 and September-November 2021. Using Prolific, 400 HSCWs aged 18 or above and working in the United Kingdom during the pandemic were recruited. PMIEs were assessed using the Moral Injury Events Scale, and PTED was assessed using the PTED self-rating scale. Potential predictors were measured using surveys of exposure to occupational stressors, optimism, pessimism, self-esteem, resilient coping style, consideration of future consequences, and personal just world beliefs. Seventy-one percent of participants experienced at least one COVID-related PMIE and 20% displayed clinically relevant signs of PTED at Time 2 in 2021. Exposure to occupational stressors increased the risk of experiencing PMIEs and PTED, whereas personal belief in a procedurally just world protected against transgressions by others and betrayal PMIEs. Self-esteem was protective, and a resilient coping style was a risk for experiencing betrayal. PMIEs increased embitterment by lowering personal belief in procedural justice over a 12-month period. PMIEs and PTED are being experienced by U.K. HSCWs in 2020 and 2021, particularly in those exposed to work-related stressors. Exposure to PMIEs increases the risk of embitterment by lowering belief in procedural justice. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Pastoral Narrative Disclosure

This study presents a community chaplaincy evaluation of pastoral narrative disclosure (PND) as a structured intervention for addressing moral injury (MI) among individuals who have experienced morally injurious events. Pastoral narrative disclosure is an evidence-based, eight-stage pastoral counselling, guidance and education framework that integrates the principles of both adaptive disclosure and confessional narrative. Previously, PND training was evaluated exclusively among Australian military chaplains (n = 201; Carey et al., 2024). In contrast, this evaluation focuses on community chaplains (n = 76), representing diverse organizations in Australia, including police, healthcare, welfare, prison, school, ambulance and veteran sectors. All participating community chaplains completed the Australian Defence Force Chaplaincy Moral Injury Skills Training (MIST) programme, culminating in the final praxis stage of PND. The evaluation revealed high overall satisfaction with the MIST-PND strategy, with participants reporting a mean satisfaction score of 4.88 out of 5 (n = 76), aligning closely with the satisfaction ratings obtained from military chaplains (? = 4.73/5; n = 201). Qualitative feedback was thematically collated, indicating widespread satisfaction with the (i) MIST programme, (ii) PND strategy, (iii) presenters and (iv) practical application role-plays. A diverse range of suggestions are also noted for potential improvement. Overall, the findings are consistent with those from the military chaplaincy evaluation, highlighting the utility of PND within community contexts. Despite several limitations, the results support the broader application of PND in addressing MI, particularly in community health, veteran and welfare settings, as well as among first responders. These findings justify further implementation of PND and additional research to assess its effectiveness across non-military sectors.

Osteopontin and Its Clinical Correlation to Type 1 Cardiorenal Syndrome: A Literature Review

Cardiorenal syndrome (CRS) is a spectrum of disorders involving both the heart and the kidneys, either acutely or chronically, in one organ that can lead to dysfunction in the other. Type 1 CRS, the most common CRS, is when acute heart dysfunction impacts acute kidney dysfunction, commonly known as acute kidney injury. Comorbidities involving these two significant organs contribute to a high patient mortality rate that requires a new potential diagnostic method. Biomarkers are one of the diagnostic modalities widely used in various diseases. Osteopontin (OPN) is a phosphorylated glycoprotein found primarily in bones and teeth that regulates mineralization. Osteopontin is known to be involved in describing various pathological changes in the body, including cardiovascular diseases. This review aims to evaluate the clinical correlation of OPN level changes with the occurrence of Type 1 CRS. The results indicate that OPN also plays a role in detecting the progression of cardiovascular disease towards renal injury. The imbalance in the function of OPN as a pro-inflammatory and anti-inflammatory agent increases the progression of kidney disease in patients. Further findings suggest that, more specifically, urinary OPN describes renal injury events in type 1 CRS patients.

Prevalence of Moral Injury in Nationally Representative Samples of Combat Veterans, Healthcare Workers, and First Responders.

