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 explore the feasibility of establishing a temporary trauma team led by trauma experts in primary hospitals for disaster medical rescue. METHODS: In the coal mine flooding accident in Xiaoyi City, Shanxi Province on December 15, 2021, according to the local emergency plan and the characteristics of the accident, the trauma experts trained the medical staff from the local primary hospital on advanced trauma life support (ATLS) and damage control surgery (DCS) in the short time interval between the occurrence of the mine disaster and the admission of medical staff to the disaster scene. A temporary trauma team composed of trauma experts, ATLS team, and DCS team was formed to provide early diagnosis and treatment for survivors before and in the hospital. RESULTS: The miners were found on the 36th hour of the disaster. All 22 miners were male, and 2 died underground. Another 20 people were rescued 39－43 hours after the disaster, with a median age of 48 years (34-57 years). All the survivors suffered from hypothermia, dehydration, maceration of feet and other injuries. There were 18 cases of acute inhalation tracheobronchitis, 14 cases of electrolyte acid-base disturbance, 6 cases of trunk contusion, 1 case of psoas major hematoma, and 1 case of lower extremity hematoma. Deep vein thrombosis was in 4 cases. The ATLS team focused on injury assessment, rewarming and rehydration within 50－60 minutes before admission, and completed auxiliary examinations within 2 hours after admission to clarify the diagnosis. The DCS team evaluated 6 patients with mechanical blunt trunk injury and excluded the indication of emergency surgery. The trauma experts conducted the whole process of supervision and quality control of disaster rescue. The positive rate of capillary refill test in the all survivors at the third hour of admission was significantly lower than that immediately after being rescued (75.0% vs. 15.0%, P=0.000 3), and they were discharged 4－7 days after admission. CONCLUSION Under the leadership of trauma experts and relying on the medical staff of primary hospitals, it is feasible to establish and train a temporary trauma team with ATLS and DCS functions to participate in the medical rescue of disasters, which is in line with the current national conditions of China.
Humans ; Adult ; Middle Aged ; Male ; Rescue Work/organization & administration* ; China ; Disasters ; Patient Care Team/organization & administration* ; Wounds and Injuries/therapy* ; Advanced Trauma Life Support Care/organization & administration* ; Disaster Planning/organization & administration* ; Emergency Medical Services/organization & administration*

Objective: To explore the expression level of PPFIA4 in hepatocellular carcinoma tissues and HCCLM3 cells and its regulation of the biological behavior of hepatocellular carcinoma. Methods : Bioinformatics analysis, Western blot, and immunohistochemistry were employed to detect the expression of PPFIA4 in tumor tissues of patients with hepatocellular carcinoma and analyze the prognosis of these patients. An siRNA plasmid was designed to knock down the expression of PPFIA4 in HCCLM3 cells. The effects of PPFIA4 knockdown on the migration and invasion abilities of HCCLM3 cells were then evaluated using scratch healing and Transwell assays. Furthermore, Western blot was utilized to detect the expression levels of epithelial-mesenchymal transition(EMT)-related protein markers in the HCCLM3 cell line after transfection with the siRNA plasmid. Results: PPFIA4 was highly expressed in hepatocellular carcinoma tissues and hepatocellular carcinoma cells( HCCLM3, Li-7, MHCC97H); the high expression of PPFIA4 indicated that the clinical stage of patients was late and the overall survival(OS) was short. After knocking down the expression of PPFIA4 in HCCLM3 cell line, the migration and invasion ability of HCCLM3 cells decreased(P<0.001) and the expression of EMT markers changed. The expression of epithelial cell marker E-cadherin increased(P<0.01), while the expression of mesenchymal markers Vimentin and N-cadherin decreased(P<0.05,P<0.01). Conclusion PPFIA4 is highly expressed in hepatocellular carcinoma tissues and hepatocellular carcinoma cell lines and is associated with poor prognosis of patients. Silencing PPFIA4 can regulate the biological behavior of hepatocellular carcinoma cells and inhibit the migration and invasion of HCCLM3 cells. The specific mechanism may be related to EMT.

