Traumatic massive abdominopelvic hemorrhage presents significant clinical challenges due to its complex anatomy, deep-seated and predominantly non-compressible bleeding sites, difficulties in early recognition, and rapid disease progression. Patients are often complicated with shock and coagulopathy, making timely intervention extremely critical. Despite continuous advances in treatment techniques for trauma, clinical practice still faces significant challenges, including insensitive early warning systems, limited assessment means, suboptimal selection and timing of hemostatic interventions, insufficient multidisciplinary team (MDT) collaboration, and imperfect hemostasis strategy based on anatomical stratification. Focusing on the treatment chain of "early warning-assessment-hemostasis-support", the authors reviewed key challenges in managing massive abdominopelvic hemorrhage including the establishment of early warning criteria, standardization and intelligentization of focused assessment with sonography for trauma (FAST), standardized application of (REBOA), optimization of MDT collaborative mechanisms, and integration of anatomy-based hemostatic strategies, and proposed optimization pathways, aiming to improve the success rate in managing traumatic massive abdominopelvic hemorrhage.

Traumatic massive abdominopelvic hemorrhage presents significant clinical challenges due to its complex anatomy, deep-seated and predominantly non-compressible bleeding sites, difficulties in early recognition, and rapid disease progression. Patients are often complicated with shock and coagulopathy, making timely intervention extremely critical. Despite continuous advances in treatment techniques for trauma, clinical practice still faces significant challenges, including insensitive early warning systems, limited assessment means, suboptimal selection and timing of hemostatic interventions, insufficient multidisciplinary team (MDT) collaboration, and imperfect hemostasis strategy based on anatomical stratification. Focusing on the treatment chain of "early warning-assessment-hemostasis-support", the authors reviewed key challenges in managing massive abdominopelvic hemorrhage including the establishment of early warning criteria, standardization and intelligentization of focused assessment with sonography for trauma (FAST), standardized application of (REBOA), optimization of MDT collaborative mechanisms, and integration of anatomy-based hemostatic strategies, and proposed optimization pathways, aiming to improve the success rate in managing traumatic massive abdominopelvic hemorrhage.

Objective To explore the relationship between the expression of Toll like receptor 4(TLR4)and Janus protein tyrosine kinase 3(JAK3)genes and the imbalance of helper T cell 17(Th17)/regulatory T cells(Treg)in peripheral blood mononuclear cells(PBMCs)of patients with ankylosing spondylitis(AS).Methods A total of 101 AS patients were selected as the AS group.According to the AS Disease Activity Index(BASDAI)score,patients were divided into the AS stable phase(ASS)group(＜4 points,42 cases)and the AS active phase(ASA)group(≥4 points,59 cases).Additionally,50 healthy volunteers who underwent physical examinations at our hospital during the same period were selected as the control group(health group).Real-time fluorescence quantitative polymerase chain reaction(RT-qPCR)was used to determine the mRNA expression of TLR4 and JAK3 in PBMCs,and the proportion of serum Th17 and Treg was measured and Th17/Treg levels were calculated.Results The levels of TLR4 mRNA and JAK3 mRNA in PBMCs of peripheral blood were higher in the AS group than those in the health group(P＜0.05).The levels of Th17,proportion and Th17/Treg in peripheral blood were higher in the AS group than those of the health group(P＜0.05).Higher levels of TLR4 mRNA,JAK3 mRNA,Th17,and Th17/Treg were risk factors for AS,while higher level of Treg was protective factors for AS.TLR4 mRNA and JAK3 mRNA in AS patients were positively correlated with Th17 ratio and Th17/Treg ratio,and negatively correlated with Treg ratio(P＜0.05).Conclusion TLR4 and JAK3 genes are highly expressed and Th17/Treg is unbalanced in PBMC of AS patients.The high expression of TLR4 and JAK3 genes is closely related to Th17/Treg imbalance in AS patients.

