AIM:To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.METHODS:Three patients in our study were trapped inside collapsed structures ...AIM:To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.METHODS:Three patients in our study were trapped inside collapsed structures for 22,21 and 37 h,respectively,The patients underwent 3-4 operations after sustaining their injuries,Mechanical ventilation,intermittent hemodialysis and other treatments were also provided.The patients showed signs of peritoneal irritation on postoperative days 10-38.Small intestinal necrosis was confirmed by emergency laparotomy,and for each patient,part of the small bowel was removed.RESULTS:Two patients who all performed 3 operations died of respiratory complications on the first and second postoperative days respectively.The third patient who performed 4 operations was discharged and made a full recovery.Three patients had the following common characteristics:(1) Multiple severe trauma events with no direct penetrating gastrointestinal injury;(2) Multiple surgeries with impaired renal function and intermittent hemodialysis treatment;(3) Progressive abdominal pain and tenderness,and peritoneal irritation was present on post-traumatic days 10-38;(4) Abdominal operations confirmed segment ulcer,necrosis of the small intestine,hyperplasia and stiffness of the intestinal wall;and(5) Pathological examinations suggested submucosal hemorrhage,necrosis,fibrosis and hyalinization of the vascular wall.Pathological examinations of all 3 patients suggested intestinal necrosis with fistulas.CONCLUSION:Intestinal necrosis is strongly associated with stress from trauma and post-traumatic complications;timely exploratory laparotomy maybe an effective method for preventing and treating stressinduced intestinal necrosis.展开更多
Objective To investigate the etiology and pathogenesis of hepatic stress injury after trauma.Methods 4 677 patients with severe trauma in 153th Hospital of PLA from Jan.2004 to Jul.2005 were enrolled in this study to ...Objective To investigate the etiology and pathogenesis of hepatic stress injury after trauma.Methods 4 677 patients with severe trauma in 153th Hospital of PLA from Jan.2004 to Jul.2005 were enrolled in this study to investigate the incidence of hepatic stress injury,and furthermore,in combination with medical information,the possible pathogenesis was analyzed.Results The main manifestation of hepatic stress injury was the elevated ALT or AST levels(387 cases,8.3%).The incidence of hepatic stress injury after hand injury,burn injury,head injury,bone injury,abdominal injury,and thoracic injury were 16.6%,6.9%,5.6%,5.0%,3.8% and 2.0%,respectively,and among which,the incidence of hepatic stress injury after hand injury was statistically highest(P<0.01).Conclusion The total incidence of hepatic stress injury after trauma was 8.3%.Intestinal endotoxemia might be one of the beginning components of hepatic stress injury after trauma.展开更多
AIM: To validate the first third-person-rated measure assessing combat-related peritraumatic stress symptoms and evaluate its psychometric properties and war-zone applicability.METHODS: The valid assessment of peritra...AIM: To validate the first third-person-rated measure assessing combat-related peritraumatic stress symptoms and evaluate its psychometric properties and war-zone applicability.METHODS: The valid assessment of peritraumatic symptoms in the theater of military operations represents a significant challenge in combat-related, mental health research, which mainly relies on retrospective, subjective self-report ratings. This longitudinal observational study used data from actively deployed troops to correlate third-person observer ratings of deployment peritraumatic behaviors [Peritraumatic Behavior Questionnaire- Observer Rated(PBQ-OR)] collected on a bimonthly basis with post-deployment(1-wk follow-up) ratings of the previously validated PBQ self-rate version(PBQ-SR), and(3-mo follow-up) clinician assessed and self-report posttraumatic stress disorder(PTSD) symptoms(Clinician Administered PTSD Scale, PTSD Checklist). Cronbach's alpha(α) and correlation coefficients were calculated to assess internal reliability and concurrent validity respectively. RESULTS: Eight hundred and sixty male Marines were included in this study after signing informed consents at pre-deployment(mean age 23.2 ± 2.6 years). Although our findings were limited by an overall sparse return rate of PBQ-OR ratings, the main results indicate satisfactory psychometric properties with good internal consistency for the PBQ-OR(α = 0.88) and high convergent and concurrent validity with 1-wk post-deployment PBQSR ratings and 3-mo posttraumatic stress symptoms. Overall, later PBQ-OR report date was associated with higher correlation between PBQ-OR and postdeployment measures. Kappa analysis between PBQOR and PBQ-SR single items, showed best agreement in questions relating of mortal peril, desire for revenge, and experience of intense physical reactions. Logistic regression demonstrated satisfactory predictive validity of PBQ-OR total score with respect to PTSD caseness(OR = 1.0513; 95%CI: 1.011-1.093; P = 0.02).CONCLUSION: Since no comparable tools have been developed, PBQ-OR could be valuable as real-time screening tool for earlier detection of Service Members at risk.展开更多
BACKGROUND Sleep disturbance is a core feature of post-traumatic stress disorder(PTSD).Given the relationship between sleep disturbance and PTSD,there has been a relative paucity of studies examining the potential the...BACKGROUND Sleep disturbance is a core feature of post-traumatic stress disorder(PTSD).Given the relationship between sleep disturbance and PTSD,there has been a relative paucity of studies examining the potential therapeutic impact of using pharmacotherapy to target sleep disturbance in patients with PTSD.Eszopiclone(ESZ)is a non-benzodiazepine y-aminobutyric acid-A receptor agonist indicated for the treatment of sleep and may affect sleep in patients with PTSD.AIM To evaluate the efficacy of ESZ vs placebo(PBO)for patients with PTSD and insomnia.METHODS The study was a 12-wk,double blind,randomized controlled trial with 3 mg of ESZ(n=13)or PBO(n=12).RESULTS Patients in both arms experienced significant improvement in PTSD symptoms as assessed by the Clinician-Administered PTSD Scale for DSM-IV(CAPS):ESZ(t11=-3.12,P=0.005)and PBO(t11=-3.5,P=0.002)and by self-report with the Short PTSD Rating Interview(ESZ t11=-3.38,P=0.003 and PBO t11=-4.48,P=0.0005).There were no significant differences between treatments on the CAPS(t22=-0.13,P=0.70)or the Short PTSD Rating Interview(t22=-0.58,P=0.56).Similarly,both treated groups improved on sleep measures as assessed by the Pittsburgh Sleep Quality Index with PTSD Addendum(PSQI)and on total sleep time(TST)and sleep latency assessed by actigraphy with no significant differences between groups(PSQI t22=-0.24,P=0.81;total sleep time t10=0.13,P=0.90 and sleep latency t10=0.68,P=0.50).There was a significant correlation between improvement in sleep and overall improvement in PTSD as measured by change scores on the PSQI and CAPS,r(8)=0.79,P=0.01 for ESZ treated subjects,but not for those treated with PBO r(9)=0.16,P=0.69.Adverse events of ESZ were consistent with the known profile of the medication including dysgeusia(30%,mild),sedation(20%,mild)and headache(20%,moderate to severe).CONCLUSION Results do not support the hypothesis of a specific positive effect of ESZ compared to PBO for measures of PTSD and associated sleep disturbance.展开更多
Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th) version, due to be published, two decades after i...Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th) version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder(BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses(PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities' biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.展开更多
目的分析1995-2023年分娩心理创伤(psychological birth trauma,PBT)研究主题的热点变迁及其发展趋势,为今后开展精准筛查、预防及干预PBT研究提供参考依据。方法检索中国知网、万方数据库、Web of science和Scopus数据库,获取PBT的相...目的分析1995-2023年分娩心理创伤(psychological birth trauma,PBT)研究主题的热点变迁及其发展趋势,为今后开展精准筛查、预防及干预PBT研究提供参考依据。方法检索中国知网、万方数据库、Web of science和Scopus数据库,获取PBT的相关文献,经过人工筛查最终纳入565篇文献。运用CiteSpace对该研究的发文量、关键词进行可视化分析。结果PBT研究始于1995年,预测高峰时期为2026年。高中心性的关键词为创伤后应激障碍、创伤后应激、母婴互动、产后抑郁等。研究前沿多聚焦于分娩方式、分娩满意度等方面。结论目前PBT研究处于发展期,并位于高峰增长的前夕。建议深入研究并探索PBT的最佳干预措施,提升母婴的身心健康水平,并为有效预防及治疗产后精神心理障碍提供最佳证据。展开更多
目的探讨胎盘间充质干细胞(P-MSCs)对胰腺创伤(PT)大鼠的保护作用。方法健康成年雄性SD大鼠60只,随机分为对照组、胰腺创伤组(胰腺损伤区域及创伤周围局部注射1 ml PBS溶液)与P-MSCs组[胰腺损伤区域及创伤周围局部注射1 ml P-MSCs(1...目的探讨胎盘间充质干细胞(P-MSCs)对胰腺创伤(PT)大鼠的保护作用。方法健康成年雄性SD大鼠60只,随机分为对照组、胰腺创伤组(胰腺损伤区域及创伤周围局部注射1 ml PBS溶液)与P-MSCs组[胰腺损伤区域及创伤周围局部注射1 ml P-MSCs(1×106个/ml)],每组20只。采用400 kPa的致伤压强建立胰腺创伤大鼠模型。于术后1、3、5、7 d每组处死5只大鼠,收集血清及胰腺组织。HE染色观察胰腺组织病理学变化并进行病理损伤评分,ELISA法测定血清中淀粉酶(AMS)、脂肪酶(LPS)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-10、转化生长因子-β1(TGF-β1)浓度,以及胰腺组织中髓过氧化物酶(MPO)、超氧化物歧化酶(SOD)活性,TUNEL法观察胰腺组织细胞凋亡情况。结果与对照组比较,胰腺创伤组与P-MSCs组在胰腺创伤发生后腹腔积液量增加(P<0.05),胰腺/体重比、胰腺组织病理损伤总评分均升高(P<0.05),血清AMS、LPS、TNF-α、IL-6浓度及MPO活性早期升高,随时间延长呈下降趋势(P<0.05),而抗炎因子IL-10浓度及SOD活性随时间延长呈上升趋势(P<0.01),TGF-β1浓度早期下降,随时间延长呈上升趋势(P<0.01),凋亡指数(AI)明显升高(P<0.001)。与胰腺创伤组比较,P-MSCs组大鼠胰腺组织大体形态得以改善,腹腔积液量减少(P<0.001),胰腺/体重比、胰腺组织病理损伤总评分降低(P<0.05),血清AMS、LPS、IL-6、TNF-α浓度及MPO活性更快恢复至正常水平(P<0.05),而抗炎因子IL-10、TGF-β1浓度及SOD活性升高速度增加(P<0.05),AI升高(P<0.001)。结论P-MSCs可促进PT大鼠组织修复,减轻其局部及全身炎症,改善组织氧化应激反应,促进胰腺腺泡细胞凋亡,对PT大鼠具有保护作用。展开更多
基金Supported by The Fund of the People's Liberation Army Gen-eral Hospital of Chengdu Command,No.2011YG-B24
文摘AIM:To investigate the possible reasons and suggest therapeutic plan of stress-induced intestinal necrosis resulting from the severe trauma.METHODS:Three patients in our study were trapped inside collapsed structures for 22,21 and 37 h,respectively,The patients underwent 3-4 operations after sustaining their injuries,Mechanical ventilation,intermittent hemodialysis and other treatments were also provided.The patients showed signs of peritoneal irritation on postoperative days 10-38.Small intestinal necrosis was confirmed by emergency laparotomy,and for each patient,part of the small bowel was removed.RESULTS:Two patients who all performed 3 operations died of respiratory complications on the first and second postoperative days respectively.The third patient who performed 4 operations was discharged and made a full recovery.Three patients had the following common characteristics:(1) Multiple severe trauma events with no direct penetrating gastrointestinal injury;(2) Multiple surgeries with impaired renal function and intermittent hemodialysis treatment;(3) Progressive abdominal pain and tenderness,and peritoneal irritation was present on post-traumatic days 10-38;(4) Abdominal operations confirmed segment ulcer,necrosis of the small intestine,hyperplasia and stiffness of the intestinal wall;and(5) Pathological examinations suggested submucosal hemorrhage,necrosis,fibrosis and hyalinization of the vascular wall.Pathological examinations of all 3 patients suggested intestinal necrosis with fistulas.CONCLUSION:Intestinal necrosis is strongly associated with stress from trauma and post-traumatic complications;timely exploratory laparotomy maybe an effective method for preventing and treating stressinduced intestinal necrosis.
基金Supported by the foundating for Scientific research Itim of Jinan Military Command of PLA
文摘Objective To investigate the etiology and pathogenesis of hepatic stress injury after trauma.Methods 4 677 patients with severe trauma in 153th Hospital of PLA from Jan.2004 to Jul.2005 were enrolled in this study to investigate the incidence of hepatic stress injury,and furthermore,in combination with medical information,the possible pathogenesis was analyzed.Results The main manifestation of hepatic stress injury was the elevated ALT or AST levels(387 cases,8.3%).The incidence of hepatic stress injury after hand injury,burn injury,head injury,bone injury,abdominal injury,and thoracic injury were 16.6%,6.9%,5.6%,5.0%,3.8% and 2.0%,respectively,and among which,the incidence of hepatic stress injury after hand injury was statistically highest(P<0.01).Conclusion The total incidence of hepatic stress injury after trauma was 8.3%.Intestinal endotoxemia might be one of the beginning components of hepatic stress injury after trauma.
基金Supported by The Congressionally Directed Medical Research Programs small(pilot)project mechanism,No.Contract W81XWH-10-1-0693(to Baker DG)It was linked to the MRS study,funded by VA’s Health Services Research and Development Service,No.RDIS 0024the Marine Corps and Navy BUMED,from which pre-and post-deployment data were drawn
文摘AIM: To validate the first third-person-rated measure assessing combat-related peritraumatic stress symptoms and evaluate its psychometric properties and war-zone applicability.METHODS: The valid assessment of peritraumatic symptoms in the theater of military operations represents a significant challenge in combat-related, mental health research, which mainly relies on retrospective, subjective self-report ratings. This longitudinal observational study used data from actively deployed troops to correlate third-person observer ratings of deployment peritraumatic behaviors [Peritraumatic Behavior Questionnaire- Observer Rated(PBQ-OR)] collected on a bimonthly basis with post-deployment(1-wk follow-up) ratings of the previously validated PBQ self-rate version(PBQ-SR), and(3-mo follow-up) clinician assessed and self-report posttraumatic stress disorder(PTSD) symptoms(Clinician Administered PTSD Scale, PTSD Checklist). Cronbach's alpha(α) and correlation coefficients were calculated to assess internal reliability and concurrent validity respectively. RESULTS: Eight hundred and sixty male Marines were included in this study after signing informed consents at pre-deployment(mean age 23.2 ± 2.6 years). Although our findings were limited by an overall sparse return rate of PBQ-OR ratings, the main results indicate satisfactory psychometric properties with good internal consistency for the PBQ-OR(α = 0.88) and high convergent and concurrent validity with 1-wk post-deployment PBQSR ratings and 3-mo posttraumatic stress symptoms. Overall, later PBQ-OR report date was associated with higher correlation between PBQ-OR and postdeployment measures. Kappa analysis between PBQOR and PBQ-SR single items, showed best agreement in questions relating of mortal peril, desire for revenge, and experience of intense physical reactions. Logistic regression demonstrated satisfactory predictive validity of PBQ-OR total score with respect to PTSD caseness(OR = 1.0513; 95%CI: 1.011-1.093; P = 0.02).CONCLUSION: Since no comparable tools have been developed, PBQ-OR could be valuable as real-time screening tool for earlier detection of Service Members at risk.
基金Supported by National Institute of Mental Health,No.5R34MH91338-03 and No.K23 MH103394(to Zalta AK)
文摘BACKGROUND Sleep disturbance is a core feature of post-traumatic stress disorder(PTSD).Given the relationship between sleep disturbance and PTSD,there has been a relative paucity of studies examining the potential therapeutic impact of using pharmacotherapy to target sleep disturbance in patients with PTSD.Eszopiclone(ESZ)is a non-benzodiazepine y-aminobutyric acid-A receptor agonist indicated for the treatment of sleep and may affect sleep in patients with PTSD.AIM To evaluate the efficacy of ESZ vs placebo(PBO)for patients with PTSD and insomnia.METHODS The study was a 12-wk,double blind,randomized controlled trial with 3 mg of ESZ(n=13)or PBO(n=12).RESULTS Patients in both arms experienced significant improvement in PTSD symptoms as assessed by the Clinician-Administered PTSD Scale for DSM-IV(CAPS):ESZ(t11=-3.12,P=0.005)and PBO(t11=-3.5,P=0.002)and by self-report with the Short PTSD Rating Interview(ESZ t11=-3.38,P=0.003 and PBO t11=-4.48,P=0.0005).There were no significant differences between treatments on the CAPS(t22=-0.13,P=0.70)or the Short PTSD Rating Interview(t22=-0.58,P=0.56).Similarly,both treated groups improved on sleep measures as assessed by the Pittsburgh Sleep Quality Index with PTSD Addendum(PSQI)and on total sleep time(TST)and sleep latency assessed by actigraphy with no significant differences between groups(PSQI t22=-0.24,P=0.81;total sleep time t10=0.13,P=0.90 and sleep latency t10=0.68,P=0.50).There was a significant correlation between improvement in sleep and overall improvement in PTSD as measured by change scores on the PSQI and CAPS,r(8)=0.79,P=0.01 for ESZ treated subjects,but not for those treated with PBO r(9)=0.16,P=0.69.Adverse events of ESZ were consistent with the known profile of the medication including dysgeusia(30%,mild),sedation(20%,mild)and headache(20%,moderate to severe).CONCLUSION Results do not support the hypothesis of a specific positive effect of ESZ compared to PBO for measures of PTSD and associated sleep disturbance.
文摘Complex posttraumatic stress disorder(Complex PTSD)has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases,11^(th) version, due to be published, two decades after its first initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder(BPD). Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses(PTSD; Complex PTSD; BPD), there is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities' biological background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.
文摘目的分析1995-2023年分娩心理创伤(psychological birth trauma,PBT)研究主题的热点变迁及其发展趋势,为今后开展精准筛查、预防及干预PBT研究提供参考依据。方法检索中国知网、万方数据库、Web of science和Scopus数据库,获取PBT的相关文献,经过人工筛查最终纳入565篇文献。运用CiteSpace对该研究的发文量、关键词进行可视化分析。结果PBT研究始于1995年,预测高峰时期为2026年。高中心性的关键词为创伤后应激障碍、创伤后应激、母婴互动、产后抑郁等。研究前沿多聚焦于分娩方式、分娩满意度等方面。结论目前PBT研究处于发展期,并位于高峰增长的前夕。建议深入研究并探索PBT的最佳干预措施,提升母婴的身心健康水平,并为有效预防及治疗产后精神心理障碍提供最佳证据。
文摘目的探讨胎盘间充质干细胞(P-MSCs)对胰腺创伤(PT)大鼠的保护作用。方法健康成年雄性SD大鼠60只,随机分为对照组、胰腺创伤组(胰腺损伤区域及创伤周围局部注射1 ml PBS溶液)与P-MSCs组[胰腺损伤区域及创伤周围局部注射1 ml P-MSCs(1×106个/ml)],每组20只。采用400 kPa的致伤压强建立胰腺创伤大鼠模型。于术后1、3、5、7 d每组处死5只大鼠,收集血清及胰腺组织。HE染色观察胰腺组织病理学变化并进行病理损伤评分,ELISA法测定血清中淀粉酶(AMS)、脂肪酶(LPS)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-10、转化生长因子-β1(TGF-β1)浓度,以及胰腺组织中髓过氧化物酶(MPO)、超氧化物歧化酶(SOD)活性,TUNEL法观察胰腺组织细胞凋亡情况。结果与对照组比较,胰腺创伤组与P-MSCs组在胰腺创伤发生后腹腔积液量增加(P<0.05),胰腺/体重比、胰腺组织病理损伤总评分均升高(P<0.05),血清AMS、LPS、TNF-α、IL-6浓度及MPO活性早期升高,随时间延长呈下降趋势(P<0.05),而抗炎因子IL-10浓度及SOD活性随时间延长呈上升趋势(P<0.01),TGF-β1浓度早期下降,随时间延长呈上升趋势(P<0.01),凋亡指数(AI)明显升高(P<0.001)。与胰腺创伤组比较,P-MSCs组大鼠胰腺组织大体形态得以改善,腹腔积液量减少(P<0.001),胰腺/体重比、胰腺组织病理损伤总评分降低(P<0.05),血清AMS、LPS、IL-6、TNF-α浓度及MPO活性更快恢复至正常水平(P<0.05),而抗炎因子IL-10、TGF-β1浓度及SOD活性升高速度增加(P<0.05),AI升高(P<0.001)。结论P-MSCs可促进PT大鼠组织修复,减轻其局部及全身炎症,改善组织氧化应激反应,促进胰腺腺泡细胞凋亡,对PT大鼠具有保护作用。