Trauma is recognized globally as a great public health challenge.It stands as the predomi-nant cause of mortality among those under the age of 45 and is also ranked among the top five causes of death for both urban and rural populations within China.This stark reality underscores the critical urgen-cy in establishing an efficient system for trauma care,which is pivotal for substantially enhancing the sur-vival rates of patients.An optimally developed system for trauma care not only guarantees that patients promptly receive professional medical assistance but also facilitates significant improvements in the out-comes of trauma care through the strategic establishment of trauma centers.At present,a considerable variation exists in the quality of trauma care provided across various regions within China.The adoption of comprehensive quality management strategies for the medical processes involved in trauma care,alongside the standardized management of on-site rescue operations,pre-hospital emergency care,and in-hospital treatment protocols,stands as a fundamental approach to boost the capabilities of trauma care and,conse-quently,the survival rates of trauma patients.Serving as the cornerstone of comprehensive medical quali-ty management,key quality control indicators possess the capacity to steer the development direction of trauma centers.In a concerted effort to further augment the medical quality management of trauma care,standardize clinical diagnosis and treatment methodologies,and advocate for the standardization and ho-mogenization of medical services,the Medical Quality Control Professional Committee of the National Center for Trauma Medicine has undertaken a detailed refinement and update of the 16 key quality control indicators for trauma centers.These were initially put forward in the"Notice on Further Enhancing Trau-ma Care Capabilities"disseminated by the National Health Commission in 2018.Consequent to this en-deavor,a revised set of 19 quality control indicators has been devised.This comprehensive set,inclusive of the indicators'names,definitions,calculation methodologies,significance,and the subjects for quali-ty control,is designed for utilization within the quality management and control operations of trauma cen-ters across various levels.This initiative aims to furnish a concrete and executable roadmap for the quality control endeavors of trauma centers.Through the enactment of these quality control indicators,medical institutions are empowered to conduct more stringent monitoring and evaluative measures across all facets of trauma care.This not only facilitates the prompt identification and rectification of existing challenges but also substantially boosts the efficiency of internal collaboration.It enhances the synergy between dif-ferent departments,thereby markedly improving the efficiency and quality of trauma care.

The 7th edition of "Resources for Optimal Care of the Injured Patient (2022 Standards)" was released in December 2023. The main contents including establishment of trauma centers, clinical practice guidelines for the care of the trauma patients, resource allocation for trauma care, trauma care quality management, trauma data registry system, trauma care education and training, etc were introduced and analyzed to explore its implication for the construction of China′s trauma care system.Accordingly, the following measures were proposed to improve the construction of China′s trauma care system: establishing graded standards for a trauma care system covering the entire population in China, developing diagnosis and treatment regimens that cater to special groups, optimizing the allocation of trauma care resources, formulating plans to improve trauma care quality and patient safety that conform with China′s national conditions, setting unified standards for trauma data, and enhancing education and training in trauma care. This paper provides decision-making references for promoting the overall construction of China′s trauma care system and improving trauma care quality.

Objective:To investigate the risk factors of acute respiratory distress syndrome(ARDS)after traumatic hemorrhagic shock.Methods:This was a retrospective cohort study of 314 patients with traumatic hemorrhagic shock at Trauma Medicine Center,Peking University People's Hospital from De-cember 2012 to August 2021,including 152 male patients and 162 female patients,with a median age of 63.00(49.75-82.00)years.The demographic data,past medical history,injury assessment,vital signs,laboratory examination and other indicators of these patients during hospitalization were recorded.These patients were divided into two groups,ARDS group(n=89)and non-ARDS group(n=225)ac-cording to whether there was ARDS within 7 d of admission.Risk factors for ARDS were identified using Logistic regression.The C-statistic expressed as a percentage[area under curve(AUC)of the receiver operating characteristic(ROC)curve]was used to assess the discrimination of the model.Results:The incidence of ARDS after traumatic hemorrhagic shock was 28.34％.Finally,Logistic regression model showed that the independent risk factors of ARDS after traumatic hemorrhagic shock included male,histo-ry of coronary heart disease,high acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,road traffic accident and elevated troponin Ⅰ.The OR and 95％confidence intervals(CI)were 4.01(95％CI:1.75-9.20),5.22(95％CI:1.29-21.08),1.07(95％CI:1.02-1.57),2.53(95％CI:1.21-5.28),and 1.26(95％CI:1.02-1.57),respectively;the P values were 0.001,0.020,0.009,0.014,and 0.034,respectively.The ROC curve was used to analyze the value of each risk factor in predicting ARDS.It was found that the AUC for predicting ARDS after traumatic hemor-rhagic shock was 0.59(95％CI:0.51-0.68)formale,0.55(95％CI:0.46-0.64)for history of coronary heart disease,0.65(95％CI:0.57-0.73)for APACHE Ⅱ score,0.58(95％CI:0.50-0.67)for road traffic accident,and 0.73(95％CI:0.66-0.80)for elevated troponin Ⅰ,with an overall predictive value of 0.81(95％CI:0.74-0.88).Conclusion:The incidence of ARDS in pa-tients with traumatic hemorrhagic shock is high,and male,history of coronary heart disease,high APACHE Ⅱ score,road traffic accident and elevated troponin Ⅰ are independent risk factors for ARDS after traumatic hemorrhagic shock.Timely monitoring these indicators is conducive to early detection and treatment of ARDS after traumatic hemorrhagic shock.