ObjectiveTo investigate the clinical features of patients with acute-on-chronic liver failure （ACLF） and bacterial infection and early warning indicators associated with multidrug-resistant infections. MethodsA retrospective analysis was performed for 130 patients with ACLF and bacterial infection who attended The Second Affiliated Hospital of Air Force Medical University from January 1， 2010 to December 31， 2021， and according to the drug susceptibility results， the patients were divided into multidrug-resistant （MDR） bacterial infection group with 80 patients and non-MDR bacterial infection group with 50 patients. General information and laboratory examination results were compared between the two groups to screen for the early warning indicators associated with MDR bacterial infection. The Student’s t-test was used for comparison of normally distributed continuous data with homogeneity of variance between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data or continuous data with heterogeneity of variance between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The binary logistic regression analysis and the receiver operating characteristic （ROC） curve were used to assess the predictive value of early warning indicators. ResultsAmong the 130 patients with ACLF and bacterial infection， sputum （27.7%） was the most common specimen for detection， followed by blood （24.6%）， urine （18.5%）， and ascites （17.7%）. Bacterial infections were dominated by Gram-negative bacteria （58.5%）. Of all bacteria， Escherichia coli （18.5%）， Klebsiella pneumoniae （14.6%）， and Enterococcus faecium （13.8%） were the most common pathogens. Gram-positive bacteria had a high resistance rate to the antibacterial drugs such as erythromycin （72.2%）， penicillin （57.4%）， ampicillin （55.6%）， and ciprofloxacin （53.7%）， while Gram-negative bacteria had a high resistance rate to the antibacterial drugs such as ampicillin （73.3%）， cefazolin （50.0%）， and cefepime （47.4%）. The patients with ACLF and bacterial infection had a relatively high rate of MDR bacterial infection （61.5%）. Comparison of clinical data between the two groups showed that compared with the patients with non-MDR bacterial infection， the patients with MDR bacterial infection had significantly higher levels of alanine aminotransferase （Z=2.089， P=0.037）， aspartate aminotransferase （Z=2.063， P=0.039）， white blood cell count （Z=2.207， P=0.027）， and monocyte count （Z=4.413， P<0.001）. The binary logistic regression analysis showed that monocyte count was an independent risk factor for MDR bacterial infection （odds ratio=7.120， 95% confidence interval ［CI］： 2.478‍ ‍—‍ ‍20.456，P<0.001） and had an area under the ROC curve of 0.686 （95%CI： 0.597‍ ‍—‍ ‍0.776） in predicting ACLF with MDR bacterial infection（P<0.001）， with the optimal cut-off value of 0.50×10⁹/L， a sensitivity of 0.725， and a specificity of 0.400. ConclusionACLF combined with bacterial infections is mainly caused by Gram-negative bacteria， with the common pathogens of Escherichia coli and Klebsiella pneumoniae and a relatively high MDR rate in clinical practice. An increase in monocyte count can be used as an early warning indicator to distinguish MDR bacterial infection from non-MDR bacterial infection.

Objective To provide a scientific benchmark for the era of population aging and improve the medical care environment for the elderly in terms of hospital facility accessibility.Methods A random sampling method was used to select 375 individuals from 10 healthcare institutions in a specified city as survey participants from December 2022 to February 2023.A total of 375 questionnaires titled"Comprehensive Rating Scale for Patient Experience in Medical Facilities(Accessibility Category)"were distributed among the participants,with 356 valid responses received and subjected to reliability and validity assessments.The questionnaire included 6 accessibility indicators,each rated from 1 to 10,to evaluate the accessibility level of healthcare fa-cilities.The acquired data was analyzed using the Rank Sum Ratio method and the Four Quadrants model.Results The average score for building accessibility in the city's medical institutions was 35.86,with several indicators at a moderate level,indicating a need for an improvement of the facility accessibility.Meanwhile,the economic operational status of various medical institutions appeared to influence the implementation of accessibility features,which also correlated with local government construction plan-ning,staff awareness of accessible infrastructure,and other factors.Conclusion Medical facilities in cities could implement bar-rier-free modifications in parking,toilets,and other areas,improve the use of accessible AI technology,and develop intelligent medical scenarios in order to meet the challenges of an aging society,improve the medical care quality for the elderly,and reduce social security cost.The governments should accelerate the improvement of supportive policies and regulations and bolster support for the accessibility enhancements.Higher education and research institutions can collaborate with healthcare providers for innova-tive integration of industry academia,research,and application,fostering the conversion of research into practical solutions.

