Objective To investigate the therapeutic potential and prophylactic value of concomitant administration of nonsteroidal anti-inflammatory drug(NSAID)and antimicrobial agents in mitigating the incidence and severity of trauma-induced sepsis.Methods A retrospective cohort study encompassed the collection of clinical records from trauma patients managed in the department of intensive care unit(ICU)of Daping Hospital,Army Medical University(Third Military Medical University)from June 2008 to June 2024.Based on administered therapeutic protocols,patients were stratified into a control group(receiving antibiotic monotherapy)and a experimental group(undergoing adjunctive therapy with NSAID in conjunction with antimicrobial agents).Intergroup comparisons were performed to elucidate differences in baseline clinical characteristics and laboratory indices pertinent to therapeutic outcomes.Results A total of 268 trauma patients were included,with 72 patients in the control group and 196 patients in the experimental group.The majority of cases involved open trauma(67.5%)and injuries sustained from traffic accidents(44.0%),reflecting the principal mechanisms of injury.The respiratory tract was the most common site of infection(67.5%),with Acinetobacter baumannii(A.baumannii)emerging as the leading causative microorganism(18.0%).Among therapeutic agents,ibuprofen represented the most frequently employed NSAID(59.8%),whereas cephalosporins constituted the predominant class of antimicrobials(30.5%).Following intervention,the lymphocyte percentage(LYM%)was markedly elevated in the experimental group relative to control group[0.14(0.09,0.20)vs.0.12(0.09,0.15),P<0.01].In contrast,the levels of white blood cell count(WBC),neutrophil percentage(NEU%),D-dimer,glucose(Glu),and lactic acid(Lac)were significantly reduced[WBC(×109/L):8.82(6.36,12.96)vs.12.10(7.78,15.54);NEU%:0.76(0.67,0.81)vs.0.78(0.72,0.83);D-dimer(μg/L):2208.0(889.5,3301.5)vs.2943.9(1735.4,4997.6);Glu(mmol/L):6.8(6.2,7.9)vs.7.7(6.6,9.2);Lac(mmol/L):0.9(0.6,1.2)vs.1.1(0.8,1.5),all P<0.05].The experimental group demonstrated a significantly reduced incidence of traumatic sepsis compared with the control group[15.8%(31/196)vs.26.4%(19/72),P<0.05].Conclusion The combination of NSAID and antimicrobial agents exerts its protective effect by attenuating inflammatory and stress responses,reestablishing immune homeostasis,correcting coagulopathy,and enhancing tissue perfusion,thereby significantly decreasing the incidence of traumatic sepsis and contributing to improved prognostic outcomes in injured patients.

Objective To investigate the therapeutic potential and prophylactic value of concomitant administration of nonsteroidal anti-inflammatory drug(NSAID)and antimicrobial agents in mitigating the incidence and severity of trauma-induced sepsis.Methods A retrospective cohort study encompassed the collection of clinical records from trauma patients managed in the department of intensive care unit(ICU)of Daping Hospital,Army Medical University(Third Military Medical University)from June 2008 to June 2024.Based on administered therapeutic protocols,patients were stratified into a control group(receiving antibiotic monotherapy)and a experimental group(undergoing adjunctive therapy with NSAID in conjunction with antimicrobial agents).Intergroup comparisons were performed to elucidate differences in baseline clinical characteristics and laboratory indices pertinent to therapeutic outcomes.Results A total of 268 trauma patients were included,with 72 patients in the control group and 196 patients in the experimental group.The majority of cases involved open trauma(67.5%)and injuries sustained from traffic accidents(44.0%),reflecting the principal mechanisms of injury.The respiratory tract was the most common site of infection(67.5%),with Acinetobacter baumannii(A.baumannii)emerging as the leading causative microorganism(18.0%).Among therapeutic agents,ibuprofen represented the most frequently employed NSAID(59.8%),whereas cephalosporins constituted the predominant class of antimicrobials(30.5%).Following intervention,the lymphocyte percentage(LYM%)was markedly elevated in the experimental group relative to control group[0.14(0.09,0.20)vs.0.12(0.09,0.15),P<0.01].In contrast,the levels of white blood cell count(WBC),neutrophil percentage(NEU%),D-dimer,glucose(Glu),and lactic acid(Lac)were significantly reduced[WBC(×109/L):8.82(6.36,12.96)vs.12.10(7.78,15.54);NEU%:0.76(0.67,0.81)vs.0.78(0.72,0.83);D-dimer(μg/L):2208.0(889.5,3301.5)vs.2943.9(1735.4,4997.6);Glu(mmol/L):6.8(6.2,7.9)vs.7.7(6.6,9.2);Lac(mmol/L):0.9(0.6,1.2)vs.1.1(0.8,1.5),all P<0.05].The experimental group demonstrated a significantly reduced incidence of traumatic sepsis compared with the control group[15.8%(31/196)vs.26.4%(19/72),P<0.05].Conclusion The combination of NSAID and antimicrobial agents exerts its protective effect by attenuating inflammatory and stress responses,reestablishing immune homeostasis,correcting coagulopathy,and enhancing tissue perfusion,thereby significantly decreasing the incidence of traumatic sepsis and contributing to improved prognostic outcomes in injured patients.

