Police special forces (PSF) are deployed in dangerous operational situations that are associated with particular risks to mental health. Frequent training to cope with these extreme situations and selection are intended to mitigate these risks. However, the mental health consequences of critical incidents among PSF are largely unexplored. We hypothesized that following a barricaded subject operation involving hostage-taking and severe violence, deployed PSF would exhibit higher anger and impairment in their quality of life (QoL) compared to their non-deployed colleagues. In addition, we expected that these burdens would occur to a lesser extent among PSF compared to regular police forces, firefighters and ambulance personnel involved. In the study, N = 192 emergency personnel were included six months after the operation, of which n = 104 (n = 45 PSF) were deployed and n = 88 (n = 19 PSF) were not. QoL (WHOQOL-BREF), forms of anger (STAXI-2) and post-traumatic stress symptoms (PCL-5) were assessed using questionnaires. The mental health of deployed PSF did not differ significantly from their non-deployed colleagues. In comparison to firefighters and ambulance personnel on site, deployed PSF showed a higher psychological QoL, lower levels of anger expression-in and angry temperament. Regular police forces reported a lower environmental QoL. These results suggest greater resilience among PSF compared to other occupational groups, despite experiencing the highest acute operational stresses due to their tasks. Further research is needed to investigate influences of protective factors in PSF after potentially traumatic deployments and to refine methods for directly strengthening them.
Abstract Background The quadriceps tendon (QT) has emerged as a reliable autograft for anterior cruciate ligament reconstruction (ACLR), but uncertainty remains regarding several key comparative aspects—particularly donor-site morbidity, long-term graft survival, knee stability, and complication rates—when evaluated against hamstring tendon (HT) and bone–patellar tendon–bone (BPTB) autografts. High-level evidence restricted to randomized controlled trials directly comparing QT with HT or BPTB remains limited. To compare clinical outcomes, graft failure, donor-site morbidity, and knee stability among QT, HT, and BPTB autografts for primary ACLR using level-I and level-II randomized controlled trials (RCTs). Methods The MEDLINE (PubMed), Embase (Elsevier), and Cochrane Library databases were searched on 1 September 2025, and repeated 2 weeks later. Only level-I or -II RCTs comparing QT to HT or BPTB in primary ACLR were included. Random-effects meta-analyses were performed for International Knee Documentation Committee (IKDC) and Lysholm scores, instrumented laxity, graft failure, donor-site morbidity, and reoperation. Risk of bias was assessed with RoB 2.0, and small-study effects with funnel and doi plots. Results Eleven RCTs (mean follow-up, 2–10 years) were included. Pooled IKDC scores averaged 84.8 (95% CI 81.9–87.9) and Lysholm scores averaged 93.1 (95% CI 91.6–94.6), with no significant differences between QT and either comparator (P > 0.05). Side-to-side anterior tibial translation averaged 1.2 mm (95% CI 0.99–1.54 mm) across all grafts, also without significant differences (P > 0.05). Pooled graft failure and ipsilateral reoperation rates were 0.7% (95% CI 0.0–1.9%) and 2.3% (95% CI 0.6–4.7%), respectively, again with no between-graft differences (P > 0.05). Donor-site morbidity did not differ significantly between QT and HT (mean 13.83 [95% CI 9.6–19.83]; P > 0.05). Conclusion This meta-analysis of level-I/II randomized controlled trials found no statistically significant differences among quadriceps tendon, hamstring tendon, and bone–patellar tendon–bone autografts in patient-reported outcomes, knee stability, graft re-rupture, or additional knee surgery. Donor-site morbidity comparisons were limited by incomplete reporting, particularly for BPTB. These findings suggest that contemporary surgical techniques and rehabilitation protocols may minimize graft-specific differences in mid-term outcomes, although interpretation should consider the limited number of direct comparative trials across all three graft types. Level of evidence Systematic review and meta-analysis; level of evidence, 1 and 2.