Objective:To determine the effects of preperitoneal balloon (PPB) tamponade with different volumes of fluid on hemodynamically unstable pelvic fracture-associated arterial and venous hemorrhage in a swine model.Methods:A model of open-book pelvic fracture with injuries to external iliac vessels was established in 18 female 12-month old Bama miniature pigs. After the successful establishment of hemodynamically unstable pelvic fracture with vascular injury was confirmed by contrast agent imaging, the animals were randomized into 3 even groups ( n=6): a control group (group C) subjected to PPB tamponade with 0 mL fluid injected, group T1 subjected to PPB tamponade with 500-mL fluid injected, and group T2 subjected to PPB tamponade with 1,000-mL fluid injected. The 3 groups were compared in terms of 60-min survival rate, balloon pressure, peritoneal pressure, bladder pressure, 70-min survival rate, blood loss, and infusion volume. Results:There was no statistically significant difference in the basic hemodynamic or other experimental indicators among the 3 groups before experiment, indicating comparability ( P>0.05). The 60-min survival rate in group T2 was 100.0% (6/6), significantly higher than those in group C and group T1 [0.0% (0/6), 0.0% (0/6)] ( P<0.05). After fluid injection, the balloon pressure and preperitoneal pressure in group T2 were respectively (127.2±4.7) mmHg and (34.5±3.6) mmHg, significantly higher than those in group T1 [(78.7±3.8) mmHg and (13.7±2.8) mmHg] and in group C [0 mmHg and (9.0±1.4) mmHg], and the 2 indicators in group T1 were significantly higher than those in group C (all P<0.05). After fluid injection, there was no statistically significant difference among groups C, T1, and T2 in bladder pressure [(6.7±1.0) mmHg, (5.8±1.9) mmHg, and (6.0±1.1) mmHg] or in bleeding volume [(1,163.0±191.3) mL, (1,212.0±148.4) mL, and (975.0±133.2) mL] (all P≥ 0.05). The infusion volume in group T1 [(1,250.0±225.8) mL] was significantly larger than that in group C [(951.7±177.8) mL] ( P<0.05). No colorectal or bladder injuries were found by the anatomy of the experimental animals in 3 groups. Conclusions:PPB tamponade with 1,000-mL fluid injected in a swine model can efficiently control pelvic fracture-associated arterial and venous hemorrhage, and increase the 60-min survival rate with no colorectal or bladder injuries.

Ketone bodies have beneficial metabolic activities, and the induction of plasma ketone bodies is a health promotion strategy. Dietary supplementation of sodium butyrate (SB) is an effective approach in the induction of plasma ketone bodies. However, the cellular and molecular mechanisms are unknown. In this study, SB was found to enhance the catalytic activity of 3-hydroxy-3-methylglutaryl-CoA synthase 2 (HMGCS2), a rate-limiting enzyme in ketogenesis, to promote ketone body production in hepatocytes. SB administrated by gavage or intraperitoneal injection significantly induced blood ß-hydroxybutyrate (BHB) in mice. BHB production was induced in the primary hepatocytes by SB. Protein succinylation was altered by SB in the liver tissues with down-regulation in 58 proteins and up-regulation in 26 proteins in the proteomics analysis. However, the alteration was mostly observed in mitochondrial proteins with 41% down- and 65% up-regulation, respectively. Succinylation status of HMGCS2 protein was altered by a reduction at two sites (K221 and K358) without a change in the protein level. The SB effect was significantly reduced by a SIRT5 inhibitor and in Sirt5-KO mice. The data suggests that SB activated HMGCS2 through SIRT5-mediated desuccinylation for ketone body production by the liver. The effect was not associated with an elevation in NAD⁺/NADH ratio according to our metabolomics analysis. The data provide a novel molecular mechanism for SB activity in the induction of ketone body production.
Mice ; Animals ; Butyric Acid/metabolism* ; Ketone Bodies/metabolism* ; Liver/metabolism* ; Hydroxybutyrates/metabolism* ; Down-Regulation ; Sirtuins/metabolism* ; Hydroxymethylglutaryl-CoA Synthase/metabolism*