Traumatic sepsis is a life-threatening organ dysfunction syndrome caused by an uncontrolled host response to infection after trauma. It is characterized by complex pathogenesis,and rapid deterioration of clinical condition,and is often accompanied by septic shock and multiple organ dysfunction. The incidence and mortality of traumatic sepsis are high,and its treatment presents more difficult. The occurrence of traumatic sepsis is not only related to the traumatic type and severity,but also influenced by various factors such as the type of pathogenic microorganisms,the timing of infection,and the intensity of the immune response. As the key character in the progression of severe traumatic infection,the excessive inflammatory response and immune imbalance are important causes to constitute risk factors and biomarkers of traumatic sepsis. Previous studies on the prevention and treatment of traumatic sepsis paid more attention to early infection control,effective anti-infection treatment,fluid resuscitation,immune modulation and supportive treatment,especially for antibiotics use. However,the role of inflammatory response was ignored in the prognosis of traumatic patients. The immune system activation after trauma not only plays a crucial role in preventing and controlling infections but also closely relates to the systemic inflammatory response. Excessive or uncontrolled inflammatory response may exacerbate the situation of patients with traumatic sepsis,trigger multiple organ dysfunction syndrome (MODS),and even result in death. Current studies imply that the combined treatment of bacteria,their toxins,and inflammatory mediators may be a key measure for preventing and treating traumatic sepsis. This strategy emphasizes not only anti-infection therapy against pathogenic microorganisms but also immune modulation to suppress excessive inflammatory response and restore immune balance. The pattern of "combined treatment of bacteria,their toxins,and inflammation" is expected to reduce the incidence and mortality of traumatic sepsis by inhibiting excessive inflammatory response and enhancing immune capacity. This review describes the progress of the combined treatment of bacteria,their toxins,and inflammatory mediators in preventing and treatment for traumatic sepsis,from the perspectives of epidemiology,risk factors,biomarkers,pathogenesis,concept development,and application. It provides a new idea to study and research the key technologies for the prevention and treatment of severe traumatic complications.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To explore the effect and predictive value of blood lactate level on bronchopulmonary dysplasia(BPD)in newborns with neonatal respiratory distress syndrome(NRDS).Methods A total of 78 children with NRDS admitted to the First People's Hospital of Pingdingshan from January 2019 to December 2022 were selected as the research subjects.Based on whether they had BPD,the children were divided into a BPD group and a non-BPD group.The general clinical data of the children,including gestational age,gender,birth weight,1-minute Apgar score,5-minute Apgar score,and premature rupture of membranes,were collected.At admission,1 mL of arterial blood was extracted from the children,and the blood lactate level,arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),pH value,and oxygenation index(OI)were measured using a JM1113-739853 blood gas analyzer;3 mL of peripheral venous blood was extracted from the children,and the level of interleukin-6(IL-6)in the serum was detected by enzyme-linked immunosorbent assay,while the levels of C-reactive protein(CRP)and procalcitonin(PCT)in the plasma were detected by double antibody sandwich method.The general information,blood lactate levels,PaO2,PaCO2,pH value,OI,serum IL-6 levels,plasma CRP and PCT levels of children were compared between the two groups.The correlation between blood lactate levels and NRDS complicated with BPD was determined by point-biserial correlation analysis,the influencing factors of NRDS complicated with BPD was analyzed by logistic regression,and the predictive value of blood lactate levels for NRDS complicated with BPD was analyzed by receiver operating characteristic curve.Results The blood lactate levels of 78 children with RDS ranged from 3.35 to 6.64(5.04±0.72)mmol·L-1.There were 16 children with BPD,with an incidence rate of 20.51％(16/78).The birth weight and OI of children in the BPD group were significantly lower than those in the non-BPD group,while the serum IL-6,plasma CRP,and blood lactate levels were significantly higher than those in the non-BPD group(P＜0.05).There was no statistically significant difference in gestational age,gender,1-minute Apgar score,5-minute Apgar score,premature rupture of membranes,PaO2,PaCO2,pH value,and PCT of children between the two groups(P＞0.05).The point-biserial correlation analysis showed that blood lactate,serum IL-6,and plasma CRP levels were positively correlated with the risk of BPD in children with NRDS(r=0.502,0.475,0.507;P＜0.05);while birth weight and OI were negatively correlated with the risk of BPD in children with NRDS(r=-0.242,-0.403;P＜0.05).Logistic regression analysis showed that blood lactate accumulation,high expression of serum IL-6,high expression of plasma CRP,and decreased OI were risk factors for BPD in children with NRDS(P＜0.05).The area under the curve for predicting BPD in children with NRDS based on blood lactate was 0.865,with a 95％confidence interval of 0.776 to 0.955;when the cut-off value of blood lactate was 5.065 mmol·L-1,the sensitivity and specificity of predicting BPD in children with NRDS were 0.938 and 0.501,respectively.Conclusion There is a positive correlation between blood lactate levels and the risk of BPD in children with NRDS.Blood lactate accumulation is a risk factor for NRDS complicated with BPD,and blood lactate level has a certain predictive value for NRDS complicated with BPD.

