Objective:To analyze the risk factors for postoperative intra-abdominal pressure(IAP) elevation in patients with abdominal trauma and retroperitoneal tumors, and to evaluate the clinical value of continuous dynamic IAP monitoring.Methods:A total of 196 patients with abdominal trauma or retroperitoneal tumors admitted at Peking University People's Hospital from April 2024 to April 2025 were retrospectively enrolled. Postoperative IAP monitoring data were collected, and risk factors for IAP elevation were analyzed.Results:Postoperative IAP in patients with abdominal trauma and retroperitoneal tumors exhibited a peak-shaped pattern, reaching its maximum at 24 hours and returning to baseline by 72 hours. In both the abdominal trauma and retroperitoneal tumor groups, patients with poor outcomes showed significantly higher IAP peak values, longer durations of intra-abdominal hypertension (IAH), higher incidences of IAP>12 mmHg at 6 and 24 hours postoperatively, and longer durations of abdominal perfusion pressure (APP)<60 mmHg ( P<0.05).Multivariate analysis revealed that injury severity score (ISS)≥25, shock index≥1.0, and intraoperative blood transfusion≥2 000 ml were independent risk factors for IAP elevation in patients with abdominal trauma. In patients with retroperitoneal tumors, tumor diameter≥10 cm, intraoperative blood loss≥1 500 ml, peritoneal defect area≥20 cm2, and BMI≥28 kg/m2 were identified as significant risk factors for postoperative IAP elevation. Conclusions:Postoperative IAP in patients with abdominal trauma and retroperitoneal tumors exhibits a similar common dynamic pattern. Continuous dynamic monitoring of IAP can facilitate early identification of high-risk patients, with IAP>12 mmHg at 24 hours postoperatively showing the highest predictive value for adverse outcomes. For such patients, it is recommended to implement goal-directed monitoring for 72 hours to improve clinical prognosis.

Objective:To reveal the differences in the transcriptome maps of brain tissues in mice subjected to Flash irradiation and conventional dose rate irradiation with electron beams and to explain the biological effect and mechanisms of Flash irradiation from multiple perspectives.Methods:Following the principle of grouping based on approximate body weights, 36 female C57BL/6J mice were divided into three groups, i. e., the control, conventional dose rate irradiation (CONV), and Flash irradiation (Flash) groups, with 12 mice in each group. Both the CONV and Flash groups received a single 15 Gy whole-brain irradiation with 9 MeV electron beams. At 3 d post-irradiation, the whole-brain tissue specimens were collected for hematoxylin-eosin (HE) staining to observe pathological changes. At 1, 3, and 10 weeks post-irradiation, the motion function, cognitive ability, depression level, and spatial memory capacity of the mice were assessed using ethology. At 1 and 10 weeks after behavioral experiments, brain tissue samples were collected and snap-frozen in liquid nitrogen for reference-based transcriptome sequencing. Accordingly, the differences in the transcriptome maps of radiation-induced brain injury between CONV and Flash groups were analyzed.Results:The HE staining-based pathological result revealed that compared to the CONV group, the Flash group exhibited reduced glial cell hyperplasia and inflammatory cell infiltration in brain tissues. Ethological research result at 1 week post-irradiation showed that the CONV group manifested a significantly decreased total traveled distance compared to the control and Flash groups ( t = 5.51, 2.38, P < 0.05) and a significantly increased immobility time compared to the control group ( t = 3.60, P < 0.05). Ethological research result at 3 weeks post-irradiation indicated that compared to the CONV group, the Flash group displayed significantly alleviated cognitive impairment ( t = 3.35, P < 0.05) and reduced depression levels ( t = 2.39, P < 0.05). Ethological research result at 10 weeks post-irradiation demonstrated that the CONV group showed the worst cognitive performance, significantly differing from the control group ( t = 4.53, P < 0.05). Transcriptome sequencing result revealed that besides immune-related pathways, the Flash group also exhibited multiple upregulated metabolic pathways and fibroblast growth factor (FGF)-related pathways compared to the CONV group. Conclusions:Compared to conventional dose rate irradiation, Flash irradiation can effectively alleviate radiation-induced brain injury in mice. This effect is associated with various metabolic pathways (including amino acid metabolism) and FGF-related pathways besides immune pathways.