Moral injury affects a variety of populations who make ethically complex decisions involving their own and others' well-being, including combat veterans, healthcare workers, and first responders. Yet little is known about occupational differences in the prevalence of morally injurious exposures and outcomes in nationally representative samples of such populations. To examine prevalence of potentially morally injurious event (PMIE) exposure and clinically meaningful moral injury in three high-risk groups. Cross-sectional survey with responses weighted to national geodemographic benchmarks. Combat veterans, healthcare workers, and first responders (N=1232) in the USA. Moral Injury and Distress Scale (MIDS). Many combat veterans (49.3%), healthcare workers (50.8%), and first responders (41.6%) endorsed exposure to a PMIE. Clinically meaningful moral injury symptoms were endorsed by 6.5% of combat veterans, 7.3% of healthcare workers, and 4.1% of first responders. After adjusting for age, gender, race, and ethnicity, relative to first responders, combat veterans were more likely to endorse transgressing their values by what they did and healthcare workers were more likely to endorse witnessing others' wrongful acts. Additionally, combat veterans (adjusted risk ratio (aRR) = 2.18, 95% confidence interval (95% CI) = 1.09, 2.16) and healthcare workers (aRR = 2.02, 95% CI = 1.03, 3.83) were over twice as likely to screen positive for clinically meaningful moral injury in comparison to first responders. No differences in exposures or outcomes emerged between combat veterans and healthcare workers. Results from these nationally representative samples of three high-risk populations suggest that exposure to PMIEs is common and a sizable minority report clinically meaningful moral injury.

P-1729. Implementation of a Vancomycin AUC and Trough-based Dosing Policy Across a Large Health-system Reduced Trough Levels, Acute Kidney Injury Events, and Hospital Length of Stay

Abstract Background Vancomycin dosing guidelines recommend area-under-the-cure (AUC) over trough-based dosing for severe MRSA infections. Optimal dosing of non-severe or non-MRSA is unknown. Conflicting data exists on the real-world benefits of implementing AUC-based dosing methods. Methods A standardized vancomycin dosing policy was implemented across an 8-hospital healthsystem in MN and WI. Prior to implementation, most hospitals targeted troughs between 15-20 for severe MRSA infections. The new policy recommended AUC-based dosing for patients with known or suspected severe MRSA infections and lower trough goals (10-15) for all other patients. DoseMeRx was used to calculate AUC and adjust doses. Vancomycin levels, AKI-coded diagnoses, and length of hospital stay (LOS) were compared 6 months pre and post intervention. An approximate and conservative $7,000 cost avoidance was assigned per AKI event based on a literature review. Results 8,458 patient encounters were included over the 12 month study period (4084 pre, 4,374 post) representing 7,142 patients (3,517 pre, 3,825 post). Average cumulative vancomycin doses were lower in the post group by 401 mg (4,838mg vs 4,435mg). The number of trough levels greater than 15 was significantly reduced post-intervention (56.9% vs 40.6%, p &amp;lt; 0.001). There was a 25% relative reduction in AKI-coded encounters (13.0% vs 9.6%, p &amp;lt; 0.001) and reduction in average LOS (7.8 vs 7.2 days; p &amp;lt; 0.001 ). The number of encounters with S.aureus positive blood cultures was the same between groups (13.0%). The number of patients who received at least one dose of piperacillin/tazobactam was higher in the post-group (36.0% vs 39.7%). The reduction in AKI events was associated with a $1,029,000 cost avoidance. Conclusion A system vancomycin dosing policy that incorporated both AUC and trough-based dosing methods was associated with a significant reduction in trough levels &amp;gt; 15, AKI events, and LOS. This represented a significant cost-avoidance of approximately $1,029,000 over a 6-month implementation period. Disclosures All Authors: No reported disclosures

Moral injury in treatment-seeking police officers: A qualitative study.

In their work, police officers are routinely exposed to potentially traumatic events, some of which may also be morally distressing. Moral injury refers to the multidimensional impact of exposure to such potentially morally injurious events (PMIEs). Mainly originating from a military context, there is little empirical research on moral injury in policing. The aim of this study was to gain insight into what PMIEs and moral injury in police officers entail. We used a generic qualitative research approach inspired by grounded theory. Semistructured interviews were conducted with 13 treatment-seeking, trauma-exposed police officers at a Dutch national center for psychotrauma. Participants were 11 men and two women with a diagnosis of profession-related posttraumatic stress disorder, who reported being troubled by exposure to a morally transgressive event. Findings were categorized into three categories in terms of PMIEs and moral injury: (1) no high stakes PMIEs, (2) high stakes PMIEs but no moral injury, and (3) high stakes PMIEs and moral injury. Within the third category, three main themes and associated subthemes emerged: (1) a sense of responsibility in death, (2) the illusion of control, and (3) a duty to remember. This study is the first to explore high stakes PMIEs and moral injury in trauma-exposed, help-seeking police officers. Findings show that moral injury seems a relevant clinical concept in policing. PMIEs may change their fundamental self-perception and lead to deep feelings of guilt and shame. Directions for future research include examining police officers' treatment needs and perspectives on "moral recovery." (PsycInfo Database Record (c) 2025 APA, all rights reserved).