Synaptosomal-associated protein 47 (SNAP47), a non-canonical SNARE (soluble N-ethylmaleimide-sensitive-factor attachment receptor) protein, is highly expressed in neuronal tissue and exhibits broad cytoplasmic distribution at the cellular level. However, SNAP47 does not directly participate in exocytosis or the recycling of synaptic vesicles (SVs), and its precise physiological function remains elusive. Our previous study revealed that SNAP47 is strongly expressed in GABAergic interneurons (INs) in the hippocampus. Therefore, we created a lentiviral vector carrying a small hairpin RNA (shRNA) to knockdown (KD) SNAP47 and applied this virus to autaptic hippocampal neuronal cultures. To identify GABAergic INs, cultures were prepared using transgenic mice expressing yellow fluorescent protein (YFP)-Venus under the control of the vesicular GABA transporter (VGAT) promoter. SNAP47 KD efficiently reduced the expression of the endogenous SNAP47 in the majority of neurons in autaptic cultures, significantly decreasing the somatic level of the protein. Morphological analysis of INs revealed that SNAP47 KD impacted the morphology with significant reduction in dendrite length. Furthermore, expression of both pre- and postsynaptic markers, was reduced in these neurons. Convergent to these morphological finding, physiological changes were also observed in whole-cell recordings, in particular a decrease in the amplitude and frequency of miniature inhibitory postsynaptic currents (mIPSCs), indicating an alteration in inhibitory synaptic transmission. In contrast, the somato-dendritic morphology and synaptic transmission of YFP-Venus-negative, putative glutamatergic excitatory neurons appeared to remain unaffected. In summary, our results demonstrate that reduced SNAP47 protein expression directly impacts the morphology of GABAergic neurons and their synaptic physiology.
Sepsis is increasingly recognized as a highly dynamic immunological disorder in which hyperinflammation and anti-inflammatory processes occur simultaneously. The clinical phenotype depends on which arm predominates at a given time, resulting in an early phase that is typically dominated by hyperinflammation and a subsequent phase characterized by hypoinflammation, also referred to as immunoparalysis (IP). Epstein-Barr virus (EBV) reactivation has been associated with an immunosuppressive status. However, its interaction with IP and resulting immune phenotypes remains poorly defined so far. In this current study, we investigated the temporal dynamics of EBV reactivation and IP status, and assessed their impact on immune signatures and mortality in sepsis. In this retrospective cohort of 124 intensive care unit (ICU) patients with sepsis, we performed analysis of EBV load by qPCR and analyzed the inflammatory stage by quantifying HLA-DR molecules on monocytes (mHLA-DR) using flow cytometry. Patients with < 5,000 mHLA-DR/monocyte were classified positive for immunoparalysis (IP+). Cytokine profiles and vital sign were analyzed in parallel. Patients were assigned to four sepsis groups based on EBV/IP status (EBV- IP-, EBV + IP-, EBV- IP+, EBV + IP+). Time-dependent Cox models (start-stop structure) were used to estimate hazard ratios (HR) for mortality, adjusted for age, sex and Sequential Organ Failure Assessment (SOFA) score. Cytokines and clinical markers were compared using Kruskal-Wallis and rank-based analyses. EBV positivity was associated with higher hazard of death (HR 3.30, 95
Abstract Background The COVID-19 pandemic and accompanying social distancing measures might have caused adverse health consequences. We aimed to describe changes in participants’ self-rated health and mental health (depression, anxiety, and stress), and investigate factors associated with them. Methods We collected data from the German National Cohort (NAKO). We first described changes in participants’ self-rated health and mental health from the baseline examination (1 to 6 years earlier) to the early phase of the COVID-19 pandemic. We then applied the multinomial logistic regression model (self-rated health) and the quantile regression model (mental health) to investigate the potential factors associated with the health status and changes. Results After a median of 3.1 [2.1, 4.1] years from baseline to the early pandemic phase (N = 91,809), 39.3% of participants with good health and 69.7% with less good health status at baseline reported better health. However, the percentage of participants with high depression, anxiety, and stress scores (≥ 10) increased from 6.2%, 4.1%, and 4.3% to 8.6%, 5.6%, and 10.1%, respectively. In the multivariable models, we found that being younger, being male, highly educated, being employed, having higher life satisfaction at baseline, being more physically active, drinking heavily, and experiencing improved anxiety symptoms were associated with improved self-rated health. In contrast, smoking and having mental health disorders were all associated with worse self-rated health. Our results showed that being younger, being female, smoking, drinking heavily, and drinking more since baseline were associated with higher depression scores. Having had a coronavirus test was associated with worse self-rated health and more severe anxiety and stress. Conclusions During the early COVID-19 pandemic, many participants experienced improvements in self-rated health but suffered deterioration in mental health and physical activity engagement. Female participants, those who were physically inactive, and those with pre-existing mental disorders were more likely to report poorer health.