PURPOSE: Early mortality in major trauma has decreased, but MODS remains a leading cause of poor outcomes, driven by trauma-induced cytokine storms that exacerbate injuries and organ damage. METHODS: This prospective cohort study included 79 major trauma patients (ISS >15) treated in the National Center for Trauma Medicine, Peking University People's Hospital, from September 1, 2021, to July 31, 2023. Patients (1) with ISS >15 (according to AIS 2015), (2) aged 15-80 years, (3) admitted within 6 h of injury, (4) having no prior treatment before admission, were included. Exclusion criteria were (1) GCS score <9 or AIS score ≥3 for TBI, (2) confirmed infection, infectious disease, or high infection risk, (3) pregnancy, (4) severe primary diseases affecting survival, (5) recent use of immunosuppressive or cytotoxic drugs within the past 6 months, (6) psychiatric patients, (7) participation in other clinical trials within the past 30 days, (8) patients with incomplete data or missing blood samples. Admission serum inflammatory cytokines and pathophysiological data were analyzed to develop machine learning models predicting MODS within 7 days. LR, DR, RF, SVM, NB, and XGBoost were evaluated based on the area under the AUROC. The SHAP method was used to interpret results. RESULTS: This study enrolled 79 patients with major trauma, and the median (Q₁, Q₃) age was 51 (35, 59) years (52 males, 65.8%). The inflammatory cytokine data were collected for all participants. Among these patients, 35 (44.3%) developed MODS, and 44 (55.7%) did not. Additionally, 2 patients (2.5%) from the MODS group succumbed. The logistic regression model showed strong performance in predicting MODS. Ten key cytokines, IL-18, Eotaxin, MCP-4, IP-10, CXCL12, MIP-3α, MCP-1, IL-1RA, Cystatin C, and MRP8/14 were identified as critical to the trauma-induced cytokine storm and MODS development. Early elevation of these cytokines achieved high predictive accuracy, with an AUROC of 0.887 (95% CI 0.813-0.976). CONCLUSION Trauma-induced cytokine storms are strongly associated with MODS. Early identification of inflammatory cytokine changes enables better prediction and timely interventions to improve outcomes.
Humans ; Prospective Studies ; Middle Aged ; Male ; Female ; Adult ; Aged ; Cytokine Release Syndrome/etiology* ; Adolescent ; Young Adult ; Aged, 80 and over ; Wounds and Injuries/complications* ; Cytokines/blood* ; Multiple Organ Failure/diagnosis* ; Machine Learning

Objective:To investigate the application of time series models in forecasting pre-hospital emergency ambulance trips in Handan City and develop the LPro ensemble model for improved prediction accuracy to support emergency resource allocation.Methods:Pre-hospital emergency data from Handan Emergency Medical Command Center (2019-2023) were retrospectively analyzed. From 324 799 original records, 289 949 valid records were included after cleaning. The training set (2019-2022: 215 918 records) included 35 527 records in 2019, 52 015 in 2020, 61 836 in 2021, and 66 540 in 2022. The validation set (2023) contained 74 031 records. ARIMA, linear trend seasonal, exponential smoothing, and Prophet models were fitted to the training set. The LPro ensemble model was constructed using MAPE-based weighting (linear trend seasonal model: 0.38, Prophet: 0.62). Performance metrics included MAPE, RMSE, MAE, and R 2. Results:Data showed annual growth (compound annual growth rate 23.27%) and seasonal patterns (October peaks, February troughs). Ambulance dispatches increased annually with monthly cyclical patterns. For 2023 validation predictions: ARIMA (MAPE 8.76%, RMSE 619, MAE 491, R 2 0.4563), linear trend seasonal (MAPE 9.83%, RMSE 671, MAE 545, R 2 0.3608), Prophet (MAPE 8.43%, RMSE 562, MAE 503, R 2 0.5513), exponential smoothing (MAPE 8.08%, RMSE 643, MAE 410, R 2 0.4124). LPro model showed superior performance (MAPE 7.05%, RMSE 491, MAE 393, R 2 0.6570), with 16.37% lower MAPE, 12.63% lower RMSE, 21.87% lower MAE, and 19.17% higher R 2 versus Prophet. Conclusion:The LPro ensemble model substantially enhances prediction accuracy and reliability, offering scientific support for emergency resource optimization and dispatch scheduling in Handan City.