"Beyond the Finish Line" the Epidemiology of Injury and Illness in Professional Cycling: Insights from a Year-Long Prospective Study.

Introduction: Injury and illness rates within cycling are a growing concern for riders, medical personnel, and event organisers. This study is the first to document injury and illness rates in professional cyclists throughout one competitive season including training and racing. Methods: A prospective, longitudinal study was conducted with 47 professional cyclists (30 males and 17 females) over the 2024 season (1 November 2023-31 October 2024). Injuries and illnesses were defined and recorded following the International Olympic Committee (IOC) consensus guidelines for injury reporting in sports and its cycling-specific extension. Data collection utilised a centralised online hub, integrating exposure metrics (e.g., training hours and kilometres) and medical records. All data were processed on a Macintosh computer using the Microsoft Office and R statistics packages epi tools, binom.test function, and ggplot. (V.4.3.2, R Foundation for Statistical Computing, Vienna, Austria). Ethical approval was obtained from Queens University Belfast, number MHLS 23_175. Results: Fifty-five injury events were logged, with 1.15 (±0.359) locations injured per incidence and 1.57 (±1.06) injury types per incident. The overall combined injury rate for racing was 4.14 (95% CI: 2.65-5.79) per 1000 h of exposure, with the overall combined rate for training being 1.23 (95% CI: 0.8-1.7) per 1000 h. The injury risk ratio (RR) for injury during racing and training for females was 11.10 (95% CI: 2.69-37.60), and the RR for males was 10.24 (95% CI: 3.84-43.06), both indicating there is a significantly higher risk of injury during racing compared to training. Abrasions were the most common injury type, with fractures being the most burdensome injury. The most common illness was upper respiratory, 0.63 (95% CI: 0.27-0.99) per year for males and 1.11 (95% CI: 0.64-1.59) per year for females. Saddle sores were the second most common at 0.20 (95% CI: 0.04, 0.36) per year for males and 0.08 (95% CI: 0-0.18) per year for females. Conclusions: This study provides the first comprehensive, season-long surveillance data for injuries and illnesses in male and female professional road cycling, highlighting the significant differences in injury profiles between racing and training. These results underscore the need for targeted injury prevention strategies and the establishment of a standardised injury and illness framework for professional cycling.

Evaluating Paediatric Injury Hospitalisations From Indoor Trampoline Parks Across Australia: A Multi-Centre Study.

The introduction and increasing popularity of indoor trampoline facilities has seen increases in the incidence of trampoline park injuries (TPIs), particularly amongst the paediatric population. A challenge to the development of effective injury prevention interventions is the limited study pool of detailed activity and outcome data to provide better understanding of the characteristics of injurious events. A cross-sectional study of individuals under 16 years of age hospitalised after TPI from November 2018 to December 2021 was conducted. Patient demographics and TPI characteristics were collected through prospective case notifications from clinicians across Australia, via the Australian Paediatric Surveillance Unit. Additional data were collected using retrospective medical record review at two major paediatric centres in Australia. In total, 48 cases of TPIs were reported: median age was 9.5 years with 28 (58.3%) being males. The most common injury mechanism was a fall on the trampoline (n = 34, 72.3%). The most commonly injured body region was upper limb (n = 27, 56.3%), followed by lower limb (n = 11, 22.9%): all limb injuries involved a fracture. Most patients required operative intervention (n = 37, 90.2%). The results from this study suggest that serious injuries continue to occur at trampoline parks, and thus remain an injury concern that requires attention. This issue needs to be addressed with consistent application of the Australian Standard, along with other injury prevention initiatives.

