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 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:Measure the global longitudinal strain (GLS) of the left ventricle in trauma patients by beside speckle tracking echocardiography to explore the role of STE -GLS in evaluating left ventricular systolic function in trauma patients, and then explore the clinical value of GLS in judging the prognosis of trauma patients.Methods:Trauma patients admitted to intensive care unit from September 1, 2020 to April 1, 2021 with an Injury Severity Score (ISS) of ≥ 16 points. were consecutively enrolled. Moreover, those patients who met the following criteria were selected as the research subjects: aged between 18 and 80 years old, had no serious underlying diseases in the past, the time from trauma onset to admission was within 24 hours, and were able to complete an echocardiogram examination within 24 hours after the onset of the disease. Exclude patients who are unable to complete the ultrasound examination within 24 hours after the onset of the disease, or those with poor image quality, or those complicated with severe heart diseases and systemic comorbidities. The left ventricular global longitudinal strain (GLS) was measured by bedside speckle tracking echocardiography. According to the GLS values they were divided into abnormal group (GLS> -15%) and normal group (GLS≤ -15%). Independent sample t-tests and chi-square tests were applied to conduct a comparative analysis of the clinical characteristics between the two groups of patients. Furthermore, multiple linear regression analysis was conducted to explore the correlation between STE-GLS and the duration of intensive care unit stay.Results:A total of 32 trauma patients were eligible for this study. One patient was found to have abnormal left ventricular systolic function (LVEF<50%) detected by conventional echocardiography, however speckle tracking echocardiography detected decreased left ventricular systolic function (GLS> -15%) in 13 Patients. Multiple linear regression analysis showed that the global longitudinal strain of left ventricle and serum high sensitivity troponin I were independent risk factors affecting the time of intensive care in trauma patients.Conclusions:Speckle tracking echocardiography (STE) is more sensitive than traditional echocardiography and can detect left ventricular systolic dysfunction early. STE-GLS is an independent risk factor affecting hospitalization time of trauma patients in intensive care unit. Clinically, STE-GLS and serum Hs-TnI can be combined to determine the prognosis of trauma patients.

Objective:To investigate the risk of hospital death in patients with traumatic hemorrhagic shock combined with multiple organ dysfunction syndrome(MODS)predicted by discriminant analysis.Methods:This study was a single-center retrospective study. From January 2013 to May 2023, patients with traumatic hemorrhagic shock complicated with MODS admitted to Peking University People's Hospital were selected as the research objects. According to the in-hospital survival, the patients were divided into survival group (205 cases) and death group (29 cases). The general condition, injury assessment, laboratory indexes, complications and clinical scores of the two groups were compared. Wilks's Lambda stepwise discriminant analysis was used to establish a discriminant model for in-hospital death in patients with traumatic hemorrhagic shock combined with MODS. the Receiver operating characteristic curve (ROC) was drawn and the Area under the curve (AUC) was calculated. The cross-validation method was used to evaluate the accuracy of the prediction results of the established model.Results:There was a statistical difference between the survival group and the death group in terms of the main bleeding site (limbs), the time from injury to hospital admission, temperature, platelet count, prothrombin time, activated partial thrombin time, fibrinogen, albumin, serum creatinine, estimated glomerular filtration rate, uric acid, cardiac troponin I, procalcitonin, base excess, lactate to albumin ratio, glucose to albumin ratio, acute respiratory distress syndrome, acute kidney injury, acute myocardial injury, traumatic induced coagulopathy, ISS, APACHEⅡ score and SOFA scores. There are four indicators entering the final discrimination model: Prothrombin time, ISS score, estimated glomerular filtration rate, lactate to albumin ratio. The AUC for predicting the risk of death in patients with traumatic hemorrhagic shock combined with MODS was 0.791, and the 95% CI was 0.671 to 0.911. Conclusions:The established discriminant model is highly accurate in predicting the risk of hospital death in patients with traumatic hemorrhagic shock complicated with MODS. Prothrombin time, ISS score, estimated glomerular filtration rate and lactate to albumin ratio were associated with an increased risk of death from traumatic hemorrhagic shock with MODS.

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.

The construction of the Chinese trauma care system has evolved from its initial stage to gradual development and expansion. In 2005, Peking University Traffic Medicine Center, which focused on traffic injury treatment and research, was established by Peking University People′s Hospital in collaboration with the emergency, trauma, and neurosurgery departments of Peking University First Hospital and Third Hospital. In 2010, Peking University Traffic Medicine Center led specialized scientific research projects and conducted pilot programs in multiple regions so that a regional closed-loop trauma care system which centered on comprehensive hospitals was established and a "Chinese model" for trauma care was developed. In 2016, China Trauma Rescue & Treatment Association was established so as to promote the construction of trauma care service system, the spread of the idea, and the information interconnection. In 2019, the National Center for Trauma Medicine was established and played a significant role in the clinical diagnosis and treatment, education and training, scientific research, and public rescue effort. Up to now, a multi-level trauma care system has been formed in china. In the paper, the authors elaborated the construction of the trauma care system and establishment of a national-level trauma care platform and foresaw the future development of trauma medicine in China.

The construction of the Chinese trauma care system has evolved from its initial stage to gradual development and expansion. In 2005, Peking University Traffic Medicine Center, which focused on traffic injury treatment and research, was established by Peking University People′s Hospital in collaboration with the emergency, trauma, and neurosurgery departments of Peking University First Hospital and Third Hospital. In 2010, Peking University Traffic Medicine Center led specialized scientific research projects and conducted pilot programs in multiple regions so that a regional closed-loop trauma care system which centered on comprehensive hospitals was established and a "Chinese model" for trauma care was developed. In 2016, China Trauma Rescue & Treatment Association was established so as to promote the construction of trauma care service system, the spread of the idea, and the information interconnection. In 2019, the National Center for Trauma Medicine was established and played a significant role in the clinical diagnosis and treatment, education and training, scientific research, and public rescue effort. Up to now, a multi-level trauma care system has been formed in china. In the paper, the authors elaborated the construction of the trauma care system and establishment of a national-level trauma care platform and foresaw the future development of trauma medicine in China.

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.

Skin avulsion injuries of the lower leg are common in clinical practice, which can easily lead to skin necrosis and infection of the lower leg, and have a significant impact on the appearance and function of the lower limb. Among them, the open avulsion injury has the highest incidence and is often accompanied by multiple tissue injuries. Therefore, improper diagnosis and treatment may cause skin and soft tissue defects of the lower leg combined with bone exposure or even bone defects, seriously impairing patients′ life and health. In order to have a better understanding of the open skin avulsion injury of the lower leg, achieve precise diagnosis and treatment and improve prognosis, the Chinese Society of Traumatology of Chinese Medical Association and the Chinese Association of Microsurgeons of Chinese Medical Doctor Association organized experts in the related fields to formulate Clinical guideline for the diagnosis and treatment of open skin avulsion injuries of the lower leg ( version 2024) based on evidence-based medicine principles. A total of 16 recommendations were proposed on the diagnosis, treatment, postoperative rehabilitation of open lower leg skin avulsion injury, so as to provide a reference for its diagnosis and treatment.