Objective: To investigate the association between occupational stress and health-related quality of life (HRQoL) among grassroots medical personnels, so as to provide the reference for improving their physical and mental well-being. Methods: From March to May 2024, medical staff from nine street community health service centers in Liangxi District, Wuxi City, Jiangsu Province were selected by a convenient sampling method. Basic information was collected through questionnaire surveys. Occupational stress was assessed using the Core Occupational Stress Measurement Scale. Health utility value and the Visual Analog Scale (EQ-VAS) score were investigated using the European Quality of Life Five-Dimension Five-Level (EQ-5D-5L) questionnaire. The association between occupational stress and HRQoL was analyzed using multiple linear regression model. Results: A total of 909 individuals were surveyed, including 141 males (15.51%) and 768 females (84.49%). The average occupational stress score was (24.41±9.45) points. The average health utility value was (0.96±0.07), with 372 individuals (40.92%) experiencing health problems in at least one dimension. The primarily problems were pain/discomfort and anxiety/depression, with 249 (27.39%) and 265 (29.15%) individuals, respectively. The average EQ-VAS score was (86.62±13.84) points. Multiple linear regression analysis revealed that occupation (nurses, β'=0.101; pharmacists, β'=0.101; medical technicians, β'=0.090), professional title (intermediate, β'=-0.079; associate senior, β'=-0.081; senior, β'=-0.101), and occupational stress (β'=-0.288) were influencing factors for health utility value. Occupation (nurses, β'=0.087; pharmacists, β'=0.146; medical technicians, β'=0.073) and occupational stress (β'=-0.226) were influencing factors for EQ-VAS score. After adjusting for variables such as gender, age, educational level, occupation, professional title, work experience, and monthly income, grassroots medical personnels with higher occupational stress score had lower health utility values (β'=-0.296) and EQ-VAS score (β'=-0.237). Conclusions Occupational stress can reduce the HRQoL among grassroots medical personnels. It is recommended to regularly assess occupational stress levels and intervene early to address their psychological and physical health issues.

Objective:To reveal the differences in the transcriptome maps of brain tissues in mice subjected to Flash irradiation and conventional dose rate irradiation with electron beams and to explain the biological effect and mechanisms of Flash irradiation from multiple perspectives.Methods:Following the principle of grouping based on approximate body weights, 36 female C57BL/6J mice were divided into three groups, i. e., the control, conventional dose rate irradiation (CONV), and Flash irradiation (Flash) groups, with 12 mice in each group. Both the CONV and Flash groups received a single 15 Gy whole-brain irradiation with 9 MeV electron beams. At 3 d post-irradiation, the whole-brain tissue specimens were collected for hematoxylin-eosin (HE) staining to observe pathological changes. At 1, 3, and 10 weeks post-irradiation, the motion function, cognitive ability, depression level, and spatial memory capacity of the mice were assessed using ethology. At 1 and 10 weeks after behavioral experiments, brain tissue samples were collected and snap-frozen in liquid nitrogen for reference-based transcriptome sequencing. Accordingly, the differences in the transcriptome maps of radiation-induced brain injury between CONV and Flash groups were analyzed.Results:The HE staining-based pathological result revealed that compared to the CONV group, the Flash group exhibited reduced glial cell hyperplasia and inflammatory cell infiltration in brain tissues. Ethological research result at 1 week post-irradiation showed that the CONV group manifested a significantly decreased total traveled distance compared to the control and Flash groups ( t = 5.51, 2.38, P < 0.05) and a significantly increased immobility time compared to the control group ( t = 3.60, P < 0.05). Ethological research result at 3 weeks post-irradiation indicated that compared to the CONV group, the Flash group displayed significantly alleviated cognitive impairment ( t = 3.35, P < 0.05) and reduced depression levels ( t = 2.39, P < 0.05). Ethological research result at 10 weeks post-irradiation demonstrated that the CONV group showed the worst cognitive performance, significantly differing from the control group ( t = 4.53, P < 0.05). Transcriptome sequencing result revealed that besides immune-related pathways, the Flash group also exhibited multiple upregulated metabolic pathways and fibroblast growth factor (FGF)-related pathways compared to the CONV group. Conclusions:Compared to conventional dose rate irradiation, Flash irradiation can effectively alleviate radiation-induced brain injury in mice. This effect is associated with various metabolic pathways (including amino acid metabolism) and FGF-related pathways besides immune pathways.