Ferroptosis-related genes participate in the microglia-induced neuroinflammation of spinal cord injury via NF-κB signaling: evidence from integrated single-cell and spatial transcriptomic analysis

BackgroundFerroptosis and immune responses are critical pathological events in spinal cord injury (SCI), whereas relative molecular and cellular mechanisms remain unclear.MethodsMicro-array datasets (GSE45006, GSE69334), RNA sequencing (RNA-seq) dataset (GSE151371), spatial transcriptome datasets (GSE214349, GSE184369), and single cell RNA sequencing (scRNA-seq) datasets (GSE162610, GSE226286) were available from the Gene Expression Omnibus (GEO) database. Through weighted gene co-expression network analysis and differential expression analysis in GSE45006, we identified differentially expressed time- and immune-related genes (DETIRGs) associated with chronic SCI and differentially expressed ferroptosis- and immune-related genes (DEFIRGs), which were validated in GSE151371. Protein–protein interaction and microRNA-mRNA-transcription factor regulatory networks were constructed based on Search Tool for the Retrieval of Interacting Genes (STRING) and NetworkAnalyst, respectively, which were validated by chromatin immunoprecipitation followed by sequencing (ChIP-seq). Cell subclusters and unique features of microglia in SCI were identified by single-cell transcriptomic analysis, which were validated in GSE226286. Spatial expression patterns of DETIRGs and DEFIRGs were validated in brain injury (GSE214349) and SCI (GSE184369). Potential mechanisms underlying neuronal regeneration by neurotrophin-3 (NT3)-chitosan were revealed by transcriptomic analyses in GSE69334. Immune- and ferroptosis-related mechanisms of nanolayered double hydroxide loaded with NT3 (LDH-NT3) were investigated in vivo and in vitro.ResultsGBP2, TEC, UNC93B1, PLXNC1, NFATC1, IL10RB, and TLR8 were DETIRGs represented chronic SCI-specific genes and peripheral blood biomarkers. NFKB1 may regulate expression of CYBB and HMOX1 in a unique subcluster of M1 microglia within the middle SCI lesion, establishing links between microglial ferroptosis and neuroinflammation. Reduced inflammatory responses and microglial ferroptosis were potential effects of NT3-chitosan or LDH-NT3 on neuronal regeneration.ConclusionsA novel subcluster of microglia exhibiting M1 polarization and ferroptosis phenotype was involved in SCI. These microglia may trigger neuroinflammation and induce neuronal degeneration within the middle site of SCI, which might be inhibited by NT3-chitosan or LDH-NT3.

Assessment of moral injury and PTSD in active-duty personnel and veterans in Ukraine: a scoping review

PurposeThis study is a scoping literature review of research into post-traumatic stress disorder (PTSD) and moral injury (MI) in active-duty military personnel and veterans in Ukraine. This study aims to explore the existing research regarding the relationship between PTSD and MI in Ukrainian military personnel to identify the need for future research in a vulnerable social group that is exposed to a high level of conflict.Design/methodology/approachThis scoping review includes the results of peer-reviewed articles from online databases (PubMed, Science Direct, PsycArticles, Military Database, Sociological , Psychology Database, PTSD Pubs, Web of Science), which were searched for publications in English, Ukrainian and Russian. The data obtained was organized using Preferred Reporting Items for Systematic Reviews extension for scoping reviews and Meta-Analyses, the Critical Appraisal Skills Programme Qualitative Studies Checklist and Joanna Briggs Institute Critical Appraisal Checklist. Data was analyzed and categorized using an inductive thematic analysis.FindingsAccording to the thematic analysis, the following themes were identified in a Ukrainian military context: sources of PTSD, sources of moral injury, symptoms of PTSD, symptoms of moral injury and treating and prevention mechanisms. All studies included in the scoping review (32) report on PTSD and/or MI in military groups in Ukraine. They find the gap in research and in numerous comprehensive studies problematic and underline the need for more effective rehabilitation programs.Practical implicationsA scoping review was conducted to thematically map the research in the area, identify any knowledge gaps deficit about PTSD and MI in Military personnel in Ukraine and contribute to further development of effective rehabilitation programs.Originality/valueThe sparsity of the existing literature highlights the need for further research into enhancing the mental health services provided to military personnel. In addition, there is a growing need to further explore trauma exposure and potentially morally injurious events related to PTSD and MI, in particular. Such a review has not yet been carried out, which adds value to the current paper.

Evaluation of objective methods for analyzing ipsilateral motor evoked potentials in stroke survivors with chronic upper extremity motor impairment.