Objective To establish an early prediction model for the diagnosis of severe acute pancreatitis based on the improved machine learning models,and to analyze its clinical value.Methods A case-control study was conducted on 352 patients with acute pancreatitis admitted to the Gastroenterology and Hepatobiliary Surgery Departments of the Army Medical Center of PLA and Emergency and Critical Care Medicine Department of No.945 Hospital of Joint Logistics Support Force of PLA from January 2014 to August 2023.According to the severity of the disease,the patients were divided into the severe group(n=88)and the non-severe group(n=264).The RUSBoost model and improved Archimead optimization algorithm was used to analyze 39 routine laboratory biochemical indicators within 48 h after admission to construct an early diagnosis and prediction model for severe acute pancreatitis.The task of feature screening and hyperparameter optimization was completed simultaneously.The ReliefF algorithm feature importance rank and multivariate logistic analysis were used to analyze the value of the selected features.Results In the training set,the area under curve(AUC)of the improved machine learning model was 0.922.In the testing set,the AUC of the improved machine learning model reached 0.888.The 4 key features of predicting severe acute pancreatitis based on the improved Archimedes optimization algorithm were C-reactive protein,blood chlorine,blood magnesium and fibrinogen level,which were consistent with the results of ReliefF algorithm feature importance ranking and multivariate logistic analysis.Conclusion The application of improved machine learning model analyzing the laboratory examination results can help to early predict the occurrence of severe acute pancreatitis.