BACKGROUND:Defective outgrowth of chondrocyte mitophagy causes degenerative chondrocyte pathological changes such as apoptosis and matrix loss.OBJECTIVE:To investigate the effects and possible mechanism of Juanbi Decoction-containing serum on interleukin-1β-induced inflammatory response and apoptosis of rat knee joint chondrocytes.METHODS:Fifty male Sprague-Dawley rats were randomly given saline,Juanbi Decoction in low,medium and high doses(1.24,2.48 and 4.96 g/kg),and celecoxib(positive drug)group.Drug-containing serum was obtained by continuous gavage for 2 weeks.(1)Chondrocytes were isolated and randomly divided into control group,interleukin-1β group,Juanbi Decoction low,medium and high dose containing serum groups and positive drug serum group.Cell counting kit-8 assay was used to detect cell viability;immunofluorescence double staining was used to detect mitophagy level;immunofluorescence was used to detect the phosphorylated AMP-activated protein kinase level;western blot was used to detect the expression of PTEN induced putative kinase 1/Parkin pathway-related protein and cleaved caspase-3;and ELISA was used to detect inflammatory factor level.(2)PTEN induced putative kinase 1 siRNA and Compound C were used for intervention to explore the role of AMP-activated protein kinase/PTEN induced putative kinase 1/Parkin pathway in the regulation of mitophagy by Juanbi Decoction-containing serum.RESULTS AND CONCLUSION:(1)Compared with the control group,chondrocyte survival,type II collagen,phosphorylated AMP-activated protein kinase,PTEN induced putative kinase 1,Parkin,and microtubule-associated proteins 1 light chain 3 protein levels,and mitophagy levels were significantly lower in the interleukin-1β group(P<0.05),while cleaved caspase-3 protein levels,interleukin-6,interleukin-8 and tumor necrosis factor-α levels were significantly higher(P<0.05).Compared with the interleukin-1β group,opposite changes in all the above indexes were observed in Juanbi Decoction low,medium and high dose containing serum groups and positive drug serum group(P<0.05).(2)PTEN induced putative kinase 1 siRNA significantly inhibited the effect of Juanbi Decoction-containing serum on mitophagy in interleukin-1β-treated chondrocytes and reduced the protective effect of Juanbi Decoction-containing serum on interleukin-1β-induced inflammation and apoptosis in chondrocytes;Compound C reversed the effect of Juanbi Decoction-containing serum on the PTEN induced putative kinase 1/Parkin signaling pathway in interleukin-1β-treated chondrocytes.To conclude,Juanbi Decoction-containing serum inhibits chondrocyte inflammation and apoptosis by affecting the level of mitochondrial autophagy,thereby attenuating interleukin-1β-induced chondrocyte degradation by a mechanism that may be related to the regulation of the AMP-activated protein kinase/PTEN induced putative kinase 1/Parkin pathway.

BACKGROUND:Defective outgrowth of chondrocyte mitophagy causes degenerative chondrocyte pathological changes such as apoptosis and matrix loss.OBJECTIVE:To investigate the effects and possible mechanism of Juanbi Decoction-containing serum on interleukin-1β-induced inflammatory response and apoptosis of rat knee joint chondrocytes.METHODS:Fifty male Sprague-Dawley rats were randomly given saline,Juanbi Decoction in low,medium and high doses(1.24,2.48 and 4.96 g/kg),and celecoxib(positive drug)group.Drug-containing serum was obtained by continuous gavage for 2 weeks.(1)Chondrocytes were isolated and randomly divided into control group,interleukin-1β group,Juanbi Decoction low,medium and high dose containing serum groups and positive drug serum group.Cell counting kit-8 assay was used to detect cell viability;immunofluorescence double staining was used to detect mitophagy level;immunofluorescence was used to detect the phosphorylated AMP-activated protein kinase level;western blot was used to detect the expression of PTEN induced putative kinase 1/Parkin pathway-related protein and cleaved caspase-3;and ELISA was used to detect inflammatory factor level.(2)PTEN induced putative kinase 1 siRNA and Compound C were used for intervention to explore the role of AMP-activated protein kinase/PTEN induced putative kinase 1/Parkin pathway in the regulation of mitophagy by Juanbi Decoction-containing serum.RESULTS AND CONCLUSION:(1)Compared with the control group,chondrocyte survival,type II collagen,phosphorylated AMP-activated protein kinase,PTEN induced putative kinase 1,Parkin,and microtubule-associated proteins 1 light chain 3 protein levels,and mitophagy levels were significantly lower in the interleukin-1β group(P<0.05),while cleaved caspase-3 protein levels,interleukin-6,interleukin-8 and tumor necrosis factor-α levels were significantly higher(P<0.05).Compared with the interleukin-1β group,opposite changes in all the above indexes were observed in Juanbi Decoction low,medium and high dose containing serum groups and positive drug serum group(P<0.05).(2)PTEN induced putative kinase 1 siRNA significantly inhibited the effect of Juanbi Decoction-containing serum on mitophagy in interleukin-1β-treated chondrocytes and reduced the protective effect of Juanbi Decoction-containing serum on interleukin-1β-induced inflammation and apoptosis in chondrocytes;Compound C reversed the effect of Juanbi Decoction-containing serum on the PTEN induced putative kinase 1/Parkin signaling pathway in interleukin-1β-treated chondrocytes.To conclude,Juanbi Decoction-containing serum inhibits chondrocyte inflammation and apoptosis by affecting the level of mitochondrial autophagy,thereby attenuating interleukin-1β-induced chondrocyte degradation by a mechanism that may be related to the regulation of the AMP-activated protein kinase/PTEN induced putative kinase 1/Parkin pathway.

Objective:To analyze the risk factors for postoperative intra-abdominal pressure(IAP) elevation in patients with abdominal trauma and retroperitoneal tumors, and to evaluate the clinical value of continuous dynamic IAP monitoring.Methods:A total of 196 patients with abdominal trauma or retroperitoneal tumors admitted at Peking University People's Hospital from April 2024 to April 2025 were retrospectively enrolled. Postoperative IAP monitoring data were collected, and risk factors for IAP elevation were analyzed.Results:Postoperative IAP in patients with abdominal trauma and retroperitoneal tumors exhibited a peak-shaped pattern, reaching its maximum at 24 hours and returning to baseline by 72 hours. In both the abdominal trauma and retroperitoneal tumor groups, patients with poor outcomes showed significantly higher IAP peak values, longer durations of intra-abdominal hypertension (IAH), higher incidences of IAP>12 mmHg at 6 and 24 hours postoperatively, and longer durations of abdominal perfusion pressure (APP)<60 mmHg ( P<0.05).Multivariate analysis revealed that injury severity score (ISS)≥25, shock index≥1.0, and intraoperative blood transfusion≥2 000 ml were independent risk factors for IAP elevation in patients with abdominal trauma. In patients with retroperitoneal tumors, tumor diameter≥10 cm, intraoperative blood loss≥1 500 ml, peritoneal defect area≥20 cm2, and BMI≥28 kg/m2 were identified as significant risk factors for postoperative IAP elevation. Conclusions:Postoperative IAP in patients with abdominal trauma and retroperitoneal tumors exhibits a similar common dynamic pattern. Continuous dynamic monitoring of IAP can facilitate early identification of high-risk patients, with IAP>12 mmHg at 24 hours postoperatively showing the highest predictive value for adverse outcomes. For such patients, it is recommended to implement goal-directed monitoring for 72 hours to improve clinical prognosis.