Objective:Ipsilateral motor evoked potentials (iMEPs) are believed to represent cortically evoked excitability of uncrossed brainstem-mediated pathways. In the event of extensive injury to (crossed) corticospinal pathways, which can occur following a stroke, uncrossed ipsilateral pathways may serve as an alternate resource to support the recovery of the paretic limb. However, iMEPs, even in neurally intact people, can be small, infrequent, and noisy, so discerning them in stroke survivors is very challenging. This study aimed to investigate the inter-rater reliability of iMEP features (presence/absence, amplitude, area, onset, and offset) to evaluate the reliability of existing methods for objectively analyzing iMEPs in stroke survivors with chronic upper extremity motor impairment.&#xD;Approach:Two investigators subjectively measured iMEP features from thirty-two stroke participants with chronic upper extremity motor impairment. Six objective methods based on standard deviation (SD) and mean consecutive differences (MCD) were used to measure the iMEP features from the same 32 participants. IMEP analysis used both trial-by-trial (individual signal) and average-signal analysis approaches. Inter-rater reliability of iMEP features and agreement between the subjective and objective methods were analyzed (percent agreement-PA and intraclass correlation coefficient-ICC).&#xD;Main results:Inter-rater reliability was excellent for iMEP detection (PA> 85%), amplitude, and area (ICC> 0.9). Of the six objective methods we tested, the 1SD method was most appropriate for identifying and analyzing iMEP amplitude and area (ICC> 0.9) in both trial-by-trial and average signal analysis approaches. None of the objective methods were reliable for analyzing iMEP onset and offset. Results also support using the average-signal analysis approach over the trial-by-trial analysis approach, as it offers excellent reliability for iMEP analysis in stroke survivors with chronic upper extremity motor impairment.&#xD;Significance:Findings from our study have relevance for understanding the role of ipsilateral pathways that typically survive unilateral severe white matter injury in people with stroke.&#xD.

Cross-species analysis of genetic architecture and polygenic risk scores for non-contact ACL rupture in dogs and humans

Non-contact anterior cruciate ligament (ACL) rupture is a common serious orthopaedic disease in humans and dogs. Familial risk has been recognized in both species but interactions between genetic effects and environmental risk are not understood. We investigated ACL rupture heritability, genetic architecture, selection pressure, sharing of risk genes and biological pathways, and polygenic risk score (PRS) prediction of disease risk. In both species, ACL rupture has moderate heritability, is likely under negative selection, and has a highly polygenic architecture where thousands of variant effects act together to influence disease risk. In dogs, we found hotspots of regional heritability. We also confirmed sharing of multiple risk genes. Our findings challenge the dogma that non-contact ACL rupture is predominantly due to a single overload injury event. Our results also suggest that accurate PRS prediction of ACL rupture risk is an achievable goal in both species, enabling identification of individuals for personalized medical care.

Potentially morally injurious events and posttraumatic symptomatology: The role of experiential avoidance.

Potentially morally injurious events and posttraumatic symptomatology: The role of experiential avoidance.

Artificial Intelligence in Healthcare: Opportunities and Difficulties

The usage of Artificial Intelligence (AI) into the healthcare system gains the potential to increase efficiency, speed up the diagnostic processes &amp; improve result quality. Having said that, using the instruments in the healthcare environment in conjunction with growth of its uses, the issue of adherence to laws, morals, and regulations comes up. Therefore, the ethical, legal, and responsibility issues that come up when AI is used in healthcare have been reviewed in this review article. These issues include privacy, algorithm bias, transparency, accountability, and weakened doctor-patient relationships. Liability, the numerous legal gaps that exist, and intellectual property rights are the key legal areas of concern. To address these expanding legal difficulties, legal frameworks must be created. The author of the article emphasizes the idea on AI’innovations and responsibility; as a result, he urges regulatory bodies to develop a methodical and strategic approach to AI, encourage AI to express their opinions, and create strategies to combat bias through diversity of data. Additionally covered are patient-centered AI use, roles and duties in the event of injury, and continuous monitoring of AI systems. These steps are intended to guarantee that the usage of AI in healthcare remains appropriate, effective and harmless to lessen adverse effects and enhance patient outcomes. To accomplish this, it emphasizes the importance of patient security as a vital basis for the successful use of the researched artificial intelligence usages in the healthcare sector, as well as the necessity of proactive government regulation, the engagement of all interested stakeholders and the necessity of proactive government regulation. The conclusion reiterates the notion that AI must be positioned as a device for positive deviations in the current healthcare delivery organization that must be cast-off in compliance with the primary ethical and legal guidelines.

Conservative management of placenta accreta spectrum is associated with improved surgical outcomes compared to cesarean hysterectomy: A systematic review and meta-analysis.