OBJECTIVE: To analyze the clinical characteristics of patients with severe fall injury and explore the prehospital factors affecting the injury severity score (ISS). METHODS: Clinical data of severe trauma patients with fall injury and ISS≥16 from January 2018 to December 2020 were retrieved from trauma database of Peking University People' s Hospital. The patients' age, gender, suicidal tendencies, psychiatric disorders, fall height, properties of the impact surface, the body part hitting the ground, abbreviated injury scale, Glasgow coma scale (GCS), length of stay in intensive care unit (ICU), operation were collected. And the in-hospital mortality were calculated. Univariate analysis and multiple linear regression models were used to analyze the relationship between the above factors and ISS. The patients' GCS, length of stay in ICU, surgery, and in-hospital mortality were collected to analyze the general clinical characteristics of patients. RESULTS: A total of 160 patients were finally eligible, including 138 males and 22 females, with an average age of (45.56±15.85) years. Among the 160 patients, there were 36 cases (22.50%) with suicidal tendencies, 12 cases (7.50%) with psychiatric disorders. Their average fall height was (7.20±8.33) meters, and 48 cases (30.00%) hit the soft contact medium. 40 cases (25.00%) with impact on the head at the ground, lower limbs in 26 cases (16.25%), ventral in 16 cases (10.00%), dorsal in 40 cases (25.00%), lateral in 38 cases (23.75%). The patients' ISS was 22.8±6.85, GCS was 13.49±3.39, lengths of ICU stays were (9.96±8.12) days, and 142 (88.75%) patients underwent surgery, 8 in-hospital deaths were all due to head trauma, with an in-hospital mortality rate of 5.00%. Univariate analysis suggested that the main factors influencing ISS were the presence of suicidal tendencies (P=0.01) and the site of impact on the ground (P=0.02). Multiple linear regression analysis indicated that suicidal tendencies and head impact on the ground were in-fluential factors for high ISS. CONCLUSION Collecting prehospital information of patients with fall injuries, such as whether they have suicidal tendencies and whether they hit the ground with their heads, can effectively predict the severity of patients' injuries, which is conducive to early diagnosis, early care, and early treatment, thus reducing preventable death.
Humans ; Male ; Female ; Middle Aged ; Injury Severity Score ; Hospital Mortality ; Adult ; Accidental Falls/statistics & numerical data* ; Glasgow Coma Scale ; Intensive Care Units ; Length of Stay/statistics & numerical data* ; Wounds and Injuries/psychology* ; Abbreviated Injury Scale

In December 2023, the Trauma Professional Committee of the American Society of Surgeons officially released the seventh edition of "Resources for Optimal Care of the Injured Patient (2022 Stan-dards)". Compared to the sixth edition of the standards, the main updated content of the seventh edition includes ten aspects: (1) trauma centers need to meet new personnel configuration and qualification requirements, (2) trauma centers need to develop more structured and effective trauma treatment effectiveness improvement and patient safety plans, (3) trauma centers need to develop data quality plans, (4) trauma centers need to develop new diagnosis and treatment plans for specific patients, (5) trauma centers need to have new professional knowledge, (6) trauma centers need to meet new response time and resource availability standards, (7) trauma centers need to meet new academic and scientific requirements, (8) tertiary trauma centers need corresponding qualification certificates if providing neurological trauma treatment, (9) new requirements for pediatric trauma centers, (10) the fourth level trauma center standards. The research literature published by scholars in the field of trauma in the past decade has provided sufficient evidence-based medicine evidence for updating content. The article introduces and analyzes the updates in the seventh edition standards in light of the available evidence.
Humans ; Trauma Centers/standards* ; Wounds and Injuries/therapy* ; Societies, Medical ; Surgeons/standards* ; United States

OBJECTIVE: To investigate the growth-inhibitory and pro-apoptotic effects of piroctone olamine (PO) on glioma cells and explore the underlying mechanism. METHODS: Human glioma cell lines U251 and U373 were treated with PO and the changes in cell proliferation were detected using CCK-8 assay and EdU assay. Clone formation assay and flow cytometry were used to examine the changes in clone formation ability and apoptosis of the treated cells. Mitochondrial membrane potential of the cells and morphological changes of the mitochondria were detected using JC-1 staining and a fluorescence probe, respectively. The expressions of mitochondrial fission protein DRP1 and the fusion protein OPA1 were determined with Western blotting. Transcriptome sequencing and differential gene enrichment analysis was performed, and the expression levels of PI3K, AKT and p-AKT in the treated cells were verified using Western blotting. RESULTS: CCK-8 assay showed that PO significantly inhibited the proliferation of U251 and U373 cells in a time- and dose-dependent manner (P < 0.001). EdU test showed that the proliferative activity of PO-treated cells was significantly decreased, and the number of cell colonies also decreased significantly (P < 0.01). PO treatment significantly increased apoptotic rates (P < 0.01), decreased mitochondrial membrane potential and caused obvious changes in mitochondrial morphology of the cells. Pathway enrichment analysis showed that the down-regulated genes were significantly enriched in the PI3K/AKT pathway, which was verified by Western blotting showing significantly down-regulated expression levels of PI3K, AKT and p-AKT in PO-treated cells (P < 0.05). CONCLUSION PO interferes with mitochondrial fusion and fission function through the PI3K/AKT pathway, thereby inhibiting the proliferation and increasing apoptosis of glioma cells.
Humans ; Glioma ; Mitochondrial Dynamics ; Phosphatidylinositol 3-Kinases ; Proto-Oncogene Proteins c-akt

OBJECTIVE: To investigate the effect of lactic acid-induced upregulation of PLEKHA4 expression on biological behaviors of glioma cells and the possible molecular mechanism. METHODS: GEO database and GEPIA2 website were used to analyze the relationship between PLEKHA4 expression level and the pathological grade of glioma. A specific PLEKHA4 siRNA was transfected in glioma U251 and T98G cells, and the changes in cell proliferation ability were assessed by real-time cell analysis technology and Edu experiment. The colony-forming ability of the cells was evaluated using plate cloning assay, and cell cycle changes and cell apoptosis were analyzed with flow cytometry. The mRNA expression of PLEKHA4 was detected by PCR in glioma samples and controls and in glioma cells treated with lactic acid and glucose. Xenograft mice in vivo was used to detect tumor formation in nude mice; Western blotting was used to detect the expressions of cyclinD1, CDK2, Bcl2, β-catenin and phosphorylation of the key proteins in the MAPK signaling pathway. RESULTS: The results of GEO database and online website analysis showed that PLEKHA4 was highly expressed in glioma tissues and was associated with poor prognosis; PLEKHA4 knockdown obviously inhibited the proliferation and attenuated the clone-forming ability of the glioma cells (P < 0.05). Flow cytometry showed that PLEKHA4 knockdown caused cell cycle arrest in G1 phase and promoted apoptosis of the cells (P < 0.01). PLEKHA4 gene mRNA expression was increased in glioma samples and glioma cells after lactate and glucose treatment (P < 0.01). PLEKHA4 knockdown, tumor formation ability of nude mice decreased; PLEKHA4 knockdown obviously lowered the expression of cyclinD1, CDK2, Bcl2 and other functional proteins, inhibited the phosphorylation of ERK and p38 and reduced the expression of β-catenin protein (P < 0.01). CONCLUSION PLEKHA4 knockdown inhibited the proliferation of glioma cells and promoted apoptosis by inhibiting the activation of the MAPK signaling pathway and expression of β-catenin. Lactic acid produced by glycolysis upregulates the expression of PLEKHA4 in glioma cells.
Humans ; Animals ; Mice ; Up-Regulation ; beta Catenin/metabolism* ; Mice, Nude ; Brain Neoplasms/pathology* ; Lactic Acid ; Cell Line, Tumor ; Glioma/pathology* ; Cell Proliferation ; Apoptosis ; Proto-Oncogene Proteins c-bcl-2/metabolism* ; RNA, Messenger/genetics* ; Gene Expression Regulation, Neoplastic