Objective:To investigate the intervention effect of decision aid on the fear of falling in elderly patients after total hip arthroplasty.Methods:This study was a quasi experimental research. From June 2021 to November 2021, 84 patients after total hip arthroplasty who were admitted to the Department of Orthopedics of Zhengzhou Central Hospital Affiliated to Zhengzhou University were selected as the research objects. According to the order of admission, they were divided into the control group (42 cases, 2 cases fell off ) and the observation group (42 cases). The control group was given routine nursing care and guidance for fear of falling, while the observation group was given a decision-making aid intervention program on the basis of the control group. The time to first getting out of bed, the scores of Modified Falls Efficacy Scale (MFES), Generalized Anxiety Disorder (GAD-7) and Harris Hip Score (HHS) were compared between two groups.Results:The time to get out of bed for the first time in the observation group was (42.71 ± 6.41) h, lower than that in the control group (49.95 ± 5.73) h, and the difference was statistically significant ( t=5.38, P<0.05). Twelve weeks after discharge, the GAD-7 score in the observation group was (4.64 ± 1.43), which was lower than that of the control group (6.85 ± 1.83), and the difference was statistically significant ( t=6.10, P<0.05). The score of the MFES in the observation group was [8.50(8.00,10.00)], which was higher than that in the control group [7.50(7.00,8.00)], and the difference was statistically significant ( Z=-6.26, P<0.05). The hip joint function score of the observation group was (81.74 ± 4.24), which was higher than that of the control group (74.30 ± 4.51), and the difference was statistically significant ( t=7.69, P<0.05). Conclusions:Decision support can advance the time of downward movement of elderly patients after total hip arthroplasty, reduce their anxiety and fear of falling, and improve hip function.

Objective:To evaluate the hemostatic effects of our self-designed pelvic band with inflatable balloon in a swine model of hemodynamically unstable pelvic fracture.Methods:"Open-book like" fractures were created with the external iliac blood vessels exposed in 24 12-month-old female Bama miniature pigs which were randomly divided into 4 groups ( n=6). Group C (the control group) was subjected to no treatment other than exposure of the external iliac blood vessels, group D to no treatment following destruction of the external iliac blood vessels, group T1 to fixation with simple pelvic band after destruction of the external iliac blood vessels, and group T2 to fixation with our self-designed pelvic band with inflatable balloon after destruction of the external iliac blood vessels. The 4 groups were compared in terms of 40-min survival rate, bladder pressure, peak lactate value, total blood loss, bleeding rate, infusion rate, and angiographic images. Results:There was no significant difference in the baseline indexes among the 4 groups before experiment, showing comparability ( P>0.05). The 40-min survival rate in group T2 was 83.3% (5/6), significantly higher than that in groups D and T1 [0% (0/6) and 0% (0/6)] ( P<0.05). There were no significant differences among groups C, D, T1 and T2 in bladder pressure [(6.67±1.03) mmHg, (5.83±1.94) mmHg, (6.00±1.55) mmHg, and (6.00±1.10) mmHg] or in total blood loss among groups D, T1 and T2[(1,198.0±182.9) mL, (1,252.0±148.4) mL, and (1,150.0±125.7) mL] (all P>0.05). The peak lactate value in group T2 [(2.26±0.24) mmol/L] was significantly lower than that in group D [(5.00±0.60) mmol/L] and group T1 [(3.86±0.57) mmol/L], and the bleeding rate and infusion rate in group T2 [(25.83±5.49) mL/min and (26.00±4.69) mL/min] were also significantly lower than those in group D [(83.50±19.85) mL/min and (71.50±29.11) mL/min] and group T1 [(54.17±15.59) mL/min and (54.17±8.98) mL/min] (all P<0.05). Angiography showed contrast agent extravasation in group T2, especially from the artery, but the extravasation speed in group T2 was significantly slower than that in group D. Conclusion:In a swine model of hemodynamically unstable pelvic fracture, our self-designed pelvic band with inflatable balloon has a definite hemostatic effect on vascular injury which is better than that of a simple pelvic band.