To compare maternal and surgical outcomes between patients with placenta accreta spectrum (PAS) who underwent conservative management and those who underwent cesarean hysterectomy (CH). We performed a systematic search in PubMed, Embase and Web of Science from inception up to June 2, 2024. Studies comparing clinical outcomes among patients with PAS undergoing conservative management versus CH were included. Conservative management was defined as leaving the placenta in situ and local myometrial resection. A random-effects model was used to pool the mean differences or odds ratios (OR) and the corresponding 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic. The meta-analysis included 16 studies, with a total of 2,300 women diagnosed with PAS. Of this pooled sample, 1,072 patients underwent CH and 1,228 were managed conservatively. In pregnancies affected by PAS, CH was associated with significantly higher estimated blood loss (EBL) compared to placenta in situ (mean difference (MD) 973.5 mL, 95% CI 615.4-1331.7, 95% PI -50.2 - 1997.2, P <0.001) and local resection (MD 739.7 mL, 95% CI 287.7-1191.7, 95% PI -911.5 - 2390.9, P <0.001). Additionally, CH resulted in more intraoperative transfused red blood cell units than the local resection (MD 1.54 units, 95% CI 1.06-2.01, 95% PI 0.27 - 2.81, P = 0.001) but had similar rates as compared to placenta in situ group (MD 0.72 units, 95% CI -0.21-1.64, 95% PI -2.21 - 3.64, P = 0.065). The risk of genito-urinary (GU) injury was significantly higher for CH compared to both placenta left in situ (OR 3.79, 95% CI 1.88-7.61, 95% PI 1.52 - 9.46, P< 0.001) and local resection (OR 4.11, 95% CI 2.57-6.56, 95% PI 2.34 - 7.22, P < 0.001). Patients undergoing CH, as compared to placenta in situ group, were more likely to be admitted to intensive care unit (ICU) (OR 7.98, 95% CI 2.23-28.51, 95% PI 0.34 - 188.50, P < 0.001), however, there was no significant difference between CH and local resection group in terms of ICU admission. There were no significant differences between CH and conservative approaches regarding the risk of gastro-intestinal injury and thrombo-embolic events. This meta-analysis strengthens the evidence supporting conservative management for pregnancies with PAS, demonstrating that it is associated with reduced surgical morbidity and may offer an effective alternative to cesarean hysterectomy, particularly for patients seeking fertility preservation. However, further research, including randomized controlled trials and longitudinal studies, is necessary to more definitively evaluate conservative management approaches for pregnancies with PAS and assess long-term clinical outcomes after conservative management.

Erb palsy due to birth injury (a draft of the clinical recommendations)

The article presents a draft of clinical recommendations for the diagnosis and treatment of Erb palsy in birth injury. These recommendations are intended for physicians of maternity hospitals and are aimed at providing information support for decision-making by a doctor in the event of a birth injury, as well as improving the quality of medical care to a patient. The recommendations correspond to the latest scientific data on the topic, and also contain information that is of an applied nature for practical activities. These practical recommendations are offered for public discussion and are posted in full on the website of the Ministry of Health of the Russian Federation. The recommendations contain an information note on Erb palsy in birth injury, including the definition, etiology and pathogenesis of the disease. Three types of classification of generic traumatic lesions of the brachial plexus are presented: by prevalence, by severity of nerve damage and by severity of paresis. The clinical features of the disease are considered in detail. To diagnose the disease, an algorithm of physical examination is proposed, and the use of instrumental research methods: MRI, ultrasonic, X-ray and electromyographic studies. Recommendations for the conservative treatment of pathology and the use of physiotherapy and rehabilitation techniques are given. An algorithm of the doctor’s actions and an information certificate about the disease are proposed to inform the patient’s parents. The recommendations are given taking into account the level of credibility of the recommendations and the level of reliability of the evidence.

Understanding and Addressing Morally Injurious Events of Healthcare Chaplains in Texas: Insights for Health and Well-Being.

Healthcare chaplains may be at heightened risk of encountering potentially morally injurious events. The purpose of the current study was to explore potentially morally injurious events for healthcare chaplains and to identify strategies to enhance health and well-being. Semi-structured interviews were conducted with healthcare chaplains (n = 26) across Texas. Participants were recruited across social media, professional listservs, and word of mouth. Textual data were coded and analyzed in conjunction with directed content analysis. Findings suggest that healthcare chaplains encounter morally injurious events that are rooted in acts of omission and commission, witnessing moral transgressions, and betrayal in the workplace. Interventions include dialog with colleagues and supervisors, collaborative and transparent communication, education, and empowerment and advocacy. The study's findings have implications for interdisciplinary care teams, hospital leadership, and professional associations.