Acceptability of an adjunct equine-assisted activities and therapies program for veterans with posttraumatic stress disorder and/or traumatic brain injury

ObjectiveEquine-assisted activities and therapies (EAATs) have been a growing adjunctive integrative health modality, as they allow participants to practice mindfulness, emotional regulation, and self-mastery or self-esteem building skills. Preliminary evidence suggests that these programs may be helpful in reducing posttraumatic stress disorder (PTSD), anxiety, and depressive symptoms. The current study examines the acceptability of integrating an EAAT program as part of a two-week, intensive clinical program for veterans with PTSD and/or traumatic brain injury (TBI).MethodsA family member or support person could accompany veterans and participate in the program. One hundred and six participants (veteran n = 62, family n = 44) left the urban environment in an intensive outpatient program (IOP) to attend a two-day, weekend EAAT in rural New Hampshire. Satisfaction surveys were conducted on the last day of the program and examined using thematic analysis.ResultsThe following themes were reported in the surveys: ability of horses to catalyze emotional rehabilitation, effectiveness of immersion in equine-assisted activities, program’s ability to foster interpersonal relationships and necessity of education about PTSD for staff. Participants also reported enjoying the program as highlighted by qualitative feedback, a mean score of 9.76 (standard deviation [SD] = 0.61) as reported by veterans and a mean score of 9.91 (SD = 0.29) as reported by family members on a 10-point visual analog scale with higher scores indicating a greater overall experience.ConclusionThese data offer preliminary evidence that an adjunct EAAT program is acceptable for veterans with PTSD and/or TBI participating in an IOP.     

Therapeutics and delivery vehicles for local treatment of osteomyelitis

Osteomyelitis, or the infection of the bone, presents a major complication in orthopedics and may lead to prolonged hospital visits, implant failure, and in more extreme cases, amputation of affected limbs. Typical treatment for this disease involves surgical debridement followed by long-term, systemic antibiotic administration, which contributes to the development of antibiotic-resistant bacteria and has limited ability to eradicate challenging biofilm-forming pathogens including Staphylococcus aureus—the most common cause of osteomyelitis. Local delivery of high doses of antibiotics via traditional bone cement can reduce systemic side effects of an antibiotic. Nonetheless, growing concerns over burst release (then subtherapeutic dose) of antibiotics, along with microbial colonization of the nondegradable cement biomaterial, further exacerbate antibiotic resistance and highlight the need to engineer alternative antimicrobial therapeutics and local delivery vehicles with increased efficacy against, in particular, biofilm-forming, antibiotic-resistant bacteria. Furthermore, limited guidance exists regarding both standardized formulation protocols and validated assays to predict efficacy of a therapeutic against multiple strains of bacteria. Ideally, antimicrobial strategies would be highly specific while exhibiting a broad spectrum of bactericidal activity. With a focus on S. aureus infection, this review addresses the efficacy of novel therapeutics and local delivery vehicles, as alternatives to the traditional antibiotic regimens. The aim of this review is to discuss these components with regards to long bone osteomyelitis and to encourage positive directions for future research efforts.     

创伤性脑损伤患者创伤后成长与创伤后应激障碍的调查研究

目的分析创伤性脑损伤（TBI）患者创伤后成长（PTG）与创伤后应激障碍（PTSD）的现况及其影响因素。 方法通过便利抽样的方法，选取首都医科大学附属北京天坛医院神经外科自2019年7月至2020年1月就诊的85例TBI患者为研究对象，使用创伤后成长评定量表（PTGI）、创伤后应激障碍量表平民版（PCL-C）调查TBI患者的PTG水平、PTSD情况，并进一步分析TBI患者PTG的影响因素。 结果TBI患者PTGI总分为（58.41±23.05）分，处于低水平。PCL-C得分为（36.18±16.52）分，PCL-C阳性症状检出率为41.2%。多元线性回归分析结果显示，文化程度、性格类型、社会支持、警觉性增高、创伤再体验是TBI患者PTG的影响因素。TBI患者文化水平低、外向型性格、社会支持水平越高其PTG水平越高。TBI事件后警觉性反应低者，PTG水平较高，创伤再体验症状促进PTG的发生。 结论TBI患者创伤后早期同时出现PTG及PTSD，通过调动患者个体内部因素及外在社会联系等方面积极因素，可能提高患者PTG水平。     

基于TCD脑血流频谱评估颅脑损伤患者颅内压的研究进展

经颅多普勒（TCD）可以动态无创地监测和评估脑血管血流动力学变化，而颅内压（ICP）是评估颅脑损伤患者颅内病情的重要指标。临床工作中一直在探索一种准确、方便的无创ICP监测方法，由于TCD具有床旁无创、低廉快捷的优势，并且通过TCD检测脑血流频谱还可间接评估ICP变化，对临床治疗有重要的指导意义。本文综合国内外研究，结合ICP监测技术和TCD技术，并整合既往文献中基于搏动指数建立ICP评估模型的公式方法，就TCD脑血流频谱评估ICP的研究进展作一综述。     

Development of a new biomechanical indicator for primary blast-induced brain injury

Primary blast-induced traumatic brain injury (bTBI) has been observed at the boundary of brain tissue and cerebrospinal fluid (CSF). Such injury can hardly be explained by using the theory of compressive wave propagation, since both the solid and fluid materials have similar compressibility and thus the intracranial pressure (ICP) has a continuous distribution across the boundary. Since they have completely different shear properties, it is hypothesized the injury at the interface is caused by shear wave. In the present study, a preliminary combined numerical and theoretical analysis was conducted based on the theory of shear wave propagation/reflection. Simulation results show that higher lateral acceleration of brain tissue particles is concentrated in the boundary region. Based on this finding, a new biomechanical vector, termed as strain gradient, was suggested for primary bTBI. The subsequent simple theoretical analysis reveals that this parameter is proportional to the value of lateral acceleration. At the boundary of lateral ventricles, high spatial strain gradient implies that the brain tissue in this area (where neuron cells may be contained) undergo significantly different strains and large velocity discontinuity, which may result in mechanical damage of the neuron cells.     

脾保留手术治疗创伤性脾破裂的临床探讨

目的：分析脾保留手术治疗创伤性脾破裂的疗效。方法选取该院2011年6月—2014年6月收治的创伤性脾破裂患者，共计56例，分为两组，各28例，对照组进行脾切除手术，研究组进行脾保留手术。结果研究组临床有效率为92.86%，对照组临床有效率为78.57%；术后并发症发生率研究组为10.71%、对照组为28.57%。结论脾保留手术治疗创伤性脾破裂的疗效显著，恢复快，并发症少，在患者伤情允许情况下优先选择脾保留术。