Traumatic sepsis is a life-threatening organ dysfunction syndrome caused by an uncontrolled host response to infection after trauma. It is characterized by complex pathogenesis,and rapid deterioration of clinical condition,and is often accompanied by septic shock and multiple organ dysfunction. The incidence and mortality of traumatic sepsis are high,and its treatment presents more difficult. The occurrence of traumatic sepsis is not only related to the traumatic type and severity,but also influenced by various factors such as the type of pathogenic microorganisms,the timing of infection,and the intensity of the immune response. As the key character in the progression of severe traumatic infection,the excessive inflammatory response and immune imbalance are important causes to constitute risk factors and biomarkers of traumatic sepsis. Previous studies on the prevention and treatment of traumatic sepsis paid more attention to early infection control,effective anti-infection treatment,fluid resuscitation,immune modulation and supportive treatment,especially for antibiotics use. However,the role of inflammatory response was ignored in the prognosis of traumatic patients. The immune system activation after trauma not only plays a crucial role in preventing and controlling infections but also closely relates to the systemic inflammatory response. Excessive or uncontrolled inflammatory response may exacerbate the situation of patients with traumatic sepsis,trigger multiple organ dysfunction syndrome (MODS),and even result in death. Current studies imply that the combined treatment of bacteria,their toxins,and inflammatory mediators may be a key measure for preventing and treating traumatic sepsis. This strategy emphasizes not only anti-infection therapy against pathogenic microorganisms but also immune modulation to suppress excessive inflammatory response and restore immune balance. The pattern of "combined treatment of bacteria,their toxins,and inflammation" is expected to reduce the incidence and mortality of traumatic sepsis by inhibiting excessive inflammatory response and enhancing immune capacity. This review describes the progress of the combined treatment of bacteria,their toxins,and inflammatory mediators in preventing and treatment for traumatic sepsis,from the perspectives of epidemiology,risk factors,biomarkers,pathogenesis,concept development,and application. It provides a new idea to study and research the key technologies for the prevention and treatment of severe traumatic complications.

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.

A novel coronavirus pneumonia (NCP) epidemic has occurred in Wuhan, Hubei Province since December 2019, caused by a novel coronavirus (2019-nCoV) never been seen previously in human. China has imposed the strictest quarantine and closed management measures in history to control the spreading of the disease. However, severe trauma can still occur in the NCP patients. In order to standardize the emergency treatment and the infection prevention and control of severe trauma patients with hidden infection, suspected or confirmed infection of 2019-nCoV, Trauma Surgery Branch of Chinese Medical Doctors' Association organized this expert consensus. The consensus illustrated the classification of the NCP patients, severe trauma patients in need of emergency surgery, emergency surgery type, hierarchical protection for medical personnel and treatment places. Meanwhile, the consensus standardized the screening, injury severity evaluation, emergency surgical treatment strategy and postoperative management strategy of severe trauma patients during the epidemic period of NCP, providing a basis for the clinical treatment of such kind of patients.

Objective To investigate the diagnosis and treatment method of complicating acute pulmonary embolism(APE) after surgery in ICU.Methods Ten patients with complicating APE after surgery in ICU of this hospital from July 2014 to November 2016 were selected.Their clinical characteristics,age,basic diseases,clinical diagnosis and treatment process were retrospectively analyzed.Results Ten cases occurred on mean postoperative(2.4 ± 1.1) d,which manifested by different degrees of respiratory failure,circulatory failure,renal function failure,chest pain,hemoptysis and cough.10％ and 40％ respectively.Five cases(50％) used rt-PA thrombolysis,2 cases(20 ％) were treated with low molecular weight heparin anticoagulation and 3 cases (30 ％) were treated with heparin anticoagulation,One case(10 ％) died after treatment,1 case(10 ％) was discharged from hospital and 8 cases (80％)were improved and discharge from ICU.Conclusion Postoperative complicating pulmonary embolism has high probability.The postoperative complicating pulmonary embolism risk should be evaluated for prevention as early as possible.If APE occurs,adopting thrombolysis or anticoagulation therapy